Ben Jones Explains Reimbursement Challenges Facing Community Oncologists

There's still a big disparity in reimbursement between hospitals and community-based practices, but is looking into ways to address this, explained Ben Jones, vice president, Government Relations & Public Policy, McKesson Specialty Health.

Transcript

Are there unique challenges that community practices face in regard to reimbursement?

There have been a number of reforms that have tried to level the playing field in reimbursement. In 2015 the Bipartisan Budget Act instituted site neutrality on a go forward basis for off-campus outpatient facilities. Since then, there’s been an expansion to clinic office line visits and that could go further. But by in large today, there’s still a big disparity in reimbursement where a hospital practice or hospital-based cancer care center will receive twice as much as the outpatient facility does for the exact same service. And what this is doing is incentivizing hospitals to consolidate, and we will have situations where a community cancer center changes nothing but the sign on the door and now all of a sudden, the patient out-of-pocket cost has gone up and the cost of Medicare has gone up.

The administration—Secretary Azar and President Trump—has indicated that they want to look into this. They made a proposal in the last physician fee schedule. They want to explore site neutrality for drug administration services; that was included in the drug pricing blueprint. And this is also something that Congress is becoming well aware of in trying to figure out how they can expand what they passed in 2015, try to come to some sort of parity in reimbursement without disrupting access to care in hospital or community-based settings.