Dropping Spouses from Healthcare May Increase Employer Costs

The Employee Benefit Research Institute published a study in this month’s issue of their Notes that suggests that the employer trend of excluding spouses from health care coverage may cost them more in the long run.

As many as 15 percent of employers nationwide have already eliminated spousal coverage in cases where the previously-covered spouse has access to health care through his or her own employer. NPR reports that a continuing trend of such cuts may offset any short-term savings as their own employees lose spousal coverage picked up by other companies.

A simple example: Company A and Company B both offer spousal health care coverage. Company A currently covers Employee A and Spouse A, who works for Company B. Company B covers Employee B and Spouse B, who works for Company A. If both companies eliminate spousal coverage, Spouse A and Spouse B will return to their own company’s health care plan, which means that at the very least the companies have not saved any money.

Further, if the companies have traditionally subsidized a lower amount for spouses then each will face higher health care costs by covering two of their own employees.

Situation: Each Company Covers Spouses (cost to company)

Company A

Company B

Employee A: $5,000/year

Employee B: $5,000/year

Spouse A: $3,500/year

Spouse B: $3,500/year

Situation: Neither Company Covers Spouses (cost to company)

Company A

Company B

Employee A: $5,000/year

Employee B: $5,000/year

Spouse B: $5,000/year

Spouse A: $5,000/year

*The figures above are purely hypothetical and are only meant for illustrative purposes.

According to a weekend report in Forbes, meanwhile, more full-time employees are enrolling in employer-provided health care to take advantage of better coverage at lower costs than the plans provided on the health care exchanges. These new enrollees may also contribute to rising employer costs, even without an influx of employees who have lost coverage under their spouses’ plans.

Is your company prepared for rising healthcare costs? PRN Funding offers a variety of healthcare factoring programs that can give your company the immediate cash to meet those costs as they occur. Learn more about our healthcare factoring services and contact us today to get started.

Does Medicaid Expansion Increase ER Visits?

A study of Oregon’s 2008 Medicaid expansion has been touted as a huge blow to President Obama’s claims that Medicaid expansion through the ACA would reduce ER visits, but a parallel study of California’s 2010 Low-Income Health Program suggests that the situation is not so simple.

Medicaid expansion

Oregon: Medicaid expansion drives up costs

The Oregon study, published in Science by economists Amy Finkelstein of MIT and Kate Baicker of Harvard, measured emergency room visits of more than 20,000 residents living in the Portland area – one group of patients without insurance, and one group newly enrolled in Medicaid. Researchers determined that the Medicaid patients visited emergency rooms 1.4 times over 18 months, while the uninsured group visited 1.02 times in the same period. They further determined that nearly half of the increased visits were for complaints that could have been treated by a primary care physician (PCP), or were for emergency complaints that could have been prevented by PCP care.

Overall, ER spending in the Oregon study was estimated to have increased by $120 per covered patient. The researchers attribute this to a structural flaw in Medicaid’s design that reduces cost-sharing for covered patients to zero or near-zero, encouraging more unnecessary visits and raising state spending for Medicaid claims. State governments have responded by drastically reducing their reimbursements to medical providers, and PCPs have further responded by turning away new Medicaid patients.

Their conclusion is that Medicaid patients are more likely to visit the ER than to search for a PCP who will accept them, which then raises the cost of care even more.

San Diego: ER visits appear to be falling – with patient education

However, Paul Sisson of the San Diego Union-Tribune reported yesterday that a similar expansion of California’s Medicaid programs in 2010 has resulted in a two percent decrease of emergency room visits from July 2011 to September 2012. Nearly 50,000 San Diego-area residents enrolled in California’s Low-Income Health Program from mid-2011 to the end of 2013. There is only about a year of available data, and ER administrators have not noted significant changes in visits, but the results thus far are encouraging to doctors and health care researchers in the state.

A key difference between San Diego’s program and Portland’s is the access enrolled patients have to PCPs. In San Diego, new patients in the LIHP were counseled about their healthcare options and connected to a local PCP with whom they had a preliminary visit. These visits were designed to build a relationship so the patient would visit their doctor instead of the emergency room in the event of an illness.

In addition, county employees reached out to the community clinics where they sent their patients to make sure they were able to make same-day appointments. The UCLA Center for Health Policy Research studied ER use by LHIP participants and noted that their ER visits decline as they become accustomed to having insurance.

In Oregon, on the other hand, there is no record of patient education to suggest that patients knew about or had access to alternative healthcare options. As stated by UCLA Center for Health Policy Research director Gerald Kominski,

That behavior of seeking primary care in the ER has been reinforced for a period of years,
and it doesn’t change immediately just because you give somebody an insurance card.

Long-term effects of Medicaid expansion remain to be seen (as do short-term effects in states that have just implemented their own expansions), but these two contrasting studies make a compelling argument that patient education is necessary to fully reap the potential benefits of expanded low-income insurance programs.

Is your cash flow suffering because of slow hospital payments? PRN Funding’s healthcare factoring programs can help you close the cash flow gap and keep your business running smoothly. Learn more about invoice factoring with PRN Funding and contact us today to get started.

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Merry Christmas, Happy Holidays!

merry christmas

As we prepare to observe Christmas celebrations with our loved ones, we at PRN Funding want to wish you a joyful and prosperous holiday season – whatever your holiday.

We give special thanks to the nurses, EMTs, and other healthcare staff who will work through some or all of the holiday to keep others safe and healthy. May the hours move quickly so you can be home with family and friends.

Take the time to reevaluate your company’s goals for 2014, to form new ideas and get rid of old ideas that are not working for you. Make a plan to pursue even greater success, or to overcome the greatest challenge facing your company today.

Finally, regardless of your company’s position, consider gifting yourself with peace of mind from money concerns. PRN Funding is here to help you beat your cash flow woes with a flexible healthcare factoring program perfect for a variety of services and industries. Of the gifts under your company tree, factoring is the gift that will deliver continued success year-round.

Merry Christmas, and Happy Holidays!

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ACA: Consumers Face “Sticker Shock” with New Healthcare Plans

Consumers signing up for new ACA-compliant healthcare plans may choose a lower-tier plan to save money, but the decision comes at a high price – that is, increased deductibles and other out-of-pocket costs.

As previously reported, available plans fall into one of five cost categories that feature increasing premiums but offer decreasing deductibles in exchange. Premiums for all plans are higher than 2013 premiums, but individuals who earn up to four times the national poverty level can qualify for tax credits to offset their premiums.

Consumers who purchase at least a silver plan and who earn up to 2.5 times the poverty level can apply for additional credits to offset deductible and out-of-pocket costs, further relieving the burden of care. However, consumers who cannot receive the extra assistance may bet on their own health and choose a more affordable monthly payment over better coverage.

Higher deductibles could create scenarios in which patients forego needed care to avoid a hefty bill, which runs contrary to the purpose of the ACA, or they receive care and are later unable to pay the bill which contributes to hospitals’ bad debt.

Despite the unpleasant news, the ACA also caps annual out-of-pocket expenses (including co-pays) for an individual at $6,350 – a large number, but significantly lower than past plans that may not have capped expenses at all. This may ameliorate some of consumers’ sticker shock, particularly for patients whose cost of care quickly exceeds that threshold due to serious injuries or chronic conditions. Also, well check visits and prescriptions are covered at varying levels as minimum essential benefits and are deductible-free in some cases.

The best advice for individuals still shopping for the right health care plan is to consider not only the up-front cost of a monthly premium, but also the real cost of using the plan should the need arise.

Medical receivable factoring can help facilities preparing for the potential financial impact of higher patient deductibles. Contact PRN Funding to learn more.

Can Obamacare Help Physician Shortages?

As more Americans opt for health insurance under Obamacare, a scarcity in primary-care physicians may be prevalent. According to recent research, the new healthcare initiative introduces primary care models that may actually alleviate physician shortages. As a result, the shortage of physicians could be eliminated through the use of nurse practitioners and physician assistants.

Recently, researchers at RAND Corporation said that by increasing the number of patient-centered medical homes and health centers managed by nurses, the number of shortages among primary-care physicians could drop by 50 percent or more in the U.S. by 2025. Many of the new primary care models enacted by the Affordable Care Act call for increased interactions between nurse practitioners, physician assistants and their patients, ensuring that they are taking medications regularly, eating well, and abiding by their doctor’s orders.

With the introduction of accountable care programs and organizations, hospitals and health systems are adding several new nurse practitioners to their staff in order to ensure efficient operations. While several health plans are linking to ACOs, these organizations are rewarding healthcare providers for working as a team to help manage costs and provide quality care. Additionally, by grouping all medical care providers together under a single entity, nurses and other caregivers are used to help control care for several patients.

As a result, if the ACOs obtain better results, providers within the organizations will divide up the profits saved with the health plans. Several private health insurance companies, including Aetna, Cigna, Wellpoint, UnitedHealth Group and Humana are connecting with ACOs and patient-centered medical homes. In addition to these efforts, many large drugstores across the country, including Walgreens and CVS, are connecting with medical care providers to help manage patient treatment plans with both nurse practitioners and pharmacists in their clinics.

Although Obamacare may help alleviate physician shortages, physicians must continue to manage their finances effectively in order to ensure the success of their practice. Physician factoring can be the key to increasing your cash flow. Thanks to same-day funding and immediate cash advances, physicians can easily take care of increased overhead costs resulting from the recession. Instead of waiting for payments from private insurers, doctors can accelerate their cash flow by taking advantage of physician factoring services. Learn more about medical factoring for private practice physicians by requesting a quote online today.

Hospitals Taking Steps to Avoid Patient Falls

For weak and elderly hospital patients, a fall while in the hospital can extend a hospital stay or, in some cases, cost a patient his life. Hospitals nationwide are responding to this glaring safety concern with a blended approach between technology and human care.

To reduce the number of falls, deemed “never events” (as in, they should never happen in the hospital), many hospitals are relying on high-pitched bed alarms to alert nursing staff when a patient is up from their bed. The alarms use weight-sensitive pads in a bed or chair that emit a noticeable alert when they detect a decrease in pressure.

A study led by Ron Shorr at the University of Florida late last year, however, demonstrates that reliance on bed alarms is simply not enough to reduce the number of falls in a hospital. In a blind comparison of 16 hospital units in which eight units used bed alarms and eight units relied on standard care, there was more than one fall fewer per 1,000 patients in the units relying on standard care procedures. The results are not significant enough to blame bed alarms for more falls, but do call into question the contention that they result in fewer falls.

Nurses cite understaffing as a larger concern that results in other hospital risks. They argue that there is no replacement for capable nurse care. After all, an alarm is only effective if there is a nurse to respond, and hospitals that have increased their staff and provided comprehensive safety training have drastically reduced the number of falls they experience without the added technology.

Nurse staffing agencies are uniquely poised to help hospitals add vital staff to their units, but many may find it difficult to thrive when waiting on extended payments. PRN Funding’s nurse staffing factoring program converts your open invoices to immediate cash that you can use to hire nurses, pay your expenses, and pursue lucrative new contracts with hospitals in need.

Learn more about nurse staffing factoring with PRN Funding, and contact us today to get started.

ACA Changes Mental Health Treatment

Mental health is a critical but oft-ignored component of health care. Patients in need of mental health treatment face the double blow of social stigma and lack of insurance coverage, making effective treatment an unaffordable option. Provisions of the Affordable Care Act will make mental health treatment more accessible than before, with the potential to completely overhaul the current mental health system.

Insurers have traditionally excluded mental health coverage from their health plans, citing mental issues as a pre-existing condition. With costs as high as $150 or more for a single office visit – not counting costly prescription medication – many more patients are forced to go without care in lieu of paying those costs out of pocket.

The ACA, however, includes mental health in its list of ten Essential Health Benefits and will require insurers to offer coverage on par with other medical and surgical benefits. This will not only benefit millions of uninsured Americans with mental health concerns, but also the many insured Americans whose policies do not currently provide equal mental health coverage.

Mental health providers will face a number of challenges in January when the ACA is fully implemented. One major challenge, of course, is the ratio of available providers to the estimated number of newly enrolled patients they will see. A care gap may persist as providers scramble to provide services to as many as possible.

In addition, the inclusion of insurers as payers for mental health care adds a level of complexity to providing care that will drive many solo practitioners into group practices. Solo therapists who collect cash are able to charge higher fees and often save costs associated with billing software and office space, choosing instead to work out of their homes. However, accepting insurance will require them to get up to speed with medical billing and coding and to accept lower fees per session as part of their agreement with insurers.

A larger practice offers cost-sharing benefits in which many professionals can go in together for expensive software and real estate, though working with insurance companies can take away from the autonomy that many therapists currently enjoy. Another possibility, however, is joining a traditional medical practice to create an integrated approach to healthcare. Having a mental health professional in a group practice gives general health providers another diagnostic option that will allow them to provide better – and less costly – care.

Mental health providers considering a shift in their practice can ease the burden of insurance collections with medical receivables factoring. Factoring allows you to turn your claims into immediate cash that you can invest in the necessary software, real estate, and logistics to continue providing quality treatment to your patients. PRN Funding can get you started in a medical receivables factoring program that fits your needs – contact us today to learn more.

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Healthcare Providers Can Improve Patient Engagement

Due to changing rules regarding patient readmission and health technology under the Affordable Care Act, many healthcare providers are exploring their options for improving the quality of patient engagement at all levels of the health care experience. What they’ve found is that attitude is as important as innovation to achieving truly effective engagement.

Technology is rapidly becoming a key component of healthcare management. In addition to portable medical devices that reduce the amount of time patients spend in healthcare facilities, electronic health records and patient portals are streamlining a wealth of information that providers use to diagnose, treat, and follow up on patient concerns.

Improving Patient Engagement

When used properly these latter developments are critical to promoting patient engagement. Patients who are able to not only access their health records but also contribute to them in a digital dialogue gain the ability to notice trends of behavior and symptoms that they can then share with their healthcare provider. Likewise, the provider has a channel through which s/he can reach out to the patient for ongoing care – quite the reverse of the current state of healthcare, the only industry in which the provider waits for the customer (patient) to reach out for service.

Despite the potential benefits, most health facilities continue to balk at the cost of running such a system when they cannot envision the benefits. Instead they settle for a basic patient portal that allows the patient to book appointments and pay bills but does not offer access to medical history or direct communication with the provider. Part of the reluctance stems from a failure to adopt new strategies at all levels of the organization.

Healthcare providers should look more closely at their engagement strategies, however. Improved patient engagement can result in higher rates of post-discharge compliance, which will then reduce the cost of readmissions for the same health concern. In addition, giving patients the necessary tools to participate in their own care is an overwhelming show of empathy for the difficulty of the care process. Patients will have the ability to manage ongoing conditions without constantly needing to travel to the hospital for treatment.

The technology in question is already in various stages of development, but healthcare providers looking to use it in their own organizations must address patient engagement in every area. Boards of directors must actively invest resources into adopting new technologies and solicit feedback from every stakeholder – staff, patients, and outside caregivers – to assimilate all perspectives into a comprehensive engagement strategy. Finally, support must continue beyond the initial implementation and include assistance to patients and regular reporting of results.

Improving patient engagement can lead to exponential leaps in positive patient results, and is a worthwhile goal for healthcare providers. Medical receivable factoring can alleviate the cost concern by providing your facility with the cash flow you need to create and execute a viable engagement plan. Learn more about PRN Funding’s healthcare factoring program and get started today.

Obamacare Costs Result in Sticker Shock for Some Americans

As a result of the advent of Obamacare, many Americans were filled with high hopes that they would encounter more affordable health insurance rates. However, for some, optimism quickly diminished after discovering the healthcare coverage options under Obamacare..

A small business owner in California recently found out that she earned a bit too much to be considered for federal subsidies, which would help with her purchase to participate in Covered California, the state’s new healthcare exchange. Furthermore, her current rates have shot up almost 10 percent, due to the fact that policies are required to undergo an upgrade in accordance with the new law.

This small business owner is among many other Americans who currently purchase coverage on their own terms, but will now be forced to find new coverage as a result of their current policies being rendered outdated by the health law. Consequently, millions of Americans are finding that the new plans offered through the Affordable Care Act are not exactly affordable.

Covered California was created to aid more than 5 million Californians who were uninsured or purchased healthcare on their own terms. However, although federal tax credits are readily available to help reduce coverage costs incurred in the new healthcare marketplace, more than half of the consumers served by the initiative won’t even qualify for coverage.

Lastly, individuals enrolled under Covered California may see an increase in the cost of premiums. This would be due to two influential factors: a prohibition enacted on denying coverage to people with pre-existing medical conditions beginning Jan. 1, and the new requirement for policies sold next year to cover a minimum number of benefits.

ACA: Healthcare Coverage in the Online Marketplace

Now that federal and state online healthcare exchanges are live, questions are swirling about the available coverage for eligible consumers. How much will it cost? What will it cover? What if I don’t sign up?

The marketplaces will vary from state to state, even those run by the federal government at healthcare.gov. Variations include plan availability and pricing, Medicaid eligibility, and how the exchange itself is run.

However, there are consistent policies that will apply to consumers in all fifty states and the District of Columbia:

  • All plans will cover, at a minimum, ten benefits defined by the ACA as “essential.”
  • Five levels of coverage will be available with sliding price scales, from Catastrophic (only the most basic disaster coverage) to Platinum (plan pays 90 percent of costs)
  • No plan’s availability or price can be affected by pre-existing conditions
  • If you are not otherwise exempt, you will face an increasing annual fine for not having insurance…
  • BUT you may be eligible for tax credits or rebates to lower premiums and out-of-pocket costs, in some states by as much as half

Young people will absorb higher premiums than are currently available in every state on the federal exchange, though this goes hand-in-hand with the more comprehensive plans that will replace currently available coverage. In addition, older and sicker consumers who purchase coverage through the marketplace will benefit from lower premiums that are unaffected by pre-existing conditions or a dodgy medical history, as noted above. In all, healthcare pricing will depend on where you live, your age, and current tobacco use.

Tax subsidies for purchasing insurance are dependent on household income and the availability and cost of qualifying employer-provided insurance.

PRN Funding can help small to mid-sized healthcare vendors who do not qualify for tax subsidies to purchase insurance through their state’s marketplace. Healthcare factoring gives vendors immediate access to cash through the sale of their receivables, which they can then use to cover premiums and other expenses. Read more about PRN Funding’s factoring services.