Healthcare Sector Adds Jobs in May

Despite nationwide reports of healthcare systems eliminating jobs, the sector added 34,000 jobs last month according to the Bureau of Labor Statistics.

The healthcare sector has added jobs for 131 consecutive months, or nearly 11 straight years, despite the recession and fears that the Affordable Care Act would cause the sector to shrink. Last month’s growth was twice the standard rate at nearly three percent, most of which was concentrated in ambulatory services.

One element of continuing job growth is the increase in demand for services created by larger numbers of insured patients. At the same time, the decrease in uninsured patients due to marketplace policies and Medicaid expansion has reduced healthcare spending for charity care and covering self-pay patients.

Year over year spending has dropped significantly from 2007-2008 levels, but has remained consistent over the last several years.

PRN Funding offers healthcare factoring solutions to a variety of companies in the healthcare sector. If a lack of working capital is keeping your company from hiring the staff you need, learn how healthcare factoring can transform your cash flow and help your healthcare company compete. Contact us today to get started!

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Survey Shines a Light on Nursing Trends

CareerBuilder recently conducted a survey about the nursing profession, in which they measured nurses’ sense of loyalty and satisfaction with their field, the training they find essential to success, and their opinion of the impacts that changes in health care have had on their effectiveness.

Responses from approximately 900 nurses across the country can help health care executives make better decisions about recruiting, retaining, and properly rewarding their nursing staff.

The full results of the study are currently available, and CareerBuilder will present a free webinar discussing how healthcare organizations can integrate those results into their ongoing strategies. In the meantime, below are five of the study’s most interesting results:

5) 58 percent of nurses believe that health care changes have made the workplace less efficient.

4) Half of nurses surveyed believe technology helps them do their jobs faster.

3) Two out of three nurses reported having a mentor on the job – mostly in hospitals and hospice settings.  In facilities without a nurse mentoring program, 41 percent responded that management has not picked up on the idea and 43 percent say that potential mentors are too busy.

2) 67 percent of nurses reported that on the job training was as helpful as or more helpful than their formal training.

1) More than 80 percent of nurses would recommend a career in nursing to others. (Is your job satisfaction that high?)

For more in-depth applications of the study’s information, we recommend taking advantage of CareerBuilder’s webinar scheduled for June 5.

If you provide nursing staff to hospitals and other healthcare facilities, don’t let poor cash flow stop you from keeping them satisfied. PRN Funding can customize the ideal nurse staffing factoring program to meet your needs – contact us today to learn more and get started!

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Insurance Premiums Will Rise in 2015 – But Not by Much

Virginia insurance carriers have already filed their plan adjustments for 2015, indicating expected rate increases.

Early predictions of 2015 insurance rates had insurers raising premiums by exorbitant amounts to compensate for higher costs and restrictions imposed on their fee structures by the Affordable Care Act, as well as the greater health needs of previously uninsured enrollees who obtained healthcare during the open enrollment period. However, if Virginia filings are representative of how the nation will go then average rate increases will fall short of expectations.

Average increases will not apply equally to policyholders across the board, and range from just above three percent to nearly 15 percent depending on the provider. Those averages, meanwhile, will vary greatly in their individual application. Some providers are adjusting for average enrollee ages that skew higher, as age is one factor that allows them to differentiate. Providers are no longer able to price their premiums based on the enrollee’s current health unless s/he is a smoker.

Some states such as Washington may release their 2015 rates within the next several weeks, though most will complete their projections by the end of the summer.

Rising insurance rates are nothing new but may precipitate slow payments and other rising costs of healthcare. If you need to close the gap between service and payment in your healthcare company, consider PRN Funding’s comprehensive healthcare factoring programs. We work with healthcare vendors providing services to hospitals and other medical facilities – learn more and apply to get started today!

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Survey: ER Visits Increase During Early 2014

A survey completed by the American College of Emergency Physicians shows that emergency room visits have increased since January 1.

Approximately 46 percent of ER respondents noted an increase in patient visits and another 27 percent reported constant rates. Nearly a quarter of respondents reported decreased patient visits. According to the survey, the patient demographic is shifting toward fewer patients with private insurance but more patients with Medicaid coverage. The increase is also not restricted to certain states or any geographic area.

While proponents of the Affordable Care Act hoped that the law would decrease ER visits by expanding insurance coverage, studies of Oregon’s and California’s healthcare system overhauls in the last several years indicate that the expectation may have been unrealistic. At the same time, the survey suggests that the ACA has in fact played a role in the shifting numbers over the last three months.

The first and most significant reason is that coverage does not equal or lead to access. Many newly insured patients have little access to a primary care physician or clinic for regular care, either because they are not informed about their options or because PCPs in the area are already overwhelmed with volume. The Association of American Medical Colleges estimates that the PCP-patient gap will reach 30,000 next year and continue growing after that.

Emergency care is equally difficult to access in many states. The American College of Emergency Physicians released their 2014 Report Card which gave 21 states an F rating in the “Access to Emergency Care” category.

That said, patients who do have access to emergency rooms – insured or uninsured – may choose the setting because they cannot be turned away; because they are experiencing potentially serious symptoms; or because they need immediate care when other providers are unavailable (that is, on evenings and weekends).

A potentially significant drawback of the ACEP’s survey is the limited number of respondents: many states had too few responses to register as a percentage of the total responses, and in the top participating state – California – only 10 percent of facilities submitted responses. This indicates a great deal of missing data that could impact the survey’s findings. In addition, the survey’s focus on only the first three months of 2014 makes it insufficient to make any far-reaching assumptions about continuing trends.

If ER visits continue to increase it could create greater demand for healthcare vendors to cover staffing and equipment shortages. PRN Funding’s healthcare factoring programs can prepare your healthcare company for future growth by giving you immediate access to working capital. Learn more about our healthcare factoring services and apply today to get started!

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Nurse Group Pushes for Nurse Staffing Ratio in D.C. Hospitals

National Nurses United has joined a Washington, D.C. nurses’ union in calling for the renewal of a 2013 bill intended to mandate nurse ratios at the District’s hospitals.

NNU and the local union argue that understaffing in D.C. hospitals puts patients’ lives at risk, citing 215 separate occurrences when patients were “endangered” because of nurse staffing levels. One example describe a labor and delivery unit in which three nurses of a shift of ten were left to care for ten women in labor when five nurses were pulled away for two C-sections and a hemorrhaging patient.

The original bill would establish a minimum ratio of nurses to patients on every shift at every District hospital. Facilities in noncompliance would face a $25,000 daily fine; required overtime and averaged ratios would be banned.

While some Council members support the legislation, which mirrors legislation enacted in California ten years ago, hospitals argue that the bill fails to consider the unpredictability of staffing needs and unnecessarily raises their cost of labor.

Increased labor costs can slow down hospitals’ payments to their vendors. If slow hospital payments threaten your healthcare company’s cash flow, PRN Funding’s healthcare factoring programs can help. Contact us today to learn how healthcare factoring for your specialty can help you thrive.

Medicaid Expansion Reduces Uninsured Hospital Visits

States that chose to expand their Medicaid services under the Affordable Care Act are seeing significant reductions in uninsured hospital visits.

A review of publicly traded hospitals’ earnings calls by The Washington Post shows that uninsured (self-pay) hospital visits dropped between 28 and 33 percent at some of the largest hospital systems in the country in states that took advantage of the federally-funded Medicaid expansion. At the same time, Medicaid admissions increased anywhere from 4 to 22 percent at those same facilities.

The story is less encouraging in the 24 states that refused Medicaid expansion. Non-expansion states saw upticks in both self-pay ER visits and uninsured admissions, and some actually had decreased Medicaid admissions. Hospitals have pushed for Medicaid expansion, arguing that even Medicaid’s lower reimbursement rates are better than what they (often do not) collect from uninsured patients.

Many states have also dragged their feet in preparing for the ACA’s broader implementation of presumptive eligibility, a system by which hospitals can preemptively enroll families with qualifying income in a Medicaid program to provide them care up-front. The state Medicaid agency then processes the complete application, putting many otherwise uninsured families on the path to coverage.

There are troubling financing implications for the uneven expansion of Medicaid around the country. The increase of self-pay patients in non-expansion states increases the amount of potentially uncollectible funds owed to those hospital systems and facilities, which also raises the risk to a healthcare factoring company.

Factors collect from insurance, Medicaid, and Medicare, but not from individual patients; therefore, more self-pay accounts reduce the number of valid invoices that a hospital can factor to offset the gap in federal reimbursements. If the above numbers continue their current trajectories, there is a very real possibility that healthcare factoring companies may tighten their requirements for working with clients in non-expansion states – or decline to work with them altogether.

We will continue to provide updates on Medicaid expansion and its impact on facilities in both expanded and non-expanded states.

PRN Funding offers healthcare factoring services to vendors providing a variety of healthcare services to hospitals and other healthcare facilities. Learn more about the different healthcare factoring options we provide and fill out our easy online application to begin.

ACA: Enrollment Passes 8 Million, Uninsured Rate Lowest Since 2008

The Obama administration announced last month that enrollments in the ACA exchanges topped eight million.

As of April 19, 8.019 million people had signed up for Obamacare plans – an impressive national average despite a large disparity between individual state enrollments. Some states missed their enrollment targets by a wide margin, while others more than doubled their goal.

In addition to marketplace policies, 4.8 million consumers enrolled in Medicaid plans in their states between October 1 and April 19, and nearly five million consumers purchased policies outside the exchanges. Altogether, the administration estimates that up to 18 million consumers have purchased new healthcare policies during the six-month enrollment period measured.

While some consumers may have been previously insured, a majority of marketplace users who requested subsidies self-reported that they did not have insurance when they applied. Further evidence is in the numbers: a Gallup poll reports that the uninsured rate by the end of the first quarter is down to 13.4 percent, the lowest level since the recession began in 2008 and down from 17.3 percent in January.

Health care executives presented preliminary payment information to the House Energy and Commerce oversight subcommittee last week that shows between 80 and 90 percent of new premiums are paid, well above the 67 percent reported by members of the same committee the week prior.

PRN Funding offers healthcare factoring solutions to help providers control costs – including health care. Learn more about our healthcare factoring services and apply for a free factoring quote today!

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Medicare Payments Concentrated in Few Specialties

Medicare’s 2012 payments to providers were largely concentrated in a few specialties, according to recent disclosures.

An analysis of federal physician billing data illustrates that 14 percent of disbursements went to the top one percent of physicians, with the bulk of payments concentrated in oncology and ophthalmology.

Without information about individual patient cases, though, physicians argue that the raw data lacks the necessary context to be applied effectively. Billing data was off-limits from 1979 until 2013 due to an injunction filed by the AMA for this reason, among others. Many physicians are also concerned that patient and physician privacy could be at risk now that billing data is available.

That oncology and ophthalmology top the list of highest-paid specialties is unsurprising given that Medicare patients aged 65 and older are their primary demographic. Much of the money paid out to ophthalmologists covered many common eye drugs that the physicians purchase up front and prescribe for little profit. On the other hand, last year CMS reduced payments for cataract surgery to reflect updates to the procedure.

Economists hope to use billing data to identify physicians who perform high-revenue procedures with little value to the patient in order to increase their billing. The greatest concern posed by the information as presented is the possibility that some seniors may go through unnecessary treatment simply for a higher paycheck. The AMA cautions that the data released do not illustrate the value of services provided, however.

PRN Funding is a leading provider of invoice factoring services to healthcare providers. To learn more about healthcare factoring, visit our Web site and fill out an easy online application.

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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.

PRN Funding has offered exceptional cash flow solutions to temporary nurse staffing agencies for more than a decade. To learn more about healthcare factoring for temporary nurse staffing and receive an application, contact us today!

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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