AJMC® in the Press, May 5, 2017

A RevCycleIntelligence.com article asked, “Is Billing Some Patients at Hospital Chargemaster Rates Legal?” It was referencing an analysis in the April issue of The American Journal of Managed Care^® (AJMC^®) titled “Battling the Chargemaster: A Simple Remedy to Balance Billing for Unavoidable Out-of-Network Care.” It proposed an “effective legal mechanism to combat chargemaster abuses and to facilitate price transparency” based on contract law.

The same study was also highlighted in a Becker’s Hospital Review news story, titled “Study authors challenge legality of billing out-of-network patients at chargemaster rates.” “Contract law does not support healthcare providers billing uninsured and insured out-of-network patients at chargemaster rates, claims a recent study published in The American Journal of Managed Care,” the article began.

The findings of another study from the April issue of AJMC^® were summarized in an article on RevCycleIntelligence.com. The research, “Concentration of High-Cost Patients in Hospitals and Markets,” indicated that costly patients were only modestly concentrated in specific markets and hospitals. “Based on the results, researchers suggested tailoring cost reduction initiatives to either modify provider behavior or implement more programs in specific areas,” explained the RevCycleIntelligence.com article.

The Heartland Institute published a Research & Commentary article that asked whether direct primary care could help solve New Jersey’s physician shortage. It cited a 2012 AJMC^® study that analyzed the outcomes of a direct primary care model called the MDVIP. The findings of the study, “Personalized Preventive Care Leads to Significant Reductions in Hospital Utilization,” indicated that direct primary care initiatives can successfully lower hospital admissions.