Reimbursement

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COA President Debra Patt, MD, PhD, MBA
With Remote Patient Monitoring, Picking Tools Is Easier Than Change Management

September 14th 2025

Remote patient monitoring enhances cancer care by improving outcomes and reducing emergency visits, despite challenges in reimbursement and technology access.

340B PVP spedning increased by nearly $37 million dollars from 2010 to 2021 due to eligibility expanision and market trends. | Image Credit: @onephoto - stock.adobe.com.jpeg
340B Program Spending Increases Due to Market Trends and Eligibility Expansion

September 11th 2025

Kathy Oubre, MS
Letters From White House Could Push Some Compliance, Broad Agreements Unlikely: Q&A With Kathy Oubre, MS

September 10th 2025

Stagnation in Reimbursement Keeps Biomedical Innovation From Reaching All Patients, COA Panel Says
Stagnation in Reimbursement Keeps Biomedical Innovation From Reaching All Patients, COA Panel Says

September 9th 2025

Kathy Oubre, MS
Reductions in Drug Prices Possible With Most Favored Nation Executive Order but Large Reductions Unrealistic: Q&A With Kathy Oubre, MS

September 3rd 2025

More News

Barbara McAneny, MD
January 11th 2021

Dr Barbara McAneny Voices Concern for the Future of Payment Reform

Mary Caffrey
Barbara McAneny, MD, founding partner of New Mexico Oncology Hematology Consultants, discusses why putting risk on oncologists is not the way to fix cost issues in cancer care.
Email being delivered
January 6th 2021

What We’re Reading: Pediatric Mental Health; Study on Cognitive Decline, COVID-19 Link; UnitedHealth to Acquire Change Healthcare

AJMC Staff
The coronavirus disease 2019 (COVID-19) pandemic disrupted many mental health services for children; a study on the long-term effects of COVID-19 will soon kick off; a $13-billion deal has been struck for UnitedHealth to buy Change Healthcare.
Sibel Blau, MD, Northwest Medical Specialties, Quality Cancer Care Alliance
January 5th 2021

Dr Sibel Blau Highlights Reimbursement Concerns in Oncology

The economics of cancer care remain a major concern as practices try to figure out how to deal with the cost of providing cancer care, said Sibel Blau, MD, medical oncologist, Northwest Medical Specialties, and president and CEO, Quality Cancer Care Alliance (QCCA).
Barbara McAneny, MD
December 29th 2020

Dr Barbara McAneny on the Pitfalls of Bundled Payment Plans

Mary Caffrey
Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants, gives her insight on the potential pitfalls of bundled payment plans in oncology and how they could potentially work.
Basit Chaudhry, MD, PhD, Tuple Health
December 26th 2020

Dr Basit Chaudhry: Commercial Payers Are Expected to Start Aligning More With Medicare

There is a lot of variation among commercial payers, but broadly speaking they are expected to start moving to adopt what Medicare does, said Basit Chaudhry, MD, PhD, founder of Tuple Health.
Evidence-Based Oncology
December 24th 2020

Cost of Home vs Clinic Administration of Paclitaxel in Metastatic Breast Cancer

Dolly Sharma, PhD Jeffrey Wojtynek, PharmD Kathleen M. Fox, PhD Chelsea Cooper, PharmD Igoni Dokubo, MD
Home administration of oral paclitaxel and encequidar is associated with potential cost savings for payers compared with clinic administration of intravenous chemotherapy in metastatic breast cancer patients.
Evidence-Based Oncology
December 24th 2020

Supplemental Material: Cost of Home vs Clinic Administration of Paclitaxel in Metastatic Breast Cancer

Dolly Sharma, PhD Jeffrey Wojtynek, PharmD Kathleen M. Fox, PhD Chelsea Cooper, PharmD Igoni Dokubo, MD
Home administration of oral paclitaxel and encequidar is associated with potential cost savings for payers compared with clinic administration of intravenous chemotherapy in metastatic breast cancer patients.
What We’re Reading: Panel Recommends Next Vaccine Recipients; Package Addresses Surprise Medical Billing; Tennessee Virus Cases Surge
December 21st 2020

What We’re Reading: Panel Recommends Next Vaccine Recipients; Package Addresses Surprise Medical Billing; Tennessee Virus Cases Surge

AJMC Staff
An advisory panel recommends who should receive the next doses of a coronavirus disease 2019 vaccine; bipartisan legislation includes measures to curb surprise medical billing; Tennessee faces virus surge.
As Reimbursement for Mohs Surgery Increased, So Did Use, Study Finds
December 20th 2020

As Reimbursement for Mohs Surgery Increased, So Did Use, Study Finds

Larry Hanover
The use of Mohs micrographic surgery, which had the highest average Medicare payment from 2012-2017 among a set of 4 skin cancer procedures, has increased by more than 20%.
Community Oncology Practices Show Resilience in COVID-19
December 17th 2020

Impact of the COVID-19 Pandemic on Specialty Community Practices: An Oncology Perspective

Lucio Gordan, MD Susan Weidner, MS
The COVID-19 pandemic has impacted specialty practices generally and oncology practices especially have been resilient throughout the pandemic.
Barbara McAneny, MD
December 15th 2020

Dr Barbara McAneny on the Problems with Physician Risk in the OCM

Mary Caffrey
Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants, discusses the issues with placing risk on oncologists as they work to provide quality care to patients.
What We’re Reading: Regulators Find Moderna Vaccine Safe, Effective; 340 Drug Pricing Dispute; Food Insecurity Crisis Worsens
December 15th 2020

What We’re Reading: Regulators Find Moderna Vaccine Safe, Effective; 340 Drug Pricing Dispute; Food Insecurity Crisis Worsens

AJMC Staff
FDA regulators find Moderna's experimental coronavirus disease 2019 (COVID-19) vaccine safe and effective; 27 states and the District of Columbia are asking HHS to step in regarding drug companies restricting access to 340B pharmaceuticals; pandemic worsens food insecurity in America.
CMS Postpones Radiation Oncology Model Until July
December 12th 2020

CMS Postpones Radiation Oncology Model Until July

Gianna Melillo
In its 2021 Hospital Outpatient Prospective Payment Final Rule, CMS announced it will delay its radiation oncology payment model from January 2020 until July 2021.
Mike Fazio, Archway Health
December 10th 2020

Mike Fazio Discusses Opportunities for Change During the Delay Before Oncology Care First Begins

There are certain adjustments that CMS can make to Oncology Care First (OCF) during the delay that CMS is already doing successfully in other alternative payment models, said Mike Fazio, at Archway Health.
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December 9th 2020

Payment Incentives and the Use of Higher-Cost Drugs: A Retrospective Cohort Analysis of Intravenous Iron in the Medicare Population

Bryan C. Hambley, MD, MPH Kelly E. Anderson, MPP Satish P. Shanbhag, MBBS, MPH Aditi P. Sen, PhD Gerard Anderson, PhD
During a period of rapid fluctuation in the intravenous iron market, there was increased use of a more expensive drug that afforded providers additional revenue.
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December 9th 2020

Calibrating Medicaid Payment to Need for Long-term Services and Supports

Matthew Alcusky, PharmD, PhD Eric O. Mick, ScD Melissa A. Clark, PhD Arlene S. Ash, PhD
Incorporating data from functional status assessments, we developed a Medicaid payment model for long-term services and supports in a community-dwelling population of older adults.
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December 8th 2020

Prospective or Retrospective ACO Attribution Matters for Seriously Ill Patients

Brystana G. Kaufman, PhD, MSPH William K. Bleser, PhD, MSPH Robert Saunders, PhD David Anderson, MSPPM Courtney H. Van Houtven, PhD David B. Muhlestein, PhD, JD Jeffrey Clough, MD Mark B. McClellan, MD, PhD
This study compared beneficiary characteristics and Medicare per capita expenditures among seriously ill Medicare accountable care organization (ACO) populations defined using prospective and retrospective claims-based attribution methods.
Basit Chaudhry, MD, PhD, Tuple Health
December 2nd 2020

Dr Basit Chaudhry Discusses the Impact of Delayed Care on APMs Like OCM

Delayed care due to the coronavirus disease 2019 pandemic has created a lot of uncertainty around alternative payment models (APMs) like the Oncology Care Model (OCM), said Basit Chaudhry, MD, PhD, founder of Tuple Health.
Mike Fazio, Archway Health
November 28th 2020

Mike Fazio Highlights How Oncology Practices Can Take Advantage of the Delay to OCF

There are ways practices can take advantage of the delay of Oncology Care First (OCF) to continue learning from their experience in Oncology Care Model (OCM), said Mike Fazio, of Archway Health.
How Japan, Germany, and France Control Spending in a Fee-for-Service System
November 24th 2020

How Japan, Germany, and France Control Spending in a Fee-for-Service System

Gianna Melillo
An analysis published in Health Affairs outlines the benefits of structuring negotiations and standardizing fee-for-service payments independent of any specific reform proposals to control health care spending in 3 high-income countries.
Mike Fazio, Archway Health
November 21st 2020

Mike Fazio Addresses Risk Adjustment in OCM, OCF Due to COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is going to test the new risk adjustment in the Oncology Care Model as patients delay care, said Mike Fazio, senior vice president of Client Services at Archway Health.
Trump Targets Drug Prices With 2 Orders Using International Pricing, Ending Rebates
November 21st 2020

Trump Targets Drug Prices With 2 Orders Using International Pricing, Ending Rebates

Allison Inserro
President Donald Trump issued 2 orders Friday aiming to lower drug prices paid by Medicare by invoking a "most favored nations" policy and also by targeting rebates paid to pharmacy benefit managers.
ASTRO
October 30th 2020

Too Much, Too Fast: Providers Push Back on CMS’ Final RO Model

Mary Caffrey
A discussion of the final Radiation Oncology Model; after this article went to press, CMS announced a delay until July 2021, reflecting concerns of radiation oncologists.
McKesson
October 30th 2020

Uncertainty From COVID-19 Delays Progress on the Road to Value-Based Cancer Care

Marcus Neubauer, MD Ben Jones
COVID-19 has created a significant distraction from normal practice operations. The uncertainty that comes along with the pandemic is a huge worry, and can distract from practice transformation.
Three Ways COVID-19 Makes the Oncology Care First Model More Attractive
October 29th 2020

Three Ways COVID-19 Makes the Oncology Care First Model More Attractive

Keely Macmillan, MSPH
COVID-19 has delayed the transition to Oncology Care First, but the forthcoming model could help.
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June 3rd 2020

OCM, Other APM Timelines Extended Due to COVID-19

Mary Caffrey
CMS Administrator Seema Verma announced the update today in a blog post in Health Affairs.
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