The presidents of ASTRO and ACRO provide focused analysis of CMS's 2026 proposed rules and their specific implications for radiation oncology practice. This executive briefing examines key policy changes without background context, concentrating on immediate implementation concerns and the September 12 comment period.

Key Topics Covered:

• Critical APC "crosswalk" methodology issues affecting new treatment delivery codes
• CMS's new "efficiency adjustment" reducing procedural service payments by 2.5%
• Transition from survey-based valuations to hospital cost data methodology
• Image guidance and port film bundling into treatment delivery codes
• Surface radiation therapy coding updates and valuation changes
• RUC committee dynamics and specialty representation challenges
• Strategic considerations for the comment period ending September 12, 2025

Technical Analysis: Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) and Drs Paravati and Rewari explain how CMS may have assigned new radiation therapy codes to incorrect ambulatory payment classifications. The analysis suggests CMS deleted separate IMRT codes but may not have recognized that IMRT services are now bundled into new level 2 and level 3 treatment codes, potentially resulting in significant undervaluation.

Policy Context: The discussion examines how radiation oncology's 21% decline in relative value over 20 years, combined with these proposed changes, affects practice sustainability. Freestanding centers face particular challenges with a 32% reimbursement reduction since 2015.

About Our Guests: Dr. Sameer Keole serves as President of ASTRO and practices radiation oncology in Arizona. Dr. Brian Lally is President of ACRO and practices at an academic center in South Carolina. Both provide extensive expertise in healthcare policy and specialty society leadership.

This focused analysis provides healthcare leaders with essential technical information for participating in the rulemaking process.

Note: This is a condensed version of our full Episode 18 analysis, focusing specifically on radiation oncology implications.

Subscribe & Connect: Follow Value Health Voices Podcast for healthcare policy analysis. Find us on YouTube, LinkedIn, and all major podcast platforms.

Episode Tags: Medicare physician fee schedule, HOPPS, radiation oncology, ASTRO, ACRO, APC crosswalk, efficiency adjustment, CMS proposed rule, treatment delivery codes, comment period, healthcare policy analysis, specialty medicine, supercut

The presidents of ASTRO and ACRO join the VHV guys to provide expert analysis of CMS's newly released 2026 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) proposed rules. Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) join us one week after the July 2025 release to examine the implications for radiation oncology and procedural specialties.

Key Topics Covered:

• CMS's new "efficiency adjustment"—a 2.5% reduction to work RVUs for procedural services
• New treatment delivery codes and potential APC "crosswalk" issues in radiation oncology
• Budget neutrality's role in specialty medicine reimbursement competition
• The shift from survey-based valuations to hospital cost data methodology
• Practice expense changes affecting technical component payments
• RUC committee dynamics and specialty representation challenges
• 34-year evolution of the RVU system and its impact on different specialties

Critical Policy Analysis: The episode examines how CMS assigned new radiation therapy codes to ambulatory payment classifications, potentially using incorrect methodologies that may not account for IMRT services bundled into new level 2 and level 3 codes. Our expert guests explain why radiation oncology has experienced a 21% decline in relative value over two decades while primary care increased 38%.

About Our Guests: Dr. Sameer Keole serves as President of the American Society for Radiation Oncology (ASTRO) and is a practicing radiation oncologist in Arizona. Dr. Brian Lally is President of the American College of Radiation Oncology (ACRO) and practices at an academic center in South Carolina. Both bring extensive experience in healthcare policy and specialty society leadership.

This executive briefing provides physicians and healthcare leaders essential context for the 60-day comment period ending September 12, 2025, and explores strategies for effective advocacy during the rulemaking process.

Subscribe & Connect: Follow Value Health Voices for comprehensive healthcare policy analysis. Find us on YouTube, LinkedIn, and all major podcast platforms.

Episode Tags: Medicare physician fee schedule, MPFS, HOPPS, efficiency adjustment, radiation oncology, ASTRO, ACRO, CMS proposed rule, RUC committee, budget neutrality, APC methodology, conversion factor, practice expense, healthcare policy analysis, specialty medicine, procedural services

Alice Ayres, President and CEO of the Association for Healthcare Philanthropy, reveals the critical funding lifeline that most people don't know exists. As Congress slashes healthcare budgets and millions face losing Medicaid coverage, Alice exposes how healthcare philanthropy returns $4.16 for every dollar invested and why it's becoming the difference between hospitals thriving and closing their doors.

This powerhouse leader, former Advisory Board Company executive who worked with 4,500+ healthcare organizations and 200,000+ leaders, breaks down the urgent shift happening in healthcare funding. With 10,000 baby boomers daily moving from private insurance to Medicare, operating margins are shrinking fast.

Key Topics Covered:

• Why "grateful patient" programs heal faster than traditional medicine
• How behavioral health donations surged 500% since COVID
• Why 100% leadership giving is non-negotiable for foundation success
• How AI is revolutionizing donor identification while respecting patient privacy
• Mobile clinics funded by donors serving vulnerable populations
• Alice's game-changing advice: "No doctor should ever ask for money—but opening gratitude conversations makes patients heal faster"

From her 20+ years leading healthcare transformation to guiding foundations that collectively raise $11 billion annually, Alice provides the roadmap hospitals need as federal funding disappears.

About Our Guest: Alice Ayres has served as President and CEO of AHP since 2018, recognized as one of Non-Profit Times Power and Influence Top 50 in 2024. She previously led strategic marketing for The Advisory Board Company, creating strategy sessions for 150+ leading healthcare providers worldwide. She holds an MBA from Northwestern Kellogg and brings deep healthcare industry knowledge to philanthropy leadership.

Subscribe & Connect: Follow Value Health Voices for insider healthcare finance strategies. Find us on YouTube, LinkedIn, and all major podcast platforms.

Episode Tags: healthcare philanthropy, hospital funding, grateful patient programs, healthcare finance, Alice Ayres, AHP, medical fundraising, healthcare donations, Medicaid cuts, hospital charity care, healthcare leadership, nonprofit management

Dr. Eric Bricker returns for Part 2 of our analysis of the "One Big Beautiful Bill" and the timing couldn't be more critical. Just as the Senate moves toward a final vote, the nonpartisan Congressional Budget Office reported Sunday (6/29/25) that the Senate version would add at least $3.3 trillion to the national debt over the next decade.

This internal medicine physician and founder of AHealthcareZ (400+ healthcare finance videos, 100,000+ subscribers) delivers his signature straight-talk analysis on what will be the most earth-shattering healthcare legislation in decades. Dr. Bricker exposes how this bill would strip Medicaid coverage from 11-16 million Americans while dismantling the state funding mechanisms that keep safety-net hospitals alive.

Dr. Bricker and the VHV guys discuss:

• How "provider tax safe harbors" being cut from 6% to 3% will trigger massive prior authorization increases
• Why hospital systems will face a "double squeeze": less Medicaid revenue AND higher debt refinancing costs
• The brutal politics behind using patient care as a "political pawn" to fund tax cuts
• How charity care programs could become the only lifeline for millions of Americans
• Why even Republican senators are questioning these Medicaid cuts

Dr. Bricker's urgent message to physicians: "The age of passivity is over. No one is coming to save you or your patients." He provides concrete actions healthcare professionals can take locally while this legislative earthquake unfolds in Washington.

From work requirements that target caregivers to state-directed payment caps that will bankrupt safety-net hospitals, this episode breaks down thousands of legislative pages into what every healthcare leader needs to know before the Senate votes.

Subscribe to Value Health Voices for critical healthcare policy analysis. Check out Dr. Bricker's AHealthcareZ YouTube channel for his complete healthcare finance education library.

Chapters:

00:00 The $3.3 Trillion Healthcare Bill: An Overview

02:05 GOP Budget Reconciliation Bill: Key Healthcare Proposals

03:45 The Human Cost: Real Stories from Safety-Net Hospitals

07:23 Work Requirements: Who Really Gets Hurt

10:53 The Great Medicaid Funding Squeeze: Provider Taxes Under Attack

18:03 State-Directed Payments: The End of Hospital "Scavenger Hunts"

23:33 Political Power and Healthcare: The Real Game Being Played

29:02 The Double Squeeze: Medicaid Cuts + Rising Interest Rates

31:35 Taking Action: What Physicians Can Do Right Now

37:27 Hospital Innovation: Learning from Ochsner's Success Model

44:49 The Future of Healthcare Finance: Reasons for Optimism

Keywords: #Medicaidcuts, #budgetreconcilation #Senatebill, #CongressionalBudgetOffice #Medicaid #providertaxes #statedirectedpayments #workrequirements, #safetynethospitals healthcare finance #DrEricBricker #AHealthcareZ

Dr. Eric Bricker, the powerhouse behind AHealthcareZ's 400+ healthcare finance videos with 100,000+ subscribers, joins Value Health Voices to decode the labyrinthine money flows that determine which hospitals succeed with Medicaid—and which avoid it entirely. This internal medicine physician and former co-founder of Compass Professional Health Services (which grew to 1.8M members across 2,000+ clients including T-Mobile and Southwest Airlines before being acquired) reveals the complex "scavenger hunt" that separates thriving hospital systems from struggling ones.

Discover why Medicaid isn't actually one program but 50+ different state systems with wildly different funding mechanisms. Dr. Bricker exposes how provider taxes, DSH payments, and state-directed payments create a $80 billion federal funding ecosystem—and why only sophisticated hospital systems with armies of consultants can navigate it successfully. You'll learn why California gets 50% federal matching while Mississippi receives 77%, how children's hospitals depend on Medicaid for half their revenue, and why some suburban systems can ignore Medicaid entirely while urban academic centers live or die by these payments.

Known for his viral whiteboard videos that deconstruct the US healthcare system, Dr. Bricker delivers essential insights every healthcare leader needs to understand the financial forces reshaping American healthcare. This eye-opening conversation explains why administrative complexity has become a competitive advantage—and what it means for patient care.

Subscribe to Value Health Voices for expert healthcare policy analysis. Check out Dr. Bricker's AHealthcareZ YouTube channel for his complete healthcare finance library.

Chapters:

00:00 Understanding Medicaid: A Complex Landscape

02:12 The Mechanics of Medicaid Funding

05:41 Provider Taxes and Their Impact

10:01 Disproportionate Share Hospital Payments

17:22 State-Directed Payments: Variability and Controversy

20:16 Expansion vs. Non-Expansion States

24:22 The Role of Managed Care Organizations

28:40 Challenges in Accessing Care for Medicaid Patients

32:35 Understanding the Complexities of Healthcare Funding

36:56 The Scavenger Hunt for Revenue in Healthcare

39:48 The Friction in Healthcare Administration

Keywords: Medicaid, healthcare finance, health policy, state funding, provider taxes, DSH payments, state-directed payments, expansion states, healthcare access, revenue generation

RECORDED BEFORE THE HOUSE RECONCILIATION BILL PASSED - Tricia Neuman of KFF's predictions proved accurate THE REALITY: 55% of Medicare beneficiaries are now in private Medicare Advantage plans, yet Medicare pays $83 BILLION more annually for these enrollees than similar patients in traditional Medicare. That's more than what Medicare spends on ALL physician payments combined. In this prescient conversation with KFF's Tricia Neuman, we explore the hard truths about Medicare's trajectory. Takeaways: ✅ Hundreds of billions in Medicaid cuts moving through reconciliation - PASSED by House May 22nd ✅ Traditional Medicare becoming the "forgotten stepsister" ✅ Medicare's path toward privatization accelerating ✅ Critical support programs being slashed as complexity increases WHY THIS EPISODE MATTERS NOW: This isn't theoretical policy discussion. It's the unfiltered analysis from one of America's most trusted Medicare experts. Hear the roadmap that's now moving through Congress. KEY INSIGHTS: How Medicare Advantage marketing hides real trade-offs Why traditional Medicare lacks basic consumer protections (like out-of-pocket limits) The hidden costs of Medicare privatization for hospitals, physicians, and patients How Social Security office cuts will leave seniors stranded What the future holds for 68 million Medicare beneficiaries GUEST: Tricia Neuman, Senior VP at KFF & Executive Director of Medicare Policy Program. Trusted expert who has testified before Congress and provides nonpartisan analysis relied upon by policymakers nationwide. HOSTS: Drs. Anthony Paravati & Amar Rewari bring physician and healthcare executive perspectives to policy discussions that matter. RECORDED: May 7, 2025 (Days before House passage of reconciliation bill) 🎧 SUBSCRIBE for healthcare policy insights that help you understand what's really happening in American healthcare Chapters 00:00 Introduction to Medicare Concerns 02:53 The Role of KFF in Medicare Policy 07:59 Current State of Medicare and Medicare Advantage 11:19 Challenges Facing Traditional Medicare 14:54 The Impact of Social Security on Medicare 17:48 Redesigning Medicare Advantage 20:18 Consumer Protections and Future of Medicare 22:07 Drug Pricing and Medicare Part D 26:56 Medicaid Cuts and Political Dynamics 34:44 Impact of Federal Cuts on State Programs 42:54 The Future of Long-Term Care Services 46:10 Engaging Clinicians in Medicare Reform #Medicare #MedicareAdvantage #HealthPolicy #Medicaid #Healthcare #KFF #PolicyAnalysis #ValueHealthVoices

Michael Chernew is a distinguished Harvard economist, Chair of MedPAC, and leading healthcare policy expert with decades of experience in healthcare economics. In this episode, Michael provides a masterclass on why healthcare economics differs fundamentally from other markets, unpacking information asymmetry, moral hazard, and adverse selection in accessible terms. He reveals the surprising truth that Medicare Advantage plans cost the government approximately 20% more than traditional Medicare despite delivering care more efficiently, explains how these plans use this payment gap to finance enhanced benefits, and discusses the future challenges of healthcare payment reform. Michael shares breaking news about MedPAC's upcoming recommendation to partially tie physician payments to inflation after decades of declining purchasing power, explores the complexities of drug price negotiations, and offers insider insights into how Medicare policy decisions affecting billions of healthcare dollars are actually made.

Chapters

00:00 Introduction to Healthcare Economics and MedPAC

02:56 The Evolution of Health Economics

06:05 Unique Challenges in Healthcare Markets

09:11 Moral Hazard and Insurance Dynamics

12:10 The Role of Technology in Rising Costs

15:10 Understanding MedPAC's Function and Influence

18:01 MedPAC Recommendations and Their Impact

22:16 The Complexity of Medicare Payment Systems

25:07 Challenges in Hospital Profitability

28:20 The Future of Payment Models in Healthcare

38:16 Geographic Variation in Medical Practice

39:15 Alternative Payment Models and Pricing Issues

46:53 The Rise of Medicare Advantage

55:20 Future of Medicare and Healthcare Reform

About:

Value Health Voices is a podcast redefining conversations around health policy and healthcare finance, delivering accessible and expert-driven discussions on the topics shaping the future of healthcare. Hosted by Dr. Anthony Paravati and Dr. Amar Rewari, the podcast explores how regulations, emerging technologies, and financial pressures impact patient care, provider operations, and healthcare systems. With their combined experience as radiation oncologists and healthcare leaders, they break down complex topics like Medicare reimbursement, artificial intelligence in healthcare, and prior authorization in ways that are actionable and engaging. Each episode features insights on legislative efforts, best practices for providers navigating policy changes, and trends shaping the future of value-based care, empowering listeners with knowledge they can use immediately.

Connect with Value Health Voices on:

Apple Podcasts: https://tinyurl.com/VHV-apple

Spotify: https://tinyurl.com/VHV-Spotify

Amazon music: https://tinyurl.com/VHV-amazon

LinkedIn: https://tinyurl.com/VHV-Linkedin

Even seasoned healthcare leaders—those with decades of clinical, financial, or operational experience—often miss the two most powerful levers behind how care gets paid for: the CPT process and the RUC committee. These aren't just billing codes and obscure meetings. They're the gatekeepers of what and how much is paid for care in the U.S. healthcare system.

To truly understand healthcare in the U.S., an understanding of CPT and RUC is fundamental.

In this special episode of Value Health Voices, we flip the script—Dr Anthony Paravati interviews co-host Amar Rewari, a nationally recognized expert in the CPT development process and the RUC (Relative Value Scale Update Committee). This is your backstage pass to the invisible forces that decide how doctors are paid, which services get valued, and why the U.S. healthcare system rewards what it does.

In this episode, we unpack:

• What the CPT process really is—far beyond billing codes

• How the RUC committee wields extraordinary influence over payment policy

• The lifecycle of a medical service's valuation—from clinical utility to reimbursement

• How these processes directly affect hospital strategy, service line planning, and physician compensation

No deep dive into CPT and RUC is complete without exploring the critiques—many of which are long-standing and still unresolved:

• Specialty Bias: Procedural specialties often dominate the RUC, leading to higher valuations for procedures and lower ones for cognitive services like primary care.

• Lack of Transparency: Decision-making behind closed doors fuels frustration and distrust, especially among non-physician stakeholders.

• Inertia and Inequity: Efforts to revalue services often move at a glacial pace, creating systemic lag between innovation and payment.

We challenge assumptions, unpack the politics, and explore what meaningful reform could look like.

Whether you're a hospital executive, a health policy analyst, a medical director, or a clinician trying to understand your paycheck, this episode gives you what textbooks and boardrooms don't: a clear, actionable understanding of the CPT and RUC systems and how they quietly influence everything from your budget to your workforce strategy.

You'll walk away with:

• A framework to think critically about reimbursement strategy

• Insight into why your specialty is—or isn't—being adequately valued

• Clarity on how to engage with these systems to advocate for fairer healthcare

Keywords: CPT process, RUC committee, physician reimbursement, healthcare payment reform, US healthcare finance, healthcare policy podcast, Medicare valuation, specialty society lobbying

In this episode of Value Health Voices, Dr. Vipan Nikore discusses his journey as an entrepreneur in the healthcare sector, focusing on the innovative concept of Home Care Hub. He shares insights on the challenges and opportunities in home-based care, the importance of metrics in measuring outcomes, and the regulatory hurdles faced in the industry. Dr. Nikore emphasizes the need for policy changes to support alternative care models and advocates for a future where smaller care homes provide dignified and personalized care for the aging population. He also offers advice for aspiring healthcare entrepreneurs, highlighting the importance of mentorship and networking.

takeaways

• Dr. Nikore's journey from software development to healthcare entrepreneurship.
• The importance of home-based care in improving patient outcomes.
• Home Care Hub aims to create smaller, community-based care homes.
• Metrics such as decreased readmissions are crucial for success.
• Regulatory challenges vary significantly across states and provinces.
• Advocacy for policy changes is essential for funding alternative care models.
• The future of healthcare will involve more personalized and accessible care options.
• Data collection from home care can drive better patient outcomes.
• Entrepreneurship in healthcare requires resilience and adaptability.
• Mentorship and networking are key for aspiring healthcare entrepreneurs.

Chapters

00:00 Introduction to Home-Based Care Innovations 01:39 The Journey of Dr. Vipan Nikore 10:15 Exploring Home Care Hub 17:13 Metrics and Outcomes in Home Care 20:29 Navigating Regulatory Challenges 22:34 Navigating Regulatory Challenges in Healthcare Innovation 23:49 Advocating for Alternative Care Models 25:05 The Importance of Personalized Care 26:20 Addressing Loneliness and Social Isolation 27:42 Leveraging Technology in Home Care 29:39 Policy Advocacy for Healthcare Solutions 32:18 The Role of Data in Improving Outcomes 33:03 Envisioning the Future of Home Healthcare 36:12 The Entrepreneurial Journey in Healthcare 39:16 Advice for Aspiring Healthcare Entrepreneurs

As the cost of healthcare continues to rise, more employers are turning to direct employer contracting and self-insured models to take control of their healthcare costs. But how do these models compare to fully insured arrangements? And what are the key considerations for health systems, PBMs, and employers looking to engage in value-based care?

In this episode of Value Health Voices, Dr. Anthony Paravati and Dr. Amar Rewari sit down with Ned Laubacher, CEO of Health Spectrum Advisors and an expert in direct-to-employer contracting, to break down: ✅ The shift toward self-insured models and employer-driven health benefits ✅ The role of quality metrics and shared savings in employer-provider contracts ✅ How data transparency is transforming healthcare finance and cost control ✅ The impact of legislation on employer health plans ✅ Common pitfalls in direct contracting and how to avoid them

💡 Key Takeaways: 🔹 Self-insured employers have more control over healthcare costs and provider networks 🔹 Direct contracts with health systems help improve cost transparency and health outcomes 🔹 Employers must take a proactive role in healthcare policy to navigate complex regulations 🔹 PBMs and cost-plus drug models are playing an increasing role in employer-led health plans 🔹 Analytics & data-driven decision-making are the future of value-based care