Medicare Payment Overhaul is in the Works

The Obama Administration recently announced a rapid reconstruction of the American Medicare system by the year 2018. The president intends to change the way that the enormous Medicare program makes payments to hospitals and physicians, shifting away from a “fee-for-service” system, which simply encourages to see a large volume of patients rather than deliver each one the best possible care.

According to the LA Times, Medicare will start making 30% of its direct payments to hospitals and doctors through alternative payment models. These models offer a rewards system to doctors and hospitals that provide care to patients under budget while simultaneously delivering excellent care to the patients. The overall goal of this transition is to transform the American healthcare system into a quality-based institution. The LA Times also reports that such a change to the Medicare system is paramount, as finding an efficient way to pay for healthcare will become more and more important as the baby boomer generation starts to retire.

In 2014, only 20% of Medicare spending (about $72 billion, according to Kaiser Health News) was done through alternative payment models. The shift to 30% will raise the total sum to about $113 billion. On January 26th, U.S. Secretary of Health and Human Services Sylvia M. Burwell wrote an article in the New England Journal of Medicine in which she announced that by 2018, she hopes to have 50% of all Medicare payments done through alternative payment models.

The ramifications of this plan are already being felt throughout the private sector of the healthcare industry, as commercial insurers and prominent employers have begun to invest in new payment models, the LA Times reports.

Most influential figures in the healthcare world have heralded this as a progressive and necessary step. Ensuring that the Medicare system spends its money wisely is remarkably important, as this year it is estimated that the program will spend over $600 billion to insure nearly 50 million different disabled and retired Americans. Kaiser Health News reports that with these aforementioned changes implemented, 90% of all Medicare spending will be linked to quality of care in some regard.

EMR Updates Make Tracking Health Risks Easier

In the wake of the Ebola situation in the United States, vendors of electronic medical record (EMR) technology are making improvements to how their systems identify and flag patients who may be suffering from a serious disease. These updates will allow practitioners to respond more quickly to outbreak scenarios.

Hospital administrators laud the change as a way to overcome the information decay caused by shift changes by keeping every fact about a case in the system. EMR advances include notifications about potential issues, such as an “Ebola” notification for a West African patient experiencing flu-like symptoms, and more targeted questions to establish a patient’s more recent travel and living history.

Healthcare technology developers are continuously working on new ways to collect and use patient information in EMR systems through applications and better data collection. Though doctors complain that the systems are still difficult to navigate, developers maintain that doctors are equally critical to the effective use of an EMR system.

EMR development is an important positive outcome of the Ebola situation and will hopefully prompt vendors to make their systems even more responsive to future outbreaks of infectious disease.

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Single Gene May Reduce Breast Cancer Risk by 80 Percent

Breast cancer is the most prevalent form of the disease to affect women. Fortunately, new genetic research may provide a better way to identify those at risk before a diagnosis.

Researchers have identified a genetic variant that results in less dense breast tissue, eliminating one of the key risk factors associated with breast cancer. The gene is present in women of Hispanic descent in varying proportions based on their ancestry.

Women whose genetic code shows the variant in question are between 40 and 80 percent less likely to contract breast cancer in their lifetime, depending on whether they inherited the code from one or both sides of their family.

While non-Hispanic women are less likely to benefit from the gene, the confirmation of this research could help doctors target screening and prevention measures more effectively toward women based on their respective level of risk. In addition, further research will lend insight into how the genetic variant actually protects carriers – ideally, a finding that doctors could then replicate in future preventive treatments.

Regardless of ethnic heritage, all women are encouraged to follow a recommended screening schedule including self-tests and mammograms. The National Cancer Institute has identified a list of risk factors as well as a risk assessment tool that women over 35 can use to estimate their risk of contracting breast cancer. (The online tool should not take the place of an exam by a licensed physician.)

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New CVS Prescription Plan Benefits Tobacco-Free Companies – Like CVS

CVS Health made waves in the pharmacy industry earlier this year with their announced cessation of tobacco sales. Now, they are drawing fire over a prescription plan that features higher co-pays for prescriptions filled at tobacco-vending pharmacies.

The plan, which has already been adopted by the city of Philadelphia, would give patients a discount as high as $15 per prescription if patients fill them at pharmacies in the “smoke-free” network including CVS pharmacies, of course, but also some local pharmacies as well as retail giant Target Corp. Customers at larger rival chains such as Walgreens and Rite Aid, which have chosen not to end tobacco sales, would pay the higher out-of-pocket cost.

For some smaller pharmacies, the plan could jeopardize their sales even if they don’t sell tobacco products – without sufficient marketing to advertise their smoke-free status, customers may choose to visit a verified smoke-free pharmacy to avoid the risk of higher co-pays.

CVS Health’s vice president of corporate communications explained that the network developed at the request of Caremark clients, but that hasn’t stopped a backlash from independent pharmacy associations and concerns that CVS Health will be reducing competitiveness if customers are pushed toward using CVS pharmacies for their prescriptions.

It remains to be seen whether more clients will sign on to a smoke-free network, but CVS Health assures that those who do will be provided with a full list of smoke-free pharmacies that their plan members can visit.

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Unpredictability a Challenge in Healthcare Staffing

Healthcare is one of a few industries that never quit. Hospitals and nursing homes are open through weekends, holidays, weather catastrophes and emergencies, with shifts running 24/7. The need for constant staffing and a shift in priorities toward increasing profits has combined to create a staffing maelstrom in which unpredictability is the norm – sometimes, to the detriment of workers and patients.

In their new book Unequal Time, University of Massachusetts sociologists Dan Clawson and Naomi Gerstel break down the movement toward unpredictability as it affects different healthcare workers. Through interviews with multiple workers they determined that while most are experiencing greater unpredictability, the greatest impact is felt by nurses, nursing assistants, and other low-wage healthcare workers.

As mentioned above, the dueling priorities of constant staffing and showing profits lead many healthcare facilities to schedule the minimum possible number of staff for a given shift. When a nurse or aide becomes ill or is otherwise unable to come in, it creates a coverage gap that others must scramble to cover – there is no overlap of extra hands to help out.

Low-wage healthcare workers are often at a greater disadvantage. Demographically, nurses and nurse assistants are overwhelmingly female, with children, and may or may not have a support system in place to handle personal emergencies. Restrictive sick time and attendance policies force these workers to come in even when they are ill, as one of the subjects of Unequal Time shared with Clawson and Gerstel. It should go without saying that workers who come in while ill then put the patients in their care at greater risk.

While this book covered healthcare workers in a facility setting, home care workers often suffer from similar issues of unpredictability and low wages. However, beginning January 1, 2015 home care workers in most circumstances will be covered under federal and state labor laws governing minimum wage and overtime. (Workers can use the Department of Labor’s self-assessment to determine eligibility.)

Nurses and healthcare workers in some states are pushing for changes in staffing ratios, but healthcare staffing agencies can take a proactive approach with their workers by clearly communicating staffing schedules (and not changing them unless absolutely necessary) and implementing less stringent policies governing sick days.

Healthcare staffing agencies that need an additional boost in working capital to take care of their workers may find a solution in healthcare staffing factoring. Access immediate funding without taking on new debt, and invest in your workers with confidence. PRN Funding offers comprehensive healthcare staffing factoring programs to cover a variety of needs and situations – apply today to get started!

In Healthcare, Preparation is Key

In the midst of confusion and concern about the ongoing Ebola outbreak in the United States, the nation’s attention is focused on the practices and protocols of nurses and other healthcare workers who comprise the front line in patient care.

However, Ebola is merely a high-profile example of the risks that healthcare workers face every day. There is the obvious risk of infection from a blood-borne pathogen through contact with bodily fluids, as is the case with Ebola. However, there is also the potential for injury from biohazardous materials, chemicals, and drugs. According to the World Health Organization, unintentional contact with contaminated needles affects approximately six percent of the global health workforce each year resulting in nearly 100,000 new infections.

Even less serious day-to-day interactions can cause illness or injury to healthcare workers – heavy lifting, patient altercations, and the transmission of far more common airborne illnesses among them.

The healthcare industry can take an important lesson from their current battle against Ebola, including vendors that provide healthcare staffing services to hospitals. While vendors may not have a say in the protocols that their clients have in place, it is their responsibility to educate the nurses and other staff members they employ so policies and protocols can be followed properly. In addition, invest in continuing training to keep nurses at a heightened state of readiness should any serious situation occur.

Comprehensive nurse training and preparation will pay off greatly with fewer days missed, greater nurse confidence, and overall healthier and safer practices. If your nurse staffing agency needs a boost in working capital to invest in your workforce, PRN Funding’s nurse staffing factoring program can work for you. Contact PRN Funding today to apply for immediate funding through nurse staffing factoring.

ACA: Employer Deadline Approaching

While mid-size employers (those employing 50-99 full-time employees) have another year of breathing room, employers with 100 or more employees are quickly closing in on a large Affordable Care Act deadline.

The ACA’s Employer Shared Responsibility provision goes into effect on January 1, 2015 for large employers. By that date, those employers must offer a qualifying health insurance plan to at least 70 percent of their employees and dependents. A qualifying policy must:

  • Be affordable – cost less than 9.5 percent of an employee’s salary
  • Provide “minimum value” – cover the benefits considered by the ACA to be “minimum essential coverage”

The threshold for policy offerings rises to 95 percent of eligible employees in 2016.

Employers that do not offer a qualifying policy will be subject to fines: for non-coverage, they will owe $2,000 per full-time employee after the first 30. In addition, employers will be assessed a fine of $3,000 per full-time employee who qualifies for a subsidy on the healthcare marketplace. MI Health Answers offers a simple graphic to break down the Employer Shared Responsibility provision.

While consultants studying the implementation of the ACA estimate that most employers will eventually comply or do already, there are still many business owners nationwide who are weighing the costs of alternatives to providing qualifying policies. Options include cutting personnel and employee hours to remain exempt or paying applicable penalties.

Some employers fear that they will face penalties if their employees choose other, more affordable coverage; however, the benchmark for determining whether a policy qualifies as affordable is the law and not the actions of eligible employees.

Is your company facing the healthcare deadline, and are you prepared to offer the required coverage to your employees? If cost is keeping you from complying with the employer mandate, healthcare factoring can provide the necessary cash flow to cover the expense. PRN Funding has more than a decade of experience navigating the healthcare industry and can help you access the working capital you need to cover all of your employees. Visit us to learn more about healthcare factoring and apply today.

CMS Explores Consolidated Payment System

Over the last several years, CMS has worked with the Medicare Payment Advisory Committee to streamline payments for a number of patient services and procedures. Each group has proposed changes to Medicare billing that, if adopted, could streamline and reduce annual healthcare spending for the program.

The current payment system allows for differing payments for the same service depending on where and by whom it was performed. Hospital outpatient departments, for example, receive a higher payment than a physician’s office for the same procedure. However, differentials are also present when measuring payments received by the same physician for the same procedure based on how it was coded.

Several elements contribute to the billing differences that CMS and MedPAC hope to eliminate, including packaged versus separate payments; where providers choose to perform services (and patients choose to receive them); and different methods of weighing payments between different facilities.

Proposed changes include updates to this year’s physician fee schedule and limiting billing to either physician rates or hospital rates. The larger question this creates, however, is which system is the best to determine payment rates at all

A site-neutral payment program is slowly developing: beginning in 2016, long-term care hospital pay rates will shift to align with existing inpatient PPS rates. In the meantime, both CMS and MedPAC continue to identify inconsistencies in payments and potential solutions for them.

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Union Protections Extend to Minnesota Home Care

The Service Employees International Union (SEIU) will now extend its benefits to home-care workers in Minnesota.

Home-care workers voted last week by a 60-40 split to join the SEIU. Such workers, who largely care for their own relatives, are paid by Medicaid to provide non-medical assistance to elderly or disabled patients (including feeding, dressing, and driving them to complete errands). Under the SEIU, such workers will now have collective bargaining rights to campaign for higher wages and other benefits.

This vote makes Minnesota the latest in a series of states that have extended union privileges to home health workers, even as the union fights several cases challenging mandatory union dues for workers. It is also consistent with the announcement of FLSA extensions to existing minimum wage requirements made earlier this summer.

It remains to be seen whether home-care workers in other states will vote to unionize, and what impact that may have on home care agencies in those states. Regardless of the impact, PRN Funding’s home health care factoring programs can help agencies that struggle to meet rising operating costs. Visit PRN Funding to learn more about home health care factoring and to apply today.

CVS Health Tobacco Sales Go Up in Smoke Early

To reinforce its position as a health-focused company, CVS Caremark has pushed up its plan to cease tobacco sales at retail locations by a full month. Beginning today, tobacco products are no longer available at any CVS store. The company is also rebranding itself as CVS Health.

Reactions to the decision are mixed: research to be published today in Health Affairs suggests that tobacco sales bans in San Francisco and Boston retail pharmacies correlate to an approximately 13 percent drop in tobacco purchasers, and CVS Health’s chief medical officer estimates that a nationwide ban could reduce tobacco-related deaths by tens of thousands every year. Public health advocates also cheer the move.

On the other hand, other retail pharmacies are reluctant to jump on the “ban”dwagon and cite tobacco cessation products as the more effective tool against tobacco use. CVS Health is targeting tobacco use through expanded cessation services, which they will provide at their 7,000-plus retail locations.

CVS Health is also expanding its relationship with health care providers to increase the quality of care that patients can receive at existing and future CVS walk-in clinics.

The financial impact of ending tobacco sales remains to be seen, but CVS Health executives are confident that the decision will “position it as a broader provider of basic health services”.

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