Insurance Companies Helping to Delay Nurse Practitioners Role in Primary Care

While demand for primary care providers is projected to increase dramatically following implementation of the Affordable Care Act, insurance companies and physician groups remain opposed to the credentialing of nurse practitioners to provide primary care services.

Advanced practice registered nurses hold a master’s degree and have an additional 700 hours of supervised clinical experience, allowing them to diagnose and treat many common illnesses as well as to administer anesthesia or deliver babies with the proper specialization. Despite their licensing, however, many states do not allow nurse practitioners to operate without physician oversight and many insurance providers will not credential them as primary care providers in their plans.

Physicians argue that the clinical role of nurse practitioners is different from that of doctors and that ensuing confusion could affect the quality of patient care; however, there is also a financial element regarding the current requirement that nurse practitioners bill through a physician’s office for service.

The American Nurses Associate submitted comments on the federal rules governing the national healthcare marketplace, set to open enrollment tomorrow, in which they encourage the Obama administration to include provisions requiring insurance providers to credential a certain number of nurse practitioners for independent practice. For their part, insurers are more focused on increasing access to primary care through other, “team-based” means.

At present, roughly half of the 250,000 advanced practice nurses in the United States work in physicians’ practices; many of them, it seems, would open their own practices if they were able to bill patients directly and insurers would include them in provider listings.

Learn more about funding options for nurse practitioners and other primary care providers.

Nurse Staffing May Be Slow, but Nurses Should Remain Optimisitic

Nurses throughout the US are seeing flat wages and a decreased availability in jobs in higher-paying states. The U.S. Bureau of Labor Statistics reported that the median annual wage increases for nurses increased only 1% between 2011 and 2012.

A few factors lie behind the wage stagnation and lack of desirable positions for nurses. The first is healthcare reform. The impact healthcare reform will have is unclear and many hospitals are hesitant to hire. Hospitals are being ultra-conservative when it comes to finances in the wake of decreasing Medicare reimbursements, according to the president of the National Association for Health Care Recruitment. Not only is this causing less job opportunities, but it’s also behind the trend in stagnant wages.

More supply and less demand for nurses is another reason. The amount of nursing school graduates has grown in the past decade, but the baby boomers in the field have yet to retire.

Despite the current trend, there’s reason to believe nurse staffing levels will increase in the near future. Here are a few reasons those in the nursing field should remain optimistic:

1. The Affordable Care Act
As more people obtain insurance and seek healthcare, the demand for nurses will rise.

2. Baby Boomers
As baby boomers grow older, they’ll need more care. Also, many baby boomers will be retiring from the nursing field making room for a new generation of nurses.

3. Nurse Staffing Ratio Laws
According to Aureus Medical Group, a nurse staffing company, 15 states have enacted legislation or adopted regulations to focus on nurse staffing levels. As states begin to mandate nurse-to-patient ratios, the number of nursing positions should increase.

Now is the time for nurses to take steps to set themselves apart from the competition. Nurses with specialized training in ORs, cardiovascular ICUs, pediatrics, etc. may see more career options. The ability to use electronic health record systems also gives nurses an advantage. Furthering education is another way to secure a job in nursing, especially since demand for nurse practitioners is likely to grow. According to the Bureau of Labor Statistics, nurse practitioners earn more than RNs with a 2012 median annual wage of $91,450. Nurse midwives and nurse anesthetists also earn significantly more. Nurses with associate’s degrees may want to consider a bachelor’s.

Flexibility is key to riding out the slow nursing hiring trend. Be willing to take on temporary nursing work. Remain open to the idea of relocation. Accept a job even if it isn’t your dream come true. The experience will be essential to landing your ideal position in the future.

Northside Medical Center Nurses Stage One-Day Strike

After working for more than a year without a labor contract, members of the Ohio Nurses Association/Youngstown General Duty Nurses Association staged a one-day nursing strike at the Northside Medical Center yesterday. The strike, which went from 7 am to 7 pm, follows allegations earlier this year by the O.N.A. that the hospital is not bargaining in good faith with their nurses.

Meanwhile, Northside has filed an unfair labor practice charge with the National Labor Relations Board claiming that the O.N.A. violated the NLRB’s regulation of strike notifications by issuing “three separate, conflicting and confusing notifications” of their intent to strike:

• The initial notice, that stated a strike would begin at 8 am October 24th
• An amendment stating the strike would begin at 8 am September 24th
• A final amendment changing the start time to 7 am September 24th

In addition, the hospital argues that amendments extending the strike must be agreed upon by both parties in writing and contends that they did not do so.

If the NLRB finds in Northside’s favor, the nurses who participated in yesterday’s strike will be subject to termination for violation of the notification regulation.

To cover the staffing gap, ValleyCare Ohio Health System – Northside’s parent company – brought in temporary nurses from a local staffing agency to work with non-union hospital staff and those who chose to cross the picket line. Temporary nurse staffing allows hospitals to continue providing high-quality care to their patients and maintain a safe ratio of nurses to patients despite internal issues.

Nurse staffing factoring can prepare agencies for these requests, as well as ongoing contracts with facilities, by providing them with immediate cash to hire skilled professionals to fill these positions as needed. PRN Funding’s factoring program can be customized to fit temporary nurse staffing agencies of all sizes.

Learn more about temporary nurse staffing factoring and let us help your agency succeed.

Some Employers Cut Back Health Insurance to Contain Costs

In an effort to offset rising insurance costs, and in part as a response to the Affordable Care Act going into effect, some employers will begin requiring their employees to pay an additional fee for their spouses’ healthcare coverage, or will eliminate that coverage entirely.

Some companies, such as UPS, have decided to exclude spouses from their employer-sponsored health plans beginning in 2014 if those spouses have access to health insurance through their employers. Experts suggest this as a reasonable cost-cutting measure for a couple of reasons: one, covered spouses are more likely to be women, who use the health system more through middle age and therefore cost more; and two, the employer mandate will shift those costs by requiring the spouses’ employers to offer affordable coverage.

Another factor for companies’ consideration is the pending “Cadillac tax”, which will add a further 40 percent tax to premiums above established ceilings for individual and family coverage. While the tax does not take effect until 2018, large companies are working to lower their spending now in preparation. Important to note is that restricted coverage will not affect spouses who do not have coverage through an employer, nor will it impact minor dependents on employees’ plans.

The percentage of companies who plan to eliminate or charge for spousal support is in the single digits, and several studies cited by the Department of Health and Human Services suggest that it will remain a minority plan of action. In addition, the NY Times cites Mercer senior health consultant Barry Schilmeister as claiming this type of action would “not…be a popular move among employees.”

PRN Funding can help healthcare companies seeking a cash flow alternative to scaling back their health coverage. Healthcare factoring is available for vendors filling a variety of healthcare roles, including temporary nurse staffing, medical billing, and home health care. By purchasing invoices for service and advancing immediate cash, PRN’s factoring program provides the flexibility your company needs to provide the right kind of health coverage for your employees.

Contact us to learn more about healthcare factoring and to get started today.

Captricity Seeks to Further Enhance EHR

Berkeley-based startup Captricity is looking to capitalize on the ACA-mandated transition to electronic health records (EHR).

Captricity, helmed by CEO Kuang Chen, is a “crowd-guided machine learning and computer vision platform” designed to convert records of all formats into easy-to-use digital records that can be imported into a variety of systems for internal use.

The system utilizes a “shredding” process in which uploaded records are divided into minute pieces of data and converted using a special set of algorithms and, when necessary, human entry. The process allows Captricity to comply with federal privacy standards, including HIPAA compliance. The converted data is then reassembled into a secure digital record that the subscriber can download or import as needed.

In addition to basic Latin characters, Captricity is capable of converting any non-Latin based languages that can be entered into a computer. The company also offers 24/7 access from anywhere in the world, via cloud-based platforms such as Dropbox as well as mobile applications currently available for iOS devices. Much like mobile check deposit (and protected by the same levels of encryption), Captricity allows mobile users to upload photos of documents for conversion.

Subscription to Captricity can allow backlogged health systems to quickly come into ACA compliance regarding EHR without sacrificing the integrity of the data or dedicating countless person-hours to manual conversion. Furthermore, Captricity can improve the accuracy of medical billing and coding by properly converting often illegible doctors’ notes in order to reduce the number of costly coding errors.

Captricity offers a pay-as-you-go service and graduated subscription services that increase the monthly page limit, length of data availability, and available features. Prices for paid subscription begin at $75/month.

Healthcare providers and medical billing and coding companies can greatly benefit from services like Captricity, but may lack the cash flow to make an upfront investment in the service. Medical billing and medical coding factoring offer access to immediate cash that these companies can then use to ease the transition to EHR in their own firms. PRN Funding has more than a decade of experience with medical coding and medical billing factoring programs, and can help your company get started today.

Is Obamacare Responsible for Hospital Staff Layoffs?

Hospital systems nationwide have been in the news lately for projected staff layoffs and other budget cuts. Just this week Cleveland Clinic, Cleveland’s largest employer, announced a $330 million annual budget cut without specifying how much of those cuts would come from staff reduction. Other systems have specifically announced layoffs and staff voluntary buyouts.

A scan of the headlines suggests that the Affordable Care Act is the culprit behind these healthcare staffing changes. But is that really the case?

Some recent headlines:
• Ohio Clinic touted by Obama slashes budget due to ObamaCare (Fox News)
• Citing Obamacare, Cleveland Clinic to cut $300M, Warns of Layoff (US News & World Report)
• Hospital Finds Obamacare Harmful to Its Health (
• Atlantic General Hospital Hires During ‘Obamacare’ Scare (WBOC TV 16)
Emory Healthcare to cut 100 jobs party because of Obamacare (WSB-TV)

Quotes regarding the Cleveland Clinic’s budget reduction came from both an unnamed spokeswoman and the Executive Director of Corporate Communications for the Cleveland Clinic Foundation, though the article does not specifically attribute the ACA connection to either source. In the Emory news report, however, an Emory spokesman does acknowledge that the ACA “played a role in the layoffs”.

While most of the mainstream media is running with the ACA-layoff connection, others are digging deeper to discover ongoing root causes that have little or nothing to do with the ACA. Dan Diamond of California Healthline’s Road to Reform reports that the ACA is merely one factor in hospital staffing decisions, and makes the argument that the ACA is actually poised to increase job growth.

Other factors involved in hospital layoffs and hiring freezes include changes in Medicare reimbursement policy; budget reallocation decisions that affect specific departments (as cited in the Emory reduction of inpatient psychiatric staff); and continuing financial challenges.

The ACA’s effect, meanwhile, appears to be more complex than headlines may imply. There is a great deal of uncertainty surrounding implementation of the ACA’s key provisions, and concern that expanded Medicaid coverage will mean lower reimbursements for care. Some hospitals are actually reporting an increase in hiring to provide care for a higher number of patients who are expected to utilize the system once health plans are made available to them.

Another issue reported in Huffington Post is that hospitals in some states are being forced to close because the state is not implementing ACA provisions, namely Medicaid expansion. The ACA reduces funding to hospitals serving large populations of uninsured patients, expanding Medicaid with the savings; however, if state government does not accept the resulting federal Medicaid funding then those hospitals will not be able to recoup the lost dollars.

While the debate over the Affordable Care Act continues to rage in Congress, there will undoubtedly be more headlines attributing hospital cuts to the law. There is certainly a degree of truth to many of these claims, but given the contentious nature of the ACA it is especially important to look beyond the headlines and carefully consider all the facts involved.

As the full effects of the Affordable Care Act remain to be seen, make sure your healthcare staffing agency is prepared. PRN Funding’s healthcare staffing factoring program can provide you immediate cash to expand your workforce or weather staffing gaps in your area. Learn more and contact us today to get started.

Physician Pay Gap: Female Doctors Earn 25% Less Than Male Doctors

Female doctors, who account for a third of all doctors in the United States, are still not earning as much as their male counterparts earned 20 years ago.

Researchers posted their findings in JAMA Internal Medicine earlier this month. Their data indicated a pay gap of more than $50,000 per year between female and male doctors’ incomes in 2010 – a difference of 25 percent. Female physicians’ median income was $165,278 between 2006 and 2010, which is still two percent lower than male physicians’ median income ($168,795) in 1990.

However, the data were insufficient to draw more specific conclusions based on physician specialty. This leaves the findings open to greater interpretation based on the question of opportunity versus preference: are female physicians choosing specialties with lower pay scales, or are they being turned away from preferred higher-pay specialties in favor of male physicians?

The research team has indicated that there is considerable room for further study into the reasons for the income disparity between genders. Based on their findings, there could be interesting implications for physician pay models in the future.

A survey by WebMD-affiliated Medscape, meanwhile, indicates an income disparity of 30 percent between male and female physicians (17 percent in primary care) and illustrates the difference in pay between several different specialties. They ascribe much of the gap to choice of specialty, though they acknowledge that set, regular schedules do a great deal to close that gap in large health systems. Last year’s report suggested a difference in the number of hours worked contributed to income disparity.

Of course, the reality of the income gap has a very important implication for private practitioners in the present: the cost of doing business is not adjusted for a provider’s gender, meaning that rising costs pose a greater threat to the success of a female physician’s practice than to a male physician’s practice. Private practice medical factoring can offset that pay gap and allow doctors of both genders to continue providing top-quality care to their patients.

Final Obamacare Regulations are in Place

Of the many provisions found in the Affordable Care Act, none is as contentious as the individual mandate. This provision, which requires that affected American purchase health insurance or pay a fine, goes into effect January 1, 2014. The Obama administration released the final regulations for the healthcare reform mandate earlier this week; however, these regulations indicate that the individual mandate will not be the healthcare enforcer that both proponents and opponents claim it to be.

The individual mandate will require taxpayers to cover their dependents (as reported on annual tax returns) or assume the fine for not doing so. The employer mandate, meanwhile, does not require employers to offer insurance for dependents. This could potentially force many individuals to seek supplemental health coverage for their spouses and children in the healthcare marketplace.

In addition, any employer-sponsored coverage will largely meet the mandate’s threshold of “minimum essential coverage”. This has already led to employers offering low-cost plans that cover very few services, and will be a strong incentive to other employers to follow suit.

Both of these are troubling characteristics of a hugely unpopular mandate. Other regulations, though, exempt as much as 40 percent of the population from the individual mandate; people exempt from the individual mandate include:

• The elderly, whose higher premiums and lower income may drive the cost of their coverage over the established limit of eight percent of household income (though a much lower income will qualify individuals for tax subsidies, in which case the mandate applies);
• Those who don’t file IRS tax returns;
• “Members of recognized religious sects” – these protected populations belong to groups such as the Amish that have existed since the end of 1950 and whose tenets are opposed to taking advantage of benefits such as Social Security, Medicare, and Medicaid in addition to health and life insurance plans;
• American Indians – members of recognized Indian tribes already receive government health care through the Indian Health Service.

The prescribed fine (the loftily-titled “Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage”) for failing to purchase health care is itself minimal compared to the potential costs of purchasing outside health coverage. Each taxpayer is responsible for their individual fine as well as the fines for up to two dependents. The fine will increase parallel with cost-of-living adjustments, from the greater of $95/1% of income to the greater $695/2.5% of income per person from 2014-2016.

Even so, the fine’s increase is still smaller than annual insurance premium increases historically. It may be a better financial decision for some people to pay the fine and continue without coverage. Furthermore, the IRS is specifically prohibited from penalizing non-exempt taxpayers who fail to purchase health care or pay the fine; the only thing they are able to do is withhold the fine from your tax return (if you don’t file, see above).

The effectiveness of the individual mandate remains to be seen for consumers, facilities, and vendors, but combined with the employer mandate we will see a large number of new enrollments in healthcare plans around the country.

To ease the transition, and offset the added cost of exempt or non-compliant patients, consider healthcare factoring to keep your cash flow sound.