The US Centers for Medicare and Medicaid Services (CMS) has proposed a 2026 Physician Fee Schedule (PFS), which takes steps to address payment disparities between physicians and hospitals. However, the community oncology community warns that this progress is offset by plans to include the negotiated price of key drugs in calculations determining what practices are paid to administer high-cost cancer drugs.
The proposed PFS increases “practice expense relative value units” for nonfacility services, supporting scheduling and clinical coordination, while reducing high facility payments to hospitals. This shift toward site neutrality is welcomed by the Community Oncology Alliance (COA), which praises CMS for taking a long-overdue step toward correcting payment disparities based on where care is received.
However, COA Managing Director Nicolas Ferreyros cautions that this progress is threatened by plans to include the negotiated price of key drugs under the Inflation Reduction Act in calculations determining what practices are paid. This could result in nearly half the revenue lost for practices administering Part B drugs, according to projections.
The proposed PFS also promotes the administration’s goals of reducing wasteful spending and shifting resources toward chronic disease prevention. CMS Administrator Mehmet Oz MD, MBA, stated that the changes aim to modernize Medicare, cut waste, and improve patient care.
Despite these steps, Ferreyros emphasizes that there is still a long way to go in addressing payment shortfalls for community oncology practices. COA has sounded the alarm on the need to decouple physician payment from the negotiated price of key drugs since before the Inflation Reduction Act passed in 2022. The organization is urging policymakers to take action to address this issue.
Overall, while the proposed PFS marks an important step forward, Ferreyros warns that it does not fully address the financial pressures facing community oncology practices. As CMS continues to propose meaningful changes to address payment disparities, it is essential to prioritize the long-term stability of the nation’s cancer system.
Source: https://www.ajmc.com/view/for-community-oncology-good-news-in-pfs-offset-by-potential-wreckage-of-mfp-proposal