Hospital Outpatient Prices Sharply Higher than Docs', Study Finds
Hospital outpatient prices for standard blood tests, cancer screening and other services varied widely and were sharply higher, on average, than prices charged by ambulatory clinics and independent doctors, an analysis of autoworker health-plan spending across 18 cities has found.
In Push to Extend Medicaid Pay Bump, Docs Downplay ACA Link
Physician groups are lobbying hard to extend an Obamacare provision that requires state Medicaid programs to pay primary-care physicians at higher Medicare rates to improve access for Medicaid patients. But to persuade congressional Republicans to go along, they are downplaying the fact that the pay bump is part of the Patient Protection and Affordable Care Act.
Drug Discount Program Has Drugmakers Crying Foul
This spring as the feds have been drawing up new rules for the program, a pitched battle has broken out between hospitals and drug manufacturers who say the program, known as 340B, is now bloated and badly regulated.
ACO Coalition Members Share Best Practices
The American Journal of Managed Care followed up the first meeting of its ACO and Emerging Healthcare Delivery Coalition with its first interactive conference call, which was open to all members. Anthony Slonim, MD, DrPH, a Coalition co-chair who on July 1 will become president and CEO at Renown Health in Reno, Nev., moderated the roundtable discussion.
As Sequencing Moves into Clinical Use, Insurers Balk
Once strictly the domain of research labs, gene-sequencing tests increasingly are being used to help understand the genetic causes of rare disease, putting insurance companies in the position of deciding whether to pay the $5,000 to $17,000 for the tests.
ACO Initiatives Test Pharma's Traditional Sales Model
The US healthcare system’s shift from volume- to value-based reimbursement for treatment in order to lower costs and improve patient care is disrupting healthcare business models. The high-profile government–led accountable care organizations (ACOs), which put financial pressure on payers and providers to share responsibility for meeting quality and cost goals, is no exception.
AJMC Sets Infectious Disease Meeting for Atlanta
The American Journal of Managed Care will host a two-day event September 25-26, 2014, to take on some of healthcare’s biggest challenges: Treatments that cure hepatitis C are making news but upending balance sheets. A recent recommendation seeks preventive therapy to stop new cases of HIV. Hospitals and public health officials are grappling with how to prevent the spread of MERS. Only AJMC will bring payers, clinicians, policy leaders, and pharmaceutical representatives together to share ideas.