The most significant changes to the reimbursement landscape in a decade just went into effect this January. While these shifts are most acute in Radiation Oncology, a capital-intensive bellwether for the broader hospital ecosystem, they signal a new financial reality that every service line administrator must now navigate.

These changes are creating palpable anxiety as clinical teams attempt to decipher the meaning of the new rules. Ofcourse, for clinicians, the patient impact should be top of mind. The need to do what is clinically optimal for patients should supersede billing guidelines, not the other way around. The challenge is that optimal patient care is also solvent patient care. When changes to reimbursement threaten that solvency, it is imperative to consider how to best address that threat without compromising the mission.

Often, administrators look for technology solutions that can be a fix, or at least a band-aid. These solutions, however, whether they are “time-saving tools” like AI automation or software “workflow optimization” platforms, are only as good as the human processes that exist in the department.

Further, while everyone claims their “AI tool” will save you “clicks,” “time,” or “money,” few ultimately deliver on their promise. This is because before any tool can “solve” an issue, the underlying process must be understood,improved, and corrected. You cannot automate a broken workflow and expect efficiency. You simply automate the chaos.

If not a software solution, what then can help when the proforma is challenged?

We posit there are three operational levers to consider. While we apply these here to the high- stakes world ofOncology, the architectural principles hold true for any capital-heavy department facing margin compression.

Lever 1: Dynamic Capital Alignment

 The first lever addresses the “Stranded Asset.”

Healthcare is a capital-intensive sport. A linear accelerator, MRI, or Robotic Surgery Suite is not just a medical device. It is a ten-year infrastructure bet. When a hospital purchased a machine in 2023, they modeled the ROI based on the reimbursement rates of that time. But on January 1, 2026, the math changed. If you are executing a capital plan today that was written 18 months ago, you are not buying an asset. You are potentially buying a liability.

The mistake most centers make is attempting to fix this delta by asking the vendor for a discount. But in this new reimbursement reality, a discount is not a strategy. The strategy is Risk Alignment.

Vendors sit at the negotiation table every day. Hospital administrators sit there perhaps once every five years. This creates a massive information asymmetry. To close that gap, administrators must stop negotiating based on “Price” andstart negotiating based on “Solvency.”

This means walking into the room with a model that proves exactly what the new reimbursement rate supports. Vendors respect data. They are willing to discuss shared-risk models, flexible payment terms, and creative financing, but only if the buyer brings the math to back it up.

Lever 2: Service Contract Optimization

 The second lever is perhaps the most overlooked area of operational waste: the Service Contract.

Many health systems are currently paying “Gold Tier” service rates, negotiated during a higher- margin era, for assetsthat are now generating “Bronze Tier” revenue. This is not about slashing coverage. It is about right-sizing it.

Service contract optimization is about understanding exactly what matters to your physicians. Do you really need 99%uptime guarantees on a backup machine that runs three days a week? Just as importantly, it is about knowing how your vendor is performing.

The reality is that vendors won’t have the hard conversation unless you do the homework. Are they hitting theirmetrics? Are you paying for first-call labor that your in-house biomed team is already handling? Being armed with the right performance data changes the dynamic from a “bill” to a “negotiation.” Every dollar saved in OpEx protects a dollar of clinical budget.

Lever 3: Net-New Revenue & Service Line Development

Finally, we must acknowledge that you cannot cut your way to growth. The third lever is the development of high-margin service lines that offset the core reimbursement declines.

In Oncology, Theranostics represents this “Growth Pivot,” but for a broader health system, this might be ambulatory surgery or specialized diagnostics. The rule remains the same: Do not launch blindly.

We have seen centers rush to stand up new programs only to find that the administrative burden erodes the margin they hoped to capture. Modeling exactly what it would take to build these service lines out, from a staffing, workflow, and utilization perspective, can make all the difference.

If you don’t validate the operational margin first, you aren’t scaling your success. You are scaling your problems. But if done correctly, these new service lines act as the “lifeboat” that stabilizes the P&L.

The Solvency Imperative

 The “Revenue Cliff” of 2026 is real. It is a call to action.

It is time to stop relying on the outdated maps of 2024 and build a new architecture, one that prioritizes operational precision. We do not focus on “Solvency” because we care about spreadsheets. We focus on Solvency because it is the guardian of Access.

When the margin breaks, the rural clinic closes. When the capital plan fails, the technology upgrade is canceled. Wefight for financial solvency so that our physicians don’t have to fight for resources.

By focusing on these three levers—Capital Alignment, Service Optimization, and Strategic Growth—we can build aSolvency Architecture that withstands the regulatory storm and keeps the focus exactly where it belongs: on the patient.