PRN Gives Thanks for Nurses

This Thanksgiving, we are thankful for the many nurses who serve their communities. Nurses work long shifts, often without a significant break, and their schedules may cross days, weekends, and holidays. They are tireless in their efforts to improve their patients’ experience while on the job.

Nurses are typically a patient’s first point of contact during a medical visit. They measure vitals and ask the necessary questions to set you up for the proper care. The nurse you encounter can set the tone for your entire visit.

Nurses must be calm under pressure. By the nature of their positions they spend more time with patients than any other medical professional, including in emergency and other potentially high-stress situations. A caring countenance can do much to soothe a patient and his family.

Nurses are your advocate with the physician. Doctors evaluate tests and observations to determine a diagnosis, but nurses are there to report your condition in the moment. They administer the medication that doctors order and speak out for or against procedures that are in your best interests.

When a woman is admitted to deliver a baby, for example, the labor and delivery nurse will take her birth plan and communicate it to the physician to make sure that patient has the best possible experience. The nurse will also, more importantly, communicate to the patient when deviations are necessary to preserve her wellness and that of her child.

Nurses provide peace of mind to patients and the concerned friends and relatives who accompany them. A nurse will sit down in the waiting room with anxious family and reassure them of the quality care their loved one is receiving. A nurse will bring an upbeat attitude into the room in order to lift a patient’s spirits, even if she has been on the floor for ten hours straight. That same nurse will also remove the complexity – and fright factor – from overly technical medical explanations.

Nurses are often companions to their patients, no matter the type of facility. The sight of one or two friendly, familiar faces throughout the day gives immeasurable comfort. This is especially true of nurses who care for our loved ones at the end of their lives.

Of course, not every nurse walks the halls of a hospital. Home care nurses spend hours a day traveling to their patients so they may convalesce in the comfort of their homes. Whether a patient is rehabilitating or receiving hospice care, these nurses allow them a measure of freedom and normality that they would otherwise lack. For many, it would not be possible to continue living at home without the help of a home care nurse.

The next time you encounter a nurse, whether you own a staffing agency or have a medical visit, don’t forget to thank them for all the work they do.

Happy Thanksgiving from PRN Funding!

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Younger Nurses Feel Positive About the Future of Nurse Employment

In a recovering economy, many older nurses are considering retirement or have plans to pursue another career. Although the job market still hasn’t full recovered, a recent survey shows that many younger nurses hold a positive outlook for their profession and plan on pursuing higher education in the field.

According to the 2013 Survey of Registered Nurses conducted by AMN Healthcare, nearly 190,000 nurses admitted that they were thinking about leaving nursing or retiring as the economy continues to improve. Additionally, one in four nurses age 55 and up said they would change their career paths entirely by searching for work in other industries.

When it comes to furthering education, less than half of the nurses who held an associate degree or diploma said they were planning to pursue higher education in the field of nursing. Conversely, younger nurses are more likely to be interested in additional education. The landmark Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, advises that 80 percent of nurses in the U.S. should hold a BSN or higher degree by the year 2020.

Although nurses among all age groups reported that they were highly satisfied with their profession, the survey found that younger nurses (19-39) held a more positive outlook than nurses 55 and older in regards to the current quality of nursing. Furthermore, 66 percent of nurses 55 and older believe that the quality of nursing care has declined.

As a result, a generational gap exists among nurses in regards to their overall perspective of their practice. The survey revealed that younger RNs often hold a positive opinion of the nurse supply. Regardless of shortages in the industry, nurses between the ages of 19-39 said they remain positive about the supply of nurses, and believe that they are capable of meeting the expectations brought on by the new healthcare initiative. Additionally, while 45 percent of younger nurses said the shortage has improved throughout the past five years, 41 percent of older RNs between the ages of 40-54 held the same belief.

The survey also measured nurses’ overall satisfaction with their current jobs. Among the respondents, 90 percent of nurses reported that they were happy with their careers, while 73 percent said they were satisfied with their current profession.

Peter McMenamin, healthcare economist and senior policy fellow for the American Nurses Association, said that this survey projects an optimistic future for nursing. Additionally, he said that the findings revealed from the survey are consistent with research conducted by the ANA.

The future of nurse staffing looks promising. Is your nurse staffing agency primed for growth? PRN Funding offers accounts receivable factoring programs designed exclusively for the nurse staffing industry. Cash flow can get tight during times of growth, but nurse staffing factoring provides a steady source of working capital to cover payroll and other expenses. Learn more about factoring for nurse staffing.


Hospital Fee Models Make Pay-for-Performance Problematic

Attempts by healthcare payers to incentivize quality care by providers are nothing new. However, a study on pay-for-performance programs, as they are called, indicates that the practice may not improve the quality of patient care to the intended extent.

Most hospitals currently operate pay-for-service models, in which providers receive a set amount for each service provided. This model tends to encourage quantity over quality and time-intensity over efficiency. Pay-for-performance, which Medicare has already implemented through its Hospital Readmissions Reduction Program, flips the traditional fee model on its head and reimburses facilities for “quality” treatment – or, in the case of the HRRP, penalizes hospitals that fail to meet established benchmarks for patient care.

There are several issues with pay-for-performance, from what to measure to the size of the incentive offered, and the model’s impact on hospitals’ performance is mixed.

What “performance” is measured?

Many payers in this model focus on measuring adherence to processes rather than patient outcomes. A facility may qualify for incentives because they follow procedure accurately, but that does not necessarily reflect added value. Providers will prioritize the care for which they will be rewarded, while showing no change or a negative change in other measures.

Measuring outcomes, meanwhile, can lead to an artificially inflated or deflated result because the care provided is only one element of patient outcomes. In addition, facilities working for certain outcomes may be risk averse to treating patients unlikely to see a positive outcome.

How should incentives work?

Andrew Ryan from Weill Cornell Medical School claims that in most pay-for-performance models, the incentives offered are insufficient to compel providers to improve their practices. On the other hand, increasing incentives may be cost-prohibitive to many facilities.

Either way, even the best pay-for-performance program may not motivate caregivers to improve their practices. One suggestion to overcome this obstacle is to leverage providers’ risk aversion by paying incentives up front, and requiring providers to pay back money for standards they fail to meet.

Is there a better way?

System-wide change to the payer-provider relationship may be a better path to higher quality care than tweaks to payer methods. Individual providers may lack the resources or motivation to attack systemic issues, but payers and providers can collaborate and cooperate with one another to address those problems together and build a system that provides the quality care that patients deserve without relying on financial incentives to do so.

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Concerns Linger About Lower Doctor Pay Through Health Exchanges

As millions of Americans are expected to purchase coverage through the new healthcare marketplace, several doctors are becoming increasingly concerned about their pay. With more patients opting for affordable coverage through the online exchanges, many physicians fear that they will be paid much less to provide care.

Some physicians have even voiced their concerns to various medical associations. These doctors explained that the discounted rates could cause a two-tiered system to develop, where fewer doctors would be willing to participate. As a result, consumers could have a harder time obtaining necessary care.

Nevertheless, insurers have been under plenty of pressure to make premiums more affordable for consumers. As a result, insurance officials have reduced the rates for some plans. Additionally, because plans usually are comprised of smaller networks, insurers believe that doctors will be compensated for pay decreases as more patients come to them for care. However, when it comes to providing care for current patients, many primary care physicians admit that they are already pressed for time.

A major reason for this conflict is that doctors aren’t always sure which plans they are listed under, or even how much payment they should expect to receive from patients covered under a certain plan. Additionally, some physicians are just starting to find out about the decreasing pay rates among particular plans sold through Obamacare’s online exchanges.

According to a senior executive at Blue Cross Blue Shield Association, a few of its 37 member organizations are already providing lower rates to doctors that belong to smaller exchange plan networks. However, the executive also said that an adequate amount of doctors are being enlisted within their plans, and that insurers are well aware that a good network of providers is necessary to retain patients.

Regardless, some doctors have a different opinion. Contracts established between insurers and physicians can vary, and some even permit insurers alone to alter rates of payment issued to doctors. Furthermore, insurers may enlist doctors into several different plans. As a result, several physicians are undecided as to whether or not they will participate in the new plans.

In a survey conducted by The Medical Society of the State of New York, more than 400 doctors were asked if they would participate in an insurer’s exchange plan. Among the respondents, 40 percent said that they would not participate, and one-third said they were unsure. Lastly, two-thirds admitted that they never received any type of reimbursement information.

7 Popular Medical Apps for Doctors

In an age driven by technology, many doctors are taking advantage of medical apps on their smartphones and tablets. Although many physicians expressed dissatisfaction with certain apps, medical app usage among medical practices remained fairly high among smartphone and tablet users.

On a daily basis, 51 percent of doctors used medical apps on their smartphones. Additionally, 30 percent of physicians accessed these apps on their tablets. Not only do medical apps help doctors save time, they also help doctors by speeding diagnosis, improving patient monitoring and reducing patient visits to a physician or hospital. Here are seven of the top medical apps for healthcare providers that are used on a regular basis.

Check out these 7 top medical apps for doctors:

Epocrates

As one of the leading medical apps, Epocrates allows doctors to access safety information and prescribing instructions for various drugs. In addition to offering drug coverage information, the app enables physicians to determine various calculations, ranging from BMI to GFR. Epocrates also provides doctors with instant access to medical news and research.

Medscape

As a branch of WebMD, this app provides physicians with safety information and prescribing instructions for drugs. Additionally, this medical app offers procedure videos, a medical calculator, and access to materials for continuing medical education.

MedCalc

This app is ideal for determining various medical calculations. MedCalc offers an extensive array of formulas, scales, scores and calculations for doctors.

Skyscape

Aside from providing doctors with access to journal article summaries, Skyscape serves as a helpful decision-making app. In addition to drug information, a medical calculator is readily available for doctors’ use.

Doximity

This networking app helps physicians connect with one another. Doximity is fully equipped with HIPAA- compliant faxing, text messaging, and emailing capabilities to help streamline communications.

ResolutionMD

Doctors can access X-rays and other images via their smartphone or tablet by using this FDA-cleared app. Physicians have reported that this app is useful for providing instant viewing access for images, regardless of where the doctor is located.  ResolutionMD has all the tools necessary for a diagnosis, including 2D, MIP/MPR, 3D and interactive collaboration.

Alivecor

This medical app doubles as a portable heart monitor and runs on a patient’s smartphone to produce electrocardiograms. The monitor’s sensors use the patient’s finger to produce the EKG over the smartphone/tablet. Patients reap huge benefits from Alivecor, since it works to reassure them that their heart health is in order.

Image courtesy of Anusorn P Nachol / FreeDigitalPhotos.Net
Image courtesy of Anusorn P Nachol / FreeDigitalPhotos.Net

brings together all of the viewing tools needed to make a diagnosis including 2D, MIP/MPR, 3D and interactive collaboration. – See more at: http://www.calgaryscientific.com/resolutionmd/mobile-resmd/#sthash.M1YdakyP.dpuf
brings together all of the viewing tools needed to make a diagnosis including 2D, MIP/MPR, 3D and interactive collaboration. – See more at: http://www.calgaryscientific.com/resolutionmd/mobile-resmd/#sthash.M1YdakyP.dpuf

Obama: Individuals May Keep Cancelled Insurance Policies for Now

Obamacare established new standards for health insurance coverage in the U.S. As a result, millions of Americans were presented with policy cancellation notices, forcing many people to drop their current coverage and opt for a new health insurance plan. In order to help alleviate this troublesome situation, the president made an announcement yesterday that his administration would not enforce the Obamacare provisions that led to policy cancellations throughout the country.

Therefore, individuals who were in favor of their current coverage plans may be able to keep them for another year. However, once midterm elections are complete, plans that are not in accordance with the new healthcare law will get canceled again.

The new transitional policy introduced by the administration will enable people who were happy with their insurance to remain on their current plans, as long as their policies were effective on Oct. 1 of this year. Furthermore, another stipulation for this newly-enacted policy is that insurers provide free advertisements for their competitors on Obamacare’s online exchanges.

Aside from the 25 million Americans who opt for their own coverage through the individual market, several employees covered by employer-based insurance will also encounter cancellations. Currently, 156 million people obtain healthcare through their employers.

In addition to this particular provision, there are many other  aspects  of Obamacare that will not be enforced yet, such as postponing the employer mandate for a year. These and other unilateral actions are being announced by the White House, since the administration wants to avoid the potential for Congress to pass legislative amendments to the new healthcare law.

In order for this cancellation fix to actually work, insurers must find some way to rush their old products into the marketplace by January 2014. This will be extremely difficult for insurers to pull off. Since new reimbursement rates for 2014 would have to be negotiated with doctors and hospitals, insurers would have to submit these plans to state insurance regulators in order to obtain approval.

Despite the proposed cancelation fix, a new Gallup poll released this week revealed an increase in disapproval rates for the Affordable Care Act, rising from 47 percent to a high of 55 percent. Additionally, the president’s overall approval ratings have fallen between the high 30s and 40s.

Even with the change, the administration is leaving it up to each individual state to determine whether or not residents can keep coverage plans that are not in accordance with the new healthcare initiative. As a result, state insurance commissioners, along with other health policy experts, have established the fact that insurance plans will greatly vary across the country.

Long Shifts Impact Nurse Health and Lower Patient Satisfaction

Working long hours at a hospital can have a negative impact on both patients and nurses. Aside from lowering patient satisfaction levels, prolonged hospital shifts can also take a toll on nurses’ overall health. In addition to these impacts, 12-hour nursing shifts increase the potential for medical mishaps, and are linked to higher burnout rates among nurses

In order to be productive and perform at their best, nurses must remain healthy and alert. However, nurses who work prolonged shifts often report that they feel fatigued, which ultimately results in patient dissatisfaction. Even though there are no policies in place regulating nurse shifts in the U.S., hospital scheduling software can help healthcare administrators avoid the negative effects of prolonged shifts on nurse health.

A recent study published by the British Medical Journal’s Occupational and Environmental Medicine revealed that nurses who work prolonged shifts are at a greater risk for developing breast cancer than their colleagues who take on shorter shifts. Additionally, according to Scrubs magazine, the correlation between prolonged hospital shifts and breast cancer is caused by disruptions to internal body mechanisms, which are responsible for maintaining a person’s health.

Aside from cancer risk, nurses who endure prolonged hospital shifts are also at risk for other types of diseases. According to Scrubs, many reports have found that healthcare employees who work night shifts or longer hours are at a higher risk for developing diabetes and prostate cancer. Other potential health issues reported included sleep deprivation, burnout and emotional fatigue.

Lastly, in a study conducted by MedScape, research revealed that longer shift lengths were directly linked to both patient and nurse dissatisfaction. Nurses who worked 10 or more hours were at a greater risk of being burned out and unhappy with their profession. Furthermore, nurses’ well-being was also correlated with patient experiences. The study showed that longer hospital shifts resulted in undesirable outcomes for both patients and nurses.

Major Hospitals Opt Out of Obamacare

Will health care reform impact your doctor choices?

As many Americans continue to sign up for Obamacare, they may be in for a big surprise, especially if they hope to receive premium care from one of the nation’s top hospitals. Unlike coverage obtained from their previous personal policies, many consumers are realizing that their current doctors and hospitals may not be covered.

Although the new health reforms enacted by the White House have resulted in more affordable health coverage for many Americans, this trend has only impacted the overall price of insurance. However, when it comes to the caps placed on premiums through Obamacare, several insurers will offer a lot less cash for services provided by top-grade doctors and hospitals. While thousands of policies with varying levels of coverage exist,  many policies cover a much smaller network of doctors and hospitals.

Recently, Watchdog.org contacted the top 18 hospitals across the country, as determined by U.S. News and World Report for 2013-2014. The investigation was conducted to learn more about the hospitals’ established contracts. Additionally, several insurance companies were also contacted. Based on the findings, Watchdog.org concluded that several top hospitals are opting out of Obamacare.

Nevertheless, many individual health plans purchased outside of Obamacare were likely to enable patients to receive care from these top-tier facilities. For instance, Cleveland Clinic accepts numerous health plans purchased within the individual marketplace. However, once an individual opts to buy coverage through Obamacare, the only way they can receive care from the Cleveland Clinic is by electing insurance through Medical Mutual of Ohio.

It’s not just Cleveland Clinic. CNN reports that NYU, UCLA and Emory academic medical centers have all limited the number of plans they will accept. Since academic medical centers often see tougher cases, they tend to be more costly.

In spite of this limitation, there are plenty of coverage options available through the state exchanges. In Ohio and California, there are a plethora of insurance companies within the online marketplace. However, two of the top-grade hospitals in these states (Cleveland Clinic and Cedars-Sinai Medical Center) only accept coverage from one company in their network.

Several state exchanges don’t provide a list of their insurers on their websites. For California and other states that do offer this information to consumers, names of doctors or hospitals are unavailable. Although it’s yet to see how well they will play out, health care reform law provisions have been established requiring an adequate number of providers in each  insurance network. It’s likely that more providers will opt in once the marketplaces have been around a bit longer.

Health Coverage under Obamacare May Prove Costly to Individual Buyers

With the introduction of new healthcare reforms enacted by the Affordable Care Act, many Americans covered by health insurance in the individual marketplace will be forced to enroll in new coverage plans. People will be required to opt for new insurance since many of these plans are not in accordance with newly established standards set by the new healthcare law. As a result, many insurers will be forced to either tack on benefits, or cancel policies altogether.

The new offerings are associated with higher rates for individual buyers, since coverage is more comprehensive and must be available to individuals affected by pre-existing conditions. Nevertheless, several insurers have managed to maintain lower rates by providing plans with higher deductibles and minimal benefits. Additionally, these insurers could be pickier in the approval process by only selecting the healthiest applicants.

As more and more people have been receiving policy cancellation notices paired with new offerings provided by their insurer for 2014, the sticker shock has brought on increased feelings of aggravation among those impacted. Many are unhappy with the options offered in the  marketplace. Some face climbing premiums and costly increases in deductibles. Some report their current deductibles of $1,500 are expected to rise to $5,000 under Obamacare for similar policies.  It isn’t just deductibles, visits to the doctor and prescriptions are also subject to increase.

Nevertheless, a small number of existing plans will become grandfathered. In order to obtain this status, two qualifying factors must be met. First, members must have been enrolled in these policies before the passage of the ACA back in March 2010. Additionally, no significant policy changes should have been made to the plans until now, ranging from alterations in co-pays and deductibles to coverage costs.

Currently, Blue Cross Blue Shield is one of the major healthcare providers within the individual insurance marketplace, as well as the exchanges. Kim Holland, the trade group’s executive director of state affairs, said that the majority of existing individual plans offered by Blue Cross will soon be altered or discontinued. As a result, some customers will be forced to enroll in new coverage plans.

Although customers may receive letters indicating significant increases in premiums, they won’t exactly know what to expect in regards to payments until they actually explore the exchange. Generally, if an individual brings in less than $46,000 a year or $94,200 for a family of four, federal subsidies will be available to decrease monthly expenses.

Online Health Exchanges Will Take a Month to Fix

After a laundry list of glitches have made it difficult – if not impossible – for consumers to use the online health exchanges, the Obama administration has announced a repair timetable that will have the sites fully operational by the end of November.

The administration has hired private firm Quality Software Services Inc. to fix the more than 100 issues with the exchange server that have frustrated consumers since the exchanges opened October 1. QSSI, an arm of UnitedHealth Group, is one of three contractors originally engaged to create the system. Among the reported issues are inaccurate reports and the failure of as many as 30 percent of consumers to successfully complete the enrollment process.

Though the proposed timeline is shorter than originally anticipated, it still cuts very close to the December 15 deadline for purchasing coverage to begin January 1. As a result, many lawmakers have called for extending the individual mandate deadline or deferring penalties for non-enrollment. The current deadline to avoid a tax penalty is March 31.

Issues with the exchange have frustrated consumers who are already unsure about the impact of the ACA and have prompted criticism from both sides of the aisle. The Obama administration is facing political fallout as well as a public relations quagmire: Health and Human Services Secretary Kathleen Sebelius has been called upon to step down, and President Obama has addressed ongoing concerns with varying success.

Troubleshooter Jeffrey Zients remarked that the exchanges will “get better” by the week until it “will work smoothly for the vast majority of users” at the end of November.

Consumers should be prepared for a shortened enrollment period if an extension is not enacted. If you are one of the millions who will purchase insurance on the exchange, PRN Funding can provide the cash flow you need to be ready when the exchanges are fully functional. Learn more about our healthcare factoring programs and contact us today to get started.

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