Encore! EP282: Do You Know How Much Cancer Centers Get Paid to Put Patients on Drugs? With Aaron Mitchell, MD, MPH

Do You Know How Much Cancer Centers Get Paid to Put Patients on Drugs? With Aaron Mitchell, MD, MPH (Encore! EP282) In this Encore rebroadcast, Stacey Richter revisits her conversation with Aaron Mitchell, MD, MPH, an oncologist and health services researcher at Memorial Sloan Kettering, about "buy and bill" — the payment model that pays cancer centers a percentage of drug cost to infuse chemo, creating a built-in incentive to reach for the more expensive drug. WHAT YOU'LL LEARN ✅ How the "buy and bill" payment model works and why it rewards oncology centers for choosing costlier drugs ✅ Why some provider organizations make four to six times the cost of a drug in profit under this model ✅ Why financial toxicity from cancer drug costs is a form of clinical toxicity for patients ✅ What reimbursement reform and capitated systems could look like as alternatives to buy and bill ✅ Why patients are the only real losers in the current system, and who needs to lead the charge for change WHY THIS MATTERS Buy and bill isn't a minor billing quirk — it's a payment structure that financially rewards oncology centers for choosing the most expensive drug rather than the most appropriate one, with patients absorbing the cost-sharing consequences. Understanding the mechanics is the first step toward the reimbursement reform Dr. Mitchell argues is overdue. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction 04:34 Following the drug and following the dollar. 04:56 The "buy and bill" system. 05:43 The perverse and problematic incentives of the system. 08:38 "It creates the incentive for us to gravitate toward the more expensive drug." 08:42 The hesitancy to address the financial toxicity of drugs for patients. 09:53 Why the only person losing in this situation is the patient. 10:51 The financial impact from the patient perspective. 13:57 Are patients realizing this impact? 14:42 Solving the problem of oncology drug choice. 16:45 Reimbursement reform. 18:24 Capitated systems and incrementalist impacts to reimbursement reform. 23:30 Are we at a tipping point? 23:51 "The current system…works too well for too many people." 25:01 Who isn't well served by the current system. 25:32 Who has to lead the charge for change. 28:28 Large oncology providers vs small oncology providers in the buy and bill system.