Business Case Studies & Business Publications

Stroke-of-Pen Risk and Vantage Oncology,...

Herpfer, Christoph...

Case

Stroke-of-Pen Risk and Vantage Oncology, LLC

Herpfer, Christoph; Adkins, Thomas

F-2128 | Published October 21, 2025 | 14 Pages Case

Collection: Darden School of Business

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In July 2013, Mike Fiore, CEO and cofounder of Vantage Oncology, LLC (Vantage), a developer and operator of freestanding radiation oncology centers, learned that the Centers for Medicare & Medicaid Services (CMS) was planning changes to its physician fee schedule (PFS) that could reduce Vantage’s revenues by 40%. Radiation therapy centers were capital-intensive assets that required specialized infrastructure and machinery. They were operated by highly trained professionals who planned and executed treatment. Fiore and his team needed to decide how to confront an unexpected, regulatory-induced drop in revenue with a business model dependent on high financial and operating leverage. This case introduces students to core elements of the health care industry such as payer mix, CMS, PFS, and “stroke-of-pen risk,” the constant threat that a shift in legislation or regulation could change the fundamentals of the industry. Students learn to analyze and respond to these risks through the lens of operating and financial leverage. They must identify ways to cut costs and increase revenues while complying with the constraints of Vantage’s capital structure and the unique characteristics of the US health care system.

• Understand how reimbursement rates are set under Medicare. • Explore the influence of Medicare throughout the US health care ecosystem. • Assess the benefits and ramifications of leverage in the health care setting. • Understand stroke-of-pen risk.