To be honest, I think the biggest challenge that oncologists in the United States are seeing right now is that the uncertainty of the reimbursement environment makes them nervous about whether they will be able to continue to deliver care in the fashion that they would like. I think that’s the biggest driver.
Unfortunately, one of the consequences of that milieu is that providers are heading toward hospital systems where the hospital system is happy to have them because there are strong economic drivers for them to want to have them within the system.
Those economic drivers, of course, are 340B reimbursement if it’s a 340B institution, and contracts with payers that, unfortunately, are almost exclusively cost?driven and, therefore, not a good value for our members.
Oncologists are really challenged. They’re challenged to try to give the kind of care they really want to give in a world that doesn’t necessarily seem to be too friendly to them right now.