Today's Challenges. Tomorrow's Solutions.

Strategic Solutions for the Cancer Program That Align Every Modality Around Enterprise Value

Cancer economics span medical, radiation, and surgical oncology at once — Part B drugs, the radiation technical component, surgical services, and imaging — each with its own payment pressure. Fulcrum Health Partners advises freestanding centers, hospital cancer programs, and PE- and payer-backed platforms on the reimbursement, contracting, and site-of-service strategy that hold a multidisciplinary program's margin together. We turn fragmented modality economics into one defensible enterprise view.

Schedule a Consultation → Speak with an Oncology Advisor

$2.7B

Reimbursement Opportunity Identified

12,500+

Payer Contracts Reviewed

States Served

350+

Client Engagements

The Oncology Reimbursement Landscape

One program, four payment systems — moving in different directions.

A cancer program's margin is not one number. It is the sum of drug economics, the radiation technical component, surgical services, and imaging — and each is being repriced under a different set of rules.

Medical oncology still runs on buy-and-bill: acquiring Part B therapies and billing ASP plus a percentage add-on, where sequestration, biosimilar substitution, and white/brown bagging steadily compress the margin that funds the infusion suite. Our companion Hematology & Oncology page treats that drug-margin book in depth.

Radiation oncology is a different animal entirely. The technical component for IMRT, SBRT, proton therapy, and brachytherapy is capital-intensive and code-driven — and it is the modality most exposed to episode- and case-rate redesign and to the freestanding-versus-hospital-outpatient site differential. Surgical oncology and PET imaging add their own contracting and utilization-management dynamics. The same tumor board can generate very different economics depending on where care is delivered, how it is coded, and how each line is contracted — which is exactly where Fulcrum works.

Illustrative composition. Replace with your confirmed figures before launch; reflects current CMS/MedPAC methodology and public payer data, 2024–2026.

Program Revenue by Modality — Illustrative

Where cancer-program margin concentrates

Medical oncology (drugs)

Radiation technical

Surgical oncology

PET & imaging

No single modality carries the program. Fulcrum quantifies each line — drug, technical, professional, and facility — and how site and contract change it.

Reimbursement Intelligence in Action

Your cancer-program economics, by profile

Fulcrum turns your claims, charge, and contract data into executive dashboards. Select a profile to explore a sample payer mix and a revenue view split between medical-oncology drug economics and radiation, surgical, and imaging services.

Community Medical Oncology · Payer Mix & Revenue Live Sample

Payer Mix (by cancer-program volume)

Net Revenue by Payer — Drugs vs. Technical, Surgical & Imaging

Medical-oncology drug & infusionRadiation technical, surgical & imaging

Illustrative sample dashboard. Fulcrum builds these from your practice-management, claims, charge-master, and contract data by HCPCS/CPT, payer, and site of service.

ASP+6%

Part B drug add-on, eroded by sequestration

~40%

Illustrative technical premium, HOPD vs. freestanding

2030

Enhancing Oncology Model runs through mid-2030

IMRT

& SBRT / proton facing episode & case-rate redesign

The Forces Reshaping Oncology Economics

The strategic questions every cancer-program leader now faces

Beyond any single fee schedule, these are the dynamics that decide multidisciplinary oncology margin — and where Fulcrum builds the strategy.

Radiation-Oncology Payment Redesign

Preparing for episode- and case-rate models that would bundle IMRT, SBRT, proton, and brachytherapy into a single technical payment regardless of fractionation.

Freestanding vs. HOPD Site Differential

The same radiation and infusion services pay materially more in a hospital outpatient department than in a freestanding center — reshaping build, buy, and alignment decisions.

Buy-and-Bill, Biosimilars & Bagging

Defending Part B drug margin against ASP compression, biosimilar substitution, and payer white/brown-bagging mandates — detailed on our Hematology & Oncology page.

Consolidation & the 340B Advantage

Competing against 340B hospital cancer programs whose drug-acquisition economics tilt the field — and evaluating alignment, acquisition, or independence in response.

Value-Based Oncology & the EOM

Deciding whether and how to participate in the Enhancing Oncology Model and commercial episode arrangements that put total cost of the cancer episode at risk.

Prior Auth, Pathways & PET Management

Managing utilization control on high-cost novel therapies, treatment pathways, and PET imaging that delay care and depress realized reimbursement.

Our Oncology Advisory Solutions

Advisory organized around the economics you manage

Not a service menu — the reimbursement problems that decide cancer-program margin and enterprise value across medical, radiation, and surgical oncology, and the strategy, analytics, and negotiation capabilities that resolve them.

01 The Challenge — You can't negotiate what you haven't benchmarked

Contract Assessment & Reimbursement Benchmarking

We digitize and normalize every payer contract and fee schedule across the program, then benchmark drug, radiation technical, surgical, and imaging reimbursement against Medicare and against market — quantifying exactly where each modality sits and what the opportunity is worth.

Contract digitization

Fee schedule normalization

% of Medicare benchmarking

ASP+ & J-code rate analysis

Radiation technical benchmarking

Site-of-service differential analysis

Underpayment identification

Revenue opportunity quantification

Contract performance scoring

02 The Challenge — Little leverage one contract at a time

Managed Care Negotiations & Strategy

We build the positioning, data, and negotiation strategy to improve commercial rates across the drug book and the radiation technical component — from renewals and carve-outs to executive payer meetings.

Commercial rate improvement

Drug & radiation carve-outs

MA & Medicaid managed care

Episode & case-rate terms

Escalation & executive strategy

Network participation strategy

03 The Challenge — Decisions made without modeling the downside

Contract Modeling & Analytics

HCPCS- and CPT-level modeling that turns claims and contracts into scenario analysis, site-of-service comparisons, and episode-model projections your executives can act on.

Drug & technical rate modeling

Scenario & what-if analysis

Freestanding vs. HOPD modeling

Fee schedule comparison

Episode / case-rate modeling

Executive Power BI dashboards

04 The Challenge — Negotiating blind to what competitors are paid

Payer Transparency & Market Rate Intelligence

Federal Transparency in Coverage data has transformed the negotiating table. We mine machine-readable rate files to show what competing cancer programs are actually paid on drugs and radiation — and arm your team with it.

Transparency in Coverage analysis

Competitor rate benchmarking

Market rate positioning

Negotiation preparation

Peer comparison

Commercial opportunity sizing

05 The Challenge — Effort spread evenly across unequal payers

Covered Lives & Market Intelligence

We map covered lives, payer penetration, referral patterns, and cancer-program competition across your market so you prioritize the negotiations and site-of-service moves that move the most margin.

Covered-lives analysis

Payer penetration & market share

Referral & catchment dynamics

Competitor program mapping

Employer & population trends

Commercial opportunity identification

06 The Challenge — Contract terms that aren't honored

Payer / Provider Disputes & Enforcement

When payers misprice J-codes, deny radiation fractions, apply step therapy improperly, or delay high-cost drugs, we lead the interpretation, escalation, and enforcement — turning contractual entitlement into collected revenue.

Contract interpretation

Drug & radiation payment disputes

Medical-necessity & policy challenges

Escalation support

Executive negotiation

Contract enforcement

07 The Challenge — Earned revenue that never arrives — in both directions

Underpayment / Overpayment Recovery & Revenue Integrity

Our analytics compare contracts, fee schedules, ASP files, and EOB/remittance data to detect variances on high-dollar drug and radiation claims, quantify recoverable revenue, surface overpayment exposure, and fix the root cause so leakage stops.

Contract compliance auditing

Under- & overpayment detection

Automated EOB/remit analytics

Recovery & appeals strategy

Root-cause remediation

Revenue integrity programs

Oncology Reimbursement Calculator

See what optimized commercial reimbursement is worth

Model the annual uplift from moving your commercial radiation technical and drug reimbursement toward market and optimized levels, expressed as a percentage of Medicare. Surgical, imaging, and value-based economics are additive.

Your inputs

Enter approximate figures — nothing is stored or transmitted.

Annual commercial radiation technical & drug reimbursement

Current commercial rate (% of Medicare)

Optimized commercial rate (% of Medicare) — 150%

Estimated annual reimbursement uplift

Adjust the inputs to model your opportunity.

Per $1M of technical & drug revenue

3-year cumulative

Directional estimate for discussion only. Models commercial radiation technical and drug rate improvement; surgical, imaging, and value-based (EOM / episode) economics are additive. A Fulcrum analysis models your actual contracts, drug book, and site of service.

Why Oncology Leaders Choose Fulcrum

The advisor that speaks oncology's economic language

Independent by design and fluent in the economics of the whole cancer program — ASP+ drug margin, the radiation technical component, surgical and imaging services, site of service, and value-based oncology — delivered by the people who do the work.

Independent Advisor

No networks, no downstream fees — only your economics.

Multidisciplinary Fluency

Medical, radiation, and surgical oncology under one lens.

Radiation Technical Expertise

IMRT, SBRT, proton, and brachytherapy economics.

Drug & J-Code Analytics

ASP+ margin, biosimilars, and bagging modeled to the code.

National Payer Experience

Insight into oncology payer policy in every market.

Site-of-Service & Episode Insight

Freestanding vs. HOPD and case-rate readiness.

Negotiation Leadership

Senior advisors at the table, not junior staff.

Data-Driven Support

Dashboards and intelligence that clarify the path.

Client Outcomes

How Fulcrum helps — and what it's worth

Anonymized outcomes from Fulcrum engagements with cancer programs and oncology platforms.

Freestanding Radiation Center

22%

radiation technical rate improvement

Situation: commercial technical rates for IMRT and SBRT sat well below the hospital-outpatient benchmark. Result: we repositioned the center on transparency data and renegotiated its top payers, lifting blended technical reimbursement without adding a single treatment slot.

Multidisciplinary Cancer Center

$5.8M

recovered drug & radiation revenue

Situation: high-dollar J-code and radiation claims were being systematically underpaid and downcoded. Result: automated remittance analytics detected the variances and drove appeals and root-cause fixes across medical and radiation oncology.

PE-Backed Oncology Platform

8 pts

margin from contract harmonization

Situation: a multi-state roll-up inherited a patchwork of legacy drug and technical contracts. Result: we harmonized terms, aligned site-of-service strategy, and lifted EBITDA ahead of a recapitalization.

Fulcrum Intelligence

Oncology insights & analysis

Executive briefings on the forces moving cancer-program economics — radiation payment redesign, the site-of-service differential, drug margin, value-based oncology, and consolidation.

Radiation Oncology & the Move to Episode Payment → Freestanding vs. HOPD: Sizing the Site Differential → Hematology & Oncology: Buy-and-Bill & ASP+ Economics →

Explore Oncology Insights →