Bundled Payments May Be the Future of Hospital Billing

If you reside firmly in the 21st century you are likely very familiar with bundling. You can bundle your car insurance with your home and life insurance policies, your cable with internet and phone services – even your soda with your pizza. Hospital billing is picking up on the trend, and soon bundled hospital bills may become the norm.

Typical hospital billing involves individual charges for each element of a given stay or procedure, down to individual doses of ibuprofen. Provider services are billed separately. In a bundled billing plan, however, hospitals would consolidate these charges to a single fee for everything involved in a typical procedure.

Not only do bundled payments offer savings to patients, but they also provide an incentive to hospitals to provide efficient, high-quality care. Hospitals would keep the net funds remaining after a procedure completed under cost, but would be required to absorb any additional costs for extra care or complications.

Medicare is working with more than 300 health care organizations to provide bundled hospital payments for large-scale procedures such as heart surgeries, and other facilities are expected to follow. In the future bundled payments may include those for chronic conditions as well. Rob Lazerow of Advisory Board Co. points out bundled price tags can help hospitals “compete on cost and quality” for patients shopping around.

Hospitals that shift toward bundled payments will need to work with high-quality vendors to provide the best care to their patients. If you want to expand your healthcare company to work with these hospitals, PRN Funding’s healthcare factoring programs can provide the working capital you need to get everything in order. Contact PRN Funding to learn more about healthcare factoring in every sector and to get started today!

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.

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.