[Rich66]

How is it that Academic oncologists have different reimbursements than community clinics?

Unfortunately, cell based assays don't seem to test for sensitivity to most endocrine therapies which are at the lower end of the cost curve.
Cell based analysis could be a great way to check for off label benefits.
Of course, repeated biopsies for test tissue isn't always possible.
Another issue is the possible need to keep the infusion rooms full.
Let's hope the repeatedly delayed Medicare reimbursement cuts (21%) don't ever happen. That could increase the influence of drug choice incentives.