Reform Needed to Take Community Cancer Care off the Chopping Block

By Dr. Busby (Chief Medical Officer), Dr. Funk (Chief Radiation Oncology Officer), and Dr. McNally (Chief Surgical Officer)

When it comes to cancer, easily accessible care saves lives. Without a second to waste, patients need timely, personalized care that adapts to their unique diagnosis, treatment needs, and life circumstances. From diagnosis through treatment and survivorship, community oncology ensures patients receive coordinated, high-quality care close to their support systems.

Yet, systematically, the three treatment cornerstones of community cancer care that patients rely on most – chemotherapy, radiation, and surgery – are being eroded, threatening the viability of accessible community cancer care. This year, the federal government proposed yet another cut to physician pay under the Medicare Physician Fee Schedule (MPFS). But that’s only part of the story.

Impact Across Community Oncology

Buried in Medicare’s payment proposal for 2027 are double-digit cuts that could further strain independent community oncology. The proposal includes reimbursement reductions of up to 14% for certain surgical services, 40% for hundreds of clinical lab tests, and 35% for proton therapy, an advanced form of radiation that can precisely target tumors while minimizing damage to healthy tissue and organs. Although the Centers for Medicare & Medicaid Services (CMS) has proposed targeted adjustments to certain radiation treatments, the broader proposal continues a pattern of reimbursement instability and uncertainty that makes it difficult for community oncology practices to plan, invest in, and sustain services.

Impact on Radiation Oncology

The Network remains concerned about the continued financial pressure on community-based radiation oncology services resulting from the CY26 Hospital Outpatient Prospective Payment System (OPPS) and Physician Fee Schedule (PFS) payment changes.

“Last year’s radiation oncology cuts also had a ripple effect beyond Medicare, contributing to significantly larger reimbursement reductions in the commercial market – some 20x larger than originally projected,” said Dr. Ryan Funk, Chief Radiation Oncology Officer of The Network.

When viewed in combination with the significant reimbursement reductions implemented in CY26, the CY27 proposal compounds existing financial pressures on community-based radiation oncology providers. Together, these cuts will make it more difficult for radiation oncology practices to invest in advanced treatment technologies, recruit specialized clinical staff, and expand services for patients.

These financial pressures are a reality now, and radiation oncology practices are already making difficult decisions to close, particularly in rural and underserved markets. This could ultimately reduce healthcare competition and force patients to drive hours each day to receive radiation treatments, which are a critical component of many patients’ care plans.

The Network will continue to work with CMS to elevate our concerns with continued payment cuts and ensure that reimbursement accurately reflects the cost of patient care. 

Impact on Surgical Services

Under the proposed policy, beginning January 1, 2027, Medicare would pay the highest-valued same-day service at 100 percent of the fee schedule amount and reduce payment for additional covered procedures or medically necessary, separately identifiable E/M services by 50 percent. For some services, payment could fall below the direct cost of the clinical staff, supplies, and equipment needed to furnish the procedure.

The Network shares CMS’s goal of ensuring Medicare payments accurately reflect resources required to furnish care and safeguard taxpayer dollars. However, CMS has not demonstrated that separately identifiable same-day services systematically contain duplicative resources warranting an across-the-board 50 percent reduction.

Finalizing the one-size-fits-all cut could accelerate consolidation of independent oncology practices and create additional barriers for Medicare patients. The Network will continue to warn CMS about these consequences and advise against finalizing this proposal.

“The proposal also perpetuates a troubling trend of declining physician reimbursement for surgical services. Unlike hospital systems that receive additional facility-based revenue to offset these reductions, community-based practices must absorb these cuts,” added Dr. Amy McNally, Chief Surgical Officer of The Network.

Community Oncology Faces Growing Financial Pressure

According to Dr. Les Busby, Chief Medical Officer of The Network, these cuts come on top of other financial pressures already facing community oncology practices. A challenging provision contained in the Inflation Reduction Act has made it more difficult for providers to recover the costs of acquiring, storing, and administering complex cancer therapies. Without a correction, this provision will trigger reimbursement cuts to physicians who provide chemotherapy in community settings, a reduction to oncology estimated at $56 billion over ten years.

At the same time, the cost of running a practice has risen 60% over the last 25 years, increasing the cost of staffing, technology, and other resources needed to provide high-quality cancer care. Cancer treatment is also becoming more sophisticated, requiring greater clinical expertise, support services, and investment in innovative therapies and technologies. Sustaining patient access to these cutting-edge treatments depends on reimbursement policies that keep pace with the growing complexity and rising cost of care delivery. Without appropriate reimbursement, independent physicians have to make the difficult choice of reducing treatments, taking on fewer patients, or shutting their doors entirely.

So, what is driving this growing disconnect between the needs of cancer patients and the policies that support their care?

For one, the MPFS has failed to keep up with inflation. Budget neutrality rules have been stuck in the 1990s, requiring payment increases in one area to be offset by cuts elsewhere, such as radiation oncology, creating winners and losers across specialties.

Often, the numbers simply do not work. Faced with relentless reimbursement cuts, community oncology practices are forced to postpone investments, leave positions unfilled, reduce advanced practice provider support, and scale back efforts to recruit and retain the next generation of cancer specialists. The result is fewer providers, longer waits for appointments, delayed treatment, and reduced access to care. If the current trajectory continues, practices will be left with impossible choices: close satellite locations, reduce services, retire early, relocate to larger metropolitan areas, or sell to hospital systems. The ultimate price is paid by patients, who face fewer options, greater travel burdens, higher out-of-pocket expenses, and delays in life-saving care.

With thousands of hospital mergers in the last two decades and acquisitions of independent practices increasing, community care is becoming increasingly scarce. This trend has become especially pronounced in rural America, where patients already face limited access to specialty care. This has serious repercussions for patients who pay higher out-of-pocket costs for care in hospital outpatient settings, and for taxpayers, who ultimately shoulder the greater financial burden of care provided in higher cost settings.

Congress Must Take Action to Protect Close-to-Home Care

Congress has long recognized this system as broken. Year after year, proposed cuts have been rolled back at the last minute, sometimes after they have started to impact providers. While those short-term fixes have provided temporary relief, they do not address the underlying problem – physician payment has lagged well below that of other providers, including hospitals, whose payment systems are linked to measures of inflation. At the same time, looming reimbursement cuts for select Medicare Part B drugs threaten to exacerbate these financial pressures.

Congress is now thinking big. Long-term proposals, such as the bipartisan Patients First Act, would help modernize the MPFS by better accounting for inflation, improving payment accuracy, and creating greater predictability for providers. Similarly, the Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299) would help preserve access to Medicare Part B drugs and keep independent practices afloat. For community oncology, this type of stability will make it easier to plan investments, recruit clinicians, and preserve access to care.

But more work remains. Policymakers must reverse the double-digit Medicare cuts recently proposed, modernize outdated payment policies, and ensure reimbursement reflects the growing complexity and cost of cancer care.  

At stake is more than the financial health of community oncology practices. It is the ability of patients to receive high-quality cancer care close to home, surrounded by their families, caregivers, and support systems. Community oncology has long been the backbone of cancer care in America. To preserve access for future generations of patients, Congress must act to strengthen and sustain it. Lawmakers must act now to take the necessary steps to protect community oncology.

To contact your lawmaker in support of H.R. 4299, CLICK HERE.