This past year has been a remarkable one for the business of community oncology. It’s seen a raft of new initiatives and reforms that have profound implications for how oncology services will be provided and paid for in the future. Among other things, this year we have seen:

• The Center for Medicare and Medicaid Innovation (CMMI) announced its Oncology Care Model to test episode-of-care payments for chemotherapy services for Medicare patients.

• The surprise enactment of Section 603 of the Bipartisan Budget Act (BBA), leveling Medicare payments between physician offices and hospitals for new off-campus, provider-based sites.

• The enactment of MACRA (the Medicare and CHIP Reauthorization Act), permitting hospitals for the first time to enter into gain-sharing arrangements with oncologists to reward them for reducing medically unnecessary hospital care, but also combining Medicare performance incentive programs.

• A new proposed Part B prescription drug model from CMMI that would begin to pay for drugs at average sales price (ASP) plus 2.5 percent, plus a fixed fee of $16.80, which would disproportionately disadvantage those, like medical oncologists, who purchase drugs that are more expensive, on average, than other prescription drugs.

• A 340B Drug Pricing Program omnibus guidance from the Health Resource and Services Administration (HRSA) that, if enacted as proposed, would significantly scale back the 340B program. Med-Pac recommendations to reduce Medicare drug payments to 340B eligible hospitals by 10 percent, and to redistribute those withheld payments to 340B hospitals with relatively higher rates of uncompensated care.

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