Are Temporary Nurses More Cost-Effective Than Overtime?

A Columbia University study suggests that hospitals can cut their costs and improve the quality of patient care by paying overtime instead of hiring temporary nurses, but other recent studies tell a different story.

The study, which focused on 900,000 admissions in the Veterans Administration health system over the last four years, correlated shorter patient stays with lower costs and better treatment. Researchers also suggested that paying overtime to a core staff of nurses resulted in more positive results than bringing in temporary nurses because of the “rhythm and routines” they establish.

Columbia’s conclusions counter those of a 2012 Penn State study, as well as a different Columbia study published last year. The results of both studies indicated that poor hospital environments are the greater contributor to adverse patient outcomes, regardless of the employment status of the nurses. The Penn study went even further and cited the hiring of temporary nurse staff as a potentially life-saving move – and, at least, that their use “does not appear to have deleterious consequences for patient mortality”.

A co-leader of the earlier Columbia study pointed out in a press release that temporary nurses are often scapegoated for lower patient outcomes that result from poor work environments that turn away qualified permanent staff. Dr. JingJing Shang also touted the benefits of a traveling nurse arrangement that creates ongoing assignments for nurses in the same facility.

Other potential issues with Columbia’s cost-benefit analysis include the potential for nurses working overtime to make costly and life-threatening errors because of burnout, a result that may be mitigated by using temporary nurse staffing.

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ICD-10 Delay: What Should We Do?

The news of ICD-10’s delay until at least October 2015 has prompted a range of responses from vendors and providers, mostly predicated on whether or not they were prepared for a transition to occur later this year. With a delay signed into law and a new deadline yet to be announced, many organizations are lamenting the dollars and hours they have spent to be ready and the money they will now have to invest in waiting out the delay.

There are two paths of action that providers and vendors can take in the minimum 18-month waiting period now facing them: stay ahead of the game, or catch up.

If you’re ready, stay on the ball.

ICD-10’s delay unfortunately has the collateral effect of punishing companies that worked to put new systems in place well ahead of the latest deadline. Many of these companies have invested money into software, employee training, and testing procedures and are reluctant to invest even more to maintain an indefinite ready state.

For these companies, professionals advise to keep forging ahead. Unless there is an announcement down the line that ICD-10 will be skipped entirely, prepared vendors and providers can stay ahead of the curve by continuing to test their updates and train coders to comply with ICD-10. In addition, you can cease dual coding once your ICD-10 accuracy reaches acceptable levels and simply translate ICD-10 codes to the less specific ICD-9 codes for billing until the new standard is officially implemented.

If you’re not ready, get there.

The minimum eighteen-month delay is a significant reprieve for providers, vendors, and payers that are not on track for a timely transition, including the Centers for Medicare and Medicaid Services. For these companies, it is critical to make the best use of the extension they have been given.

Companies that have found ICD-10 preparation to be a heavy financial burden should make and implement a plan to invest in the necessary training and software with enough time to undergo full testing. If companies choose to drag their feet further and squander the added time, it could result in hundreds of thousands of wasted dollars and more delays down the road. The Medical Group Management Association (MGMA) is pushing for CMS to take the lead on end-to-end testing, though CMS has no plans to conduct their own testing until at least July of this year.

If the ICD-10 delay is causing cash flow problems for your company, PRN Funding can help. Our healthcare factoring programs give you immediate access to cash that you can invest in infrastructure, training, and further developing advances such as the ICD-10 transition. Contact us to find out more about healthcare factoring services and to receive an application today.

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New Bill Delays ICD-10 Again, Indefinitely

Despite claims by the Centers for Medicare and Medicaid Services that the October 1, 2014 deadline for the final transition to ICD-10 was firm, President Obama has signed a new law that will push ICD-10 back until at least October 2015.

H.R. 4302, “Protecting Access to Medicare Act of 2014”, is primarily the latest in a series of patches to Medicare’s sustainable growth rate; however, Section 212 of the bill prohibits the Secretary of Health and Human Services from replacing the current coding standard, ICD-9, with the new ICD-10 any time before October 1, 2015.

The delay has caused significant frustration and may compound difficulties for providers racing to be ICD-10 compliant. Providers at various stages of preparation for ICD-10 will have to maintain both their ICD-10 systems and their current ICD-9 systems until the switch takes place; in addition, many providers who are prepared to begin training for ICD-10 will have to postpone their efforts until a new deadline is announced.

Because the ICD-10 mandate is unfunded, the cost of preparation has fallen to providers who may suffer financially due to a delay. There is also little indication that payers are prepared for billing changes that will take place with ICD-10. At the same time, however, providers who are not as close to full ICD-10 implementation will have at least an additional year to upgrade technology, train their employees, and update their procedures. For payers, the delay will provide additional opportunities for critical end-to-end systems tests.

Proponents of ICD-10 argue that the new system will allow for more accurate coding of a variety of medical conditions, which will not only improve the quality of care but will also streamline billing processes by reducing requests for additional documentation. Health information management professionals recommend that providers stay on track for complete ICD-10 preparation, including a complete shift to ICD-10 coding with translations to ICD-9 until the standard is changed.

ICD-10 may also have a significant impact on healthcare vendors. Medical billing and coding agencies stand to benefit from providers choosing to outsource coding in advance of changing standards, yet all vendors may face longer waits for payment from facilities struggling to meet increasing financial demands.

We will continue to monitor updates to the ICD-10 transition and report on them as they come.

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Study Finds Healthcare Sector among Most Obese

In a seemingly ironic twist of circumstance, the American Journal of Preventive Medicine reported that the healthcare industry is among the top 10 most obese industries.

The data analyzed came from the 2010 National Health Interview Survey as well as self-reported personal statistics from employees. All healthcare workers are included in the overall “healthcare” sector, but a breakdown of health service employees versus practitioners indicates that the former are more at risk for obesity than the latter.

Researchers correlate risk for obesity in the job sectors listed to job factors such as stress, long hours, and working conditions that minimize movement and activity. In that respect, healthcare practitioners such as doctors and nurses benefit from time spent on their feet going between patients.

Long hours and shift work can make it difficult for workers to fit exercise into their schedule or to prepare and eat healthy, balanced meals – after all, a trip through the drive-thru is faster and less labor-intensive, thus more appealing to an employee coming off of (or heading into) a 12-hour shift. Also at issue are differences in pay that can prevent some workers from choosing healthier options.

One possible contributor to obesity in the healthcare setting that is not discussed, but that has interesting implications, is a shift toward banning smoking by healthcare employees. Healthcare employees who quit smoking may compensate by eating more, either to fill the time or because of the lack of cigarettes’ appetite suppressant effect.

Obesity can be a significant contributor to health care costs. With that in mind, understanding the prevalence of obesity in the healthcare industry – as well as its causes – can help healthcare employers adapt their working conditions and employee benefits to promote healthier lifestyles. For example, a hospital may offer free or subsidized memberships to gyms or weight-loss programs, or tie the achievement of health goals to lower premiums.

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ACA: Race to Enrollment Deadline is Frustrating but Successful

By now, Monday’s deadline to enroll in a valid health insurance plan is old news – as is the eleventh-hour rule change allowing consumers to apply for short-term extensions as long as they have attempted to enroll before March 31.

Many more consumers will fall into that latter category thanks to a last-minute race by thousands to meet the enrollment deadline, a process highlighted by more difficulty accessing state and federal marketplace Web sites.

The online marketplaces went through intermittent overload periods until mid-afternoon on March 31. Consumers at home and enrollment counselors processing in-person applications were shut out of the Web site for long periods, likely due to a software glitch discovered during an overnight maintenance session. Enrollment counselors could do little more than create an account for each consumer so they would be eligible for the enrollment extension.

State-run exchanges faced similar difficulties, as well as similar influxes of consumers looking to beat the deadline. At all levels, consumers that have accessed the marketplace but have not successfully enrolled in a healthcare plan will have a blanket extension until mid-April to complete their enrollment without paying the tax penalty.

Despite the minor Web site setbacks and the decision of many Americans to not enroll in marketplace health plans at all, figures released April 1 indicate that completed enrollments exceeded the Congressional Budget Office’s projected target of seven million to the tune of at least 100,000 additional enrollments. That number does not include Medicaid enrollments in states with expanded eligibility, nor does it include consumers who began the enrollment process but did not yet complete it.

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