There has been much ado about the stiff penalties that come with remaining uninsured under the Affordable Care Act. Those who spent 2014 without a coverage plan are about to be slammed with either a $95 penalty or be subjected to confiscation of 1% of their income, whichever sum is higher. While Obamacare in itself is a remarkably famous piece of legislation, and nearly every American has heard of it, many speculate that the bulk of those who are still uninsured (and consequently facing penalties) are so due to simple ignorance of the mandate portion of the law.

A study by Avalere Health reveals that there is a major demographic of low-income Americans that, while being eligible for hefty government subsidies on the federal exchange, still have not purchased a healthcare plan.

An analysis by Kaiser Health News (KHN) interpreted the data, and concluded that while 76% of people with incomes between 100 and 150 percent of the official poverty level (between $11,670 and $17,505 for an individual) had enrolled for coverage last year, only 41% from the next demographic (between 151 and 200 percent of the federal poverty line) had 2014 coverage. Those individuals earn between $17,622 and $23,340, and are eligible for significant government subsidies through the federal exchange. Moreover, only 30% who rake in between $23,457 and $29,175 utilized the federal health insurance program.

Now, it is logical that those from the higher income levels do not use the federal exchange, as they can afford their own coverage or are provided some by their employers. And, while the government has done well to advertise their available subsidies and packages to the group right at the poverty line, the fact that only around 40% of those from the next-highest income levels have taken the government up on their financial aid is rather alarming, as they most likely do not have an alternative mode of attaining coverage, and will hence be hit with increasingly stiffer penalties in 2015 and 2016.

So, that begs the question—why is it that those who could benefit from the subsidies simply are not?

Caroline Pearson, senior vice president at Avalere Health, opines that it is because they still do not know about the mandate or the benefits for which they qualify. Her sentiments are felt by many who work in the world of health insurance.

Clearly, the Affordable Care act has done well to insure the poorest sector of the American populous. However, it evidently has room to grow when it comes to assisting those who, while keeping afloat above the federal poverty line, still need significant financial aid in order to practically afford coverage.

In January 2015, the American Nurses Association revised their Code of Ethics for the first time since 2001, Nurse.com reports.

The recent revisions are the result of an 18-month process that drew from the insight of some of the United States’ most experienced nurses. The new Code of Ethics touches upon nearly all conceivable aspects of the nursing profession, from providing appropriate end-of-life care to how to handle oneself on social media.

The Code of Ethics has a long history, dating back to 1896, according to Nurse.com. Since then, the Code has evolved into a document of nine provisions and several subsequent interpretive statements that assist nurses in understanding and applying its guidelines. The new revisions process is the first in over 25 years that features revisions in both the nine provisions and the interpretive statements.

The new Code of Ethics touches upon several delicate and difficult issues that nurses face every day on the job. One of the more controversial inclusions in the new Code is a subject that deals with the issue of medically-assisted suicide and euthanasia, a topic that is hotly contested in politics and between ideological groups. Nurse.com reports that the new Code formally prevents any nurse from administering any medicine or treatment that will end the life of a patient, even if that situation comes up in the execution of death-row inmates. The guidelines make it clear that no nurse, anywhere, under any circumstance, should administer a lethal injection.

The American Nursing Association also had to tweak their documents in light of recent technological and social advances, specifically concerning social media. The new mandates that nurses pay extra close attention to not violating patient confidentiality with their personal social media accounts. Nurses who post about the condition of some of their patients on social media sites such as Twitter or Facebook violate the secrecy and privacy of patients, which the new Code of Ethics deems unacceptable.

The Code of Ethics is just one of the reasons why nursing is consistently rated at the top of the list for honest and ethical professions, Nurse.com reports. Surely, the newly revised Code will uphold the industry’s impressive reputation.

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In recent years, VA hospitals have been the subject of a great deal of controversy and scrutiny. In 2014, the Veterans’ Affairs healthcare facilities made headlines because of their inability to provide services for a large number patients, and many had to wait months before they could see doctors in what became known as the “waiting-list scandal.”

In 2015, VA hospitals have done well to cope with the influx of veterans that need appointments with doctors and surgeons. However, reports have shown that the increased quantity of patients seen has caused the average quality of care to decrease.

In a Seattle Times article, Tim Kuncl, former member of the US Coast Guard, shared his misadventures with the Puget Sound VA Health Care System.

Kuncl suffered from a rare pilon fracture in 2011 as he was putting Christmas decorations up on his home in Washington State. Three weeks later, he went to his local VA hospital and received surgery in which doctors inserted several pins, screws, and plates in order to fix his shattered bones. His pain persisted well past his expected recovery time, though, and he ended up having to get two additional surgeries done on the same leg, each one resulting in increased pain and discomfort.

Eventually, Kuncl decided to forego the VA system and get treatment from a private organization, who found that the previous surgeries had irreversibly damaged his leg, and concluded that amputation was the only path left to take. He has since become an advocate for the improvement of the VA healthcare systems.

The unfortunate case of Tim Kuncl is following a trend of increased malpractice. According to the Seattle Times, wrongful-death claims against the VA healthcare systems throughout much of 2014 climbed 43%. The Government Accountability Office has placed Vetrans Health Administration on the “high risk agency” list by virtue of its issues in oversight and training of new employees, according to the Seattle Times. The VA hospitals are treating more patients, but the number of erroneous cases has gone up rather alarmingly.

In other news, the VA healthcare system in Tomah, Wisconsin has become the subject of investigation as whistleblowers revealed that facilities have been overprescribing narcotic drugs, the StarTribune reports. In response, the VA has implemented new computer software that helps to monitor the allocation of prescription medicines. The program is called the “opioid therapy risk report,” and currently over 2,000 VA doctors nationwide now have access to the software.

With luck, the complaints against the VA healthcare systems that are piling up will reduce very soon, as the government has decided to increase its funding. The Puget Sound VA’s budget is $7.4 million larger in 2015 than it was in 2014, and will be $14.9 million larger in 2016, the Seattle Times reports. The additional funding should result in faster treatment and higher quality of care for our nation’s veterans.

It is estimated that 78.8 million people have had their Social Security numbers, names, addresses, and dates of birth accessed by internet hackers who broke into health insurance giant Anthem’s databases, according to Bloomberg Business.

Anthem is the second-largest health insurer in the United States, and is part of the greater network of independently operated Blue Cross Blue Shield plans that provide service in parts of the country where BCBS is not easily accessible, Reuters reports.

The Indiana-based insurance company stated that preliminary investigations do not leave them to believe that costumers’ credit card or medical information was compromised.

The Anthem hack has quickly gone down as one of the largest corporate cyber breaches in history, as not only were Anthem costumers’ personal records stolen, but so too were those of nearly 8 million non-costumers who were on the Anthem databases for being affiliates of Blue Cross Blue Shield, according to CNN.

The FBI was alerted of the security infraction shortly after it was discovered, and has since been collaborating with Anthem very closely, hoping to pin-point the transgressors. While it is too early to tell who committed the cyber-attack, CNN states that a few rumors have pointed fingers at the Chinese government.

Large companies being robbed of costumers’ valuable information has become a trend of late. The Anthem hacking is somewhat reminiscent of the cyber-theft of the credit card data of over 40 million Target shoppers last year. Sony, JPMorgam Chase, Ebay, and Home Depot have also had issues with technological security in the past couple of years, says CNN.

The personal information of the administrative hierarchy of Anthem was stolen as well. In a letter notifying customers of the violation, CEO Joseph Swedish said, “Anthem’s own associates’ personal information – including my own – was accessed during this security breach. We join you in your concern and frustration, and I assure you that we are working around the clock to do everything we can to further secure your data.”

As collateral for the lost information, Anthem has vowed to individually contact victimized customers and provide them with complimentary credit monitoring and identity protection services, according to CNN. With luck, authorities will trace the source of the cyber-attack and prevent credit fraud.

If somebody were to ask you which occupation saw more back and musculoskeletal injuries per year, construction laborers or nursing assistants and orderlies, which would be your guess? Believe it or not, the answer is nursing assistants, orderlies, and healthcare staff- and the margin of victory is not even close. An article by NPR declares that the laborers of this category are prone to suffering approximately three times the amount of back/musculoskeletal injuries as construction workers.

According to surveys by the U.S. Bureau of Labor Statistics, there are over 35,000 various on-the-job injuries (predominantly in the back and spine) that require a leave from work among nursing and healthcare employees per year.

What is it in a nurse’s workday that causes so many staffing injuries? The culprit is the lifting and transporting of patients. Many orderlies and nurses assistants are tasked with hoisting patients and invalids that weigh in at 300 pounds or more. Doing this day after day takes a veritable toll on the back and spine, and each year thousands of workers feel the consequences.

What’s more, it appears that there is no way to sidestep the mishaps that accompany lifting and moving patients. NPR reveals that hospitals and nursing schools are teaching nurses lifting methods that put them in great risk of inadvertent, career-ending back injuries. William Marras of the Spine Research Institute of Ohio State University tells NPR, “The bottom line is, there’s no safe way to lift a patient manually. The magnitude of these forces that are on your spine are so large that the best body mechanics in the world are not going to keep you from getting a back problem.”

So, the age-old “bend your knees, keep your back straight, and lift with your legs” technique is facing increased scrutiny. Clearly, the new consensus is that hospitals need to find alternate methods of raising and hauling patients. NPR reports that some hospitals, such as Florida’s Baptist Health System and the Department of Veterans Affairs have reduced staffing injuries by nearly 80% by utilizing mechanized processes for patient-lifting.

While there are several progressive medical systems that are implementing machines to perform these task, the majority of hospitals and healthcare facilities are not making a concerted effort to reduce staffing injuries. It appears that until there is a more serious, committed effort to change policy, nurses and orderlies will retain their high rank on the list of occupational injuries.

Up to 200,000 people are expected to lose their Obamacare coverage after failing to produce documented proof of their citizenship or legal residence in the United States, The Fiscal Times reports.

In August of last year, the American government mailed letters to over 310,000 people demanding proof of their status as a legal U.S. resident. Of those original 310,000, nearly 112,000 never responded, and were officially taken off of the coverage policy in September 2014, according to The Fiscal Times.

Currently, those at risk of losing their healthcare coverage are the population of potentially ineligibles who responded to the August letter from the federal government, but never produced sufficient proof of their status as a legal resident of the United States. If officially deemed unqualified for insurance, their coverage will be officially cut off on February 28th.

The push to eliminate all ineligible applicants from the Obamacare roster comes as the federal government is trying to finalize the official list of coverage recipients before the healthcare application deadline ends this Sunday, says The Fiscal Times. As of last week, there were over 9.9 million reported beneficiaries of the healthcare program through a combination of the state and federal systems. That number is expected to fall, of course, as the last-minute ineligible candidates are invalidated.

Aside from determining who ought to be terminated from their coverage policies, the government, and specifically the Internal Revenue Service, must determine whether or not they are going to reclaim the money that they gave to subsidize the majority of the aforementioned 200,000 unqualified persons, nearly all of whom received significant financial aid and healthcare benefits in 2014.

After they finalize the whittling-down of the unqualified enrollees due to residency status, the government must also shift their attention to sorting out discrepancies related to people who recorded erroneous information about their income. Having accurate income levels on the applications of enrollees is imperative to efficiently apportioning Obamacare’s funds, since the money granted via subsidies is directly proportional to a recipient’s income level.

After all is said and done, the Obamacare roster will be significantly smaller than its current 9.9 million that currently have policies on both the federal and state exchanges. As of now, the government has only been working on revising the list of federal beneficiaries. It still has yet to shift its focus to the recipients on the state exchange systems.

The Obama Administration recently announced a rapid reconstruction of the American Medicare system by the year 2018. The president intends to change the way that the enormous Medicare program makes payments to hospitals and physicians, shifting away from a “fee-for-service” system, which simply encourages to see a large volume of patients rather than deliver each one the best possible care.

According to the LA Times, Medicare will start making 30% of its direct payments to hospitals and doctors through alternative payment models. These models offer a rewards system to doctors and hospitals that provide care to patients under budget while simultaneously delivering excellent care to the patients. The overall goal of this transition is to transform the American healthcare system into a quality-based institution. The LA Times also reports that such a change to the Medicare system is paramount, as finding an efficient way to pay for healthcare will become more and more important as the baby boomer generation starts to retire.

In 2014, only 20% of Medicare spending (about $72 billion, according to Kaiser Health News) was done through alternative payment models. The shift to 30% will raise the total sum to about $113 billion. On January 26th, U.S. Secretary of Health and Human Services Sylvia M. Burwell wrote an article in the New England Journal of Medicine in which she announced that by 2018, she hopes to have 50% of all Medicare payments done through alternative payment models.

The ramifications of this plan are already being felt throughout the private sector of the healthcare industry, as commercial insurers and prominent employers have begun to invest in new payment models, the LA Times reports.

Most influential figures in the healthcare world have heralded this as a progressive and necessary step. Ensuring that the Medicare system spends its money wisely is remarkably important, as this year it is estimated that the program will spend over $600 billion to insure nearly 50 million different disabled and retired Americans. Kaiser Health News reports that with these aforementioned changes implemented, 90% of all Medicare spending will be linked to quality of care in some regard.

In the wake of the Ebola situation in the United States, vendors of electronic medical record (EMR) technology are making improvements to how their systems identify and flag patients who may be suffering from a serious disease. These updates will allow practitioners to respond more quickly to outbreak scenarios.

Hospital administrators laud the change as a way to overcome the information decay caused by shift changes by keeping every fact about a case in the system. EMR advances include notifications about potential issues, such as an “Ebola” notification for a West African patient experiencing flu-like symptoms, and more targeted questions to establish a patient’s more recent travel and living history.

Healthcare technology developers are continuously working on new ways to collect and use patient information in EMR systems through applications and better data collection. Though doctors complain that the systems are still difficult to navigate, developers maintain that doctors are equally critical to the effective use of an EMR system.

EMR development is an important positive outcome of the Ebola situation and will hopefully prompt vendors to make their systems even more responsive to future outbreaks of infectious disease.

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Breast cancer is the most prevalent form of the disease to affect women. Fortunately, new genetic research may provide a better way to identify those at risk before a diagnosis.

Researchers have identified a genetic variant that results in less dense breast tissue, eliminating one of the key risk factors associated with breast cancer. The gene is present in women of Hispanic descent in varying proportions based on their ancestry.

Women whose genetic code shows the variant in question are between 40 and 80 percent less likely to contract breast cancer in their lifetime, depending on whether they inherited the code from one or both sides of their family.

While non-Hispanic women are less likely to benefit from the gene, the confirmation of this research could help doctors target screening and prevention measures more effectively toward women based on their respective level of risk. In addition, further research will lend insight into how the genetic variant actually protects carriers – ideally, a finding that doctors could then replicate in future preventive treatments.

Regardless of ethnic heritage, all women are encouraged to follow a recommended screening schedule including self-tests and mammograms. The National Cancer Institute has identified a list of risk factors as well as a risk assessment tool that women over 35 can use to estimate their risk of contracting breast cancer. (The online tool should not take the place of an exam by a licensed physician.)

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CVS Health made waves in the pharmacy industry earlier this year with their announced cessation of tobacco sales. Now, they are drawing fire over a prescription plan that features higher co-pays for prescriptions filled at tobacco-vending pharmacies.

The plan, which has already been adopted by the city of Philadelphia, would give patients a discount as high as $15 per prescription if patients fill them at pharmacies in the “smoke-free” network including CVS pharmacies, of course, but also some local pharmacies as well as retail giant Target Corp. Customers at larger rival chains such as Walgreens and Rite Aid, which have chosen not to end tobacco sales, would pay the higher out-of-pocket cost.

For some smaller pharmacies, the plan could jeopardize their sales even if they don’t sell tobacco products – without sufficient marketing to advertise their smoke-free status, customers may choose to visit a verified smoke-free pharmacy to avoid the risk of higher co-pays.

CVS Health’s vice president of corporate communications explained that the network developed at the request of Caremark clients, but that hasn’t stopped a backlash from independent pharmacy associations and concerns that CVS Health will be reducing competitiveness if customers are pushed toward using CVS pharmacies for their prescriptions.

It remains to be seen whether more clients will sign on to a smoke-free network, but CVS Health assures that those who do will be provided with a full list of smoke-free pharmacies that their plan members can visit.

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