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.

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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.

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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.

PRN Funding offers alternative financing solutions for healthcare vendors that need to tighten their cash flow in the wake of extended payments. Learn more about our various healthcare factoring programs, then contact us to receive an application and to get started immediately.

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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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ACA: The Cost of Non-Enrollment

With the March 31 enrollment deadline looming, the Obama administration is working overtime to encourage uninsured Americans to purchase coverage in state or federal marketplaces. Approximately 50 percent of uninsured consumers plan to remain uninsured for a number of reasons, raising the important question: what is the cost of not enrolling in a valid healthcare plan?

Required Coverage

ACA-compliant health insurance policies must meet the law’s requirements for minimum essential coverage, which includes all government-administered plans as well as new and grandfathered employer plans and coverage offered by universities. While other plans may also meet the minimum essential coverage standard, consumers who hold non-compliant policies will be subject to the same penalty as uninsured consumers. Vision and dental-only plans, workers’ compensation, and healthcare savings accounts do not qualify as compliant policies.

Most consumers are required to carry a compliant healthcare plan; however, the ACA provides a number of exemptions for consumers who are unable to afford a qualifying plan or who fit other criteria.

How does the penalty work?

The 2014 penalty for uninsured consumers is the greater of $95 per adult/$47.50 per child, up to $285 per family, or one percent of your family’s gross adjusted income above the tax return filing threshold. (If your income is not high enough to require a tax filing, you are exempt from the individual mandate.)

Despite the focus on the $95 flat fee, more consumers earn more than the $19,650 that matches the $95 fee and will be required to pay a higher amount. For example, a family earning $50,000 annually would have to pay $297, or one percent of their eligible AGI – $12 more than the flat fee maximum. Though penalties are capped at approximately $9,800, many families do not make enough to meet this cap and will be on the hook for their entire penalty.

Can I enroll after the March 31 deadline?

Your ability to enroll in the federal marketplace after the deadline depends on a number of conditions. Currently, consumers who have attempted to purchase a healthcare plan prior to March 31 will be granted a limited extension to complete their enrollment. Once extensions have ended, you must wait until the next open enrollment period unless you have a change in life situation that qualifies you to enroll.

If you signed up for a policy before March 31 that features a gap in coverage (i.e. does not start immediately), you will not have to pay the penalty. Also, if you are without insurance for less than three months after the deadline you will not have to pay the penalty. For periods longer than three months but less than a year, you will be responsible for each month’s portion of the annual penalty for as long as you are uninsured.

For questions about your specific healthcare needs and plans that are available, visit Healthcare.gov.

With Deadline Looming, ACA Enrollments Fall Short

One week from today marks the Affordable Care Act deadline for individual consumers to have an ACA-compliant policy from their employer or the online health marketplaces. Consumers who have not enrolled in coverage by March 31 will face a penalty on their taxes and will be prevented from signing up for subsidized healthcare until next year.

However, despite the time crunch only a quarter of Americans at this point had accessed the exchanges by January and many thousands of others are still uninformed about their responsibility to obtain coverage. Unfortunately, the majority of uninformed consumers are those who would benefit the most from tax credits and subsidies.

Misinformation is a major source of public reluctance to use the online health exchanges. The political debate over the Affordable Care Act is well-documented, and additional state laws governing the implementation of the individual mandate have further complicated the process.

The Obama administration is elbow-deep in a campaign to inform consumers and encourage them to apply for insurance. Volunteers are contacting households via phone banks, email, and door-to-door canvassing with pamphlets and applications. Canvassers hope that by educating consumers they will be able to dispel some of the myths surrounding the cost of health care plans and demonstrate the importance of having a compliant policy by next week’s deadline.

PRN Funding offers factoring services to cover expenses such as health insurance premiums for companies that work with hospitals and other medical facilities. To learn more about healthcare factoring, contact us today.

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Obamacare Enrollment Quickens Pace in March

Things didn’t look promising for the Affordable Care Act enrollment numbers in the beginning of March. Reports estimated that one sign up must be completed every 1.4 seconds in order to reach the enrollment goal of 6 million. As of March 1, 2014, sign-ups were sitting at 4.2 million. The enrollment period concludes March 31.

However, the pace is quickening. A rush of sign-ups occurred within the first two weeks of March bringing the enrollment numbers to over 5 million. If enrollment keeps up, the Obama administration may come close to 6 million within the first year. Before the ill-fated healthcare.gov rollout, the administration hoped to achieve 7 million sign-ups. The number has been adjusted to address the numerous technical issues.

The information on demographics has not been released. To keep consumer costs down, it’s imperative that a mix of young and old participate in the insurance marketplace. As of last month, it seemed as if only 25% of health insurance buyers fell into the 18-34 age range. Without the young and healthy, insurance premiums are anticipated to rise in 2015. Insurers and experts predict a variety of factors to raise premiums, including the administration’s decision to allow people to hold onto skimpy plans and other delays that accompanied the botched rollout.

31 Percent of Healthcare Facilities Plan to Increase Staffing

Preparing for a wave of newly insured patients thanks to the Affordable Care Act, a new report shows that 31 percent of health facilities are ready to increase their medical staffing.

Staff Care, a subsidiary of healthcare staffing company AMN Healthcare, conducted a survey that polled 230 managers of hospitals and medical practices in the U.S.

Over 16 percent said they plan to hire more nurse practitioners and physician assistants. Additionally, more than 7 percent said they would increase their temporary physician staffing to keep up with growing demand and an aging population. The demand for locum tenens physicians rose from 73% in 2012 to nearly 90% in 2013, showing a significant increase in temporary physician staffing. Demand is also quickly rising for locum tenens nurse practitioners and PA’s.

Data shows that healthcare facilities are moving away from traditional private practice models toward locum tenens staffing to maintain high quality patient care in spite of staffing shortages and increasing demand. This survey is one of many to highlight increasing employment opportunities for healthcare professionals and temporary healthcare staffing companies alike.

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