The Affordable Care Act Defines Full-Time Employment

As provisions of the Patient Protection and Affordable Care Act (ACA) continue to take effect, there is considerable friction over the ACA’s definition of a “full-time employee” and its implications for providing health coverage to those employees. The Fair Labor Standards Act defers to employers to define full-time employment; however, the ACA bases its definition of full-time employment on the Internal Revenue Code of 1986: “an employee who is employed on average at least 30 hours of service per week”.

Such a designation, opponents argue, may cause employers to choose between providing healthcare to a greater number of employees and cutting full-time employees’ weekly hours by at least 25 per cent to force them below the full-time threshold. Senator Susan Collins (R-ME) has introduced the “Forty Hours Is Full Time Act of 2013” on two separate occasions in an attempt to revise the IRC and, by extension, the ACA. Economist Casey Mulligan argues in The New York Times, however, that passage of such a law would actually cause more employers to cut their employees’ hours and result in more of a taxpayer burden.

According to Mulligan, it is easier for an employer to cut an employee’s hours from, say, 45 to 39 without drastically affecting the work schedule. Projections of employer cost between full-time, part-time at <30 hours and part-time at <40 hours show that the difference in a 39-hour work week and a 40-hour work week is almost negligible for employers; meanwhile, the employee becomes eligible for ACA tax incentives to purchase private insurance on the marketplace – costing the taxpayer more – and ends up with an increase in take-home pay at the same time.

The arguments above suggest that business owners need not shy away from expanding or offering full-time benefits to their employees in an attempt to cut costs; rather, service providers in medical industries may find themselves at an advantage. After all, some facilities will choose to scale back their in-house staff and rely on outside contracts, leaving a great opening for vendors to expand their own businesses.

Healthcare factoring can help those companies close the gap between their own cash flow and expenses, and ease the strain of expansion by providing the capital to cover increased overhead. Find out how PRN Funding’s accounts receivable factoring program can be tailored to your company’s needs.

2014: Expect a Busy Year for Healthcare Staffing Agencies

Thanks to a slowly improving economy and the implementation of the Affordable Care Act on the horizon, those in the healthcare staffing world need to be prepare their recruiting strategies.

Healthcare workers, especially physicians, nurses and clinical staff, are growing more confident about their job prospects and may be seeking more lucrative employment offers. The physician shortage will undoubtedly make it tough on the healthcare staffing industry as well.

In order to meet medical staffing demands, certain states are allowing APRNs, physician assistants and other mid-level healthcare providers to step in. Giving mid-level providers more freedom and responsibility will help off-set the physician shortage and open up more career opportunities.

Although healthcare hiring appeared to be slowing in July, medical staffing should prepare for a fast rebound in 2014. Make sure your staffing agency is ready to handle the demand. Discover the ways healthcare staffing factoring can ensure your cash flow remains stable despite rapid growth. PRN Funding has spent more than a decade in the healthcare services industry, and we can design an accounts receivable factoring program specifically for your staffing firm.

Learn more about accounts receivable factoring for healthcare staffing agencies.

Obamacare Out-of-Pocket Caps Provision Delayed

Another important provision of the Affordable Care Act has been postponed. The provision that would set caps for out-of-pocket insurance costs will be delayed for more than one year. Under Obamacare, the limit on out-of-pocket costs like deductibles and co-payments was not supposed to exceed $6,350 for individuals and $12,700 for a family. Now, it appears that a one year grace period has been granted to some insurers which enables them to raise limits, or in some cases, set no limits until 2015. Also, if a drug plan doesn’t currently set out-of-pocket limits, they won’t have to impose any until 2015.

The delay will leave some consumers paying much more for health insurance and drug coverage. The lag allows many group health plans to maintain separate out-of-pocket limits.

Why the health care reform delay? The New York Times reported that federal officials wanted to provide insurers and employers more time to comply because they used “separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”

The chief executive of the National Health Council said the delay will “disproportionately harm people with complex chronic conditions and disabilities.” For those with chronic illnesses like cancer, out-of-pocket costs can swell to tens of thousands of dollars each year. The same applies to prescription drug plans. Many patients will have to wait for access to affordable prescription drugs because of the out-of-pocket cost cap delay. The American Cancer Society noted that some new cancer drugs can cost more than $100,000 per year.

Obamacare still affords some consumer protections. Consumers can’t be denied insurance or face higher premium costs due to pre-existing conditions. Subsidies may be available to help bring down costs as well.

Affordable Care Act Could Lower Insurance Costs for Some Small Businesses

Numerous small business employers and owners are worried about their insurance costs rising under the health law next year. However, for some businesses, especially those with older workers or those who have employees who have been ill, costs may actually decrease according to business owners and insurance brokers.

Under a stipulation of the Affordable Care Act (ACA), which goes into effect in January, insurers will be forbidden from setting rates for healthcare coverage based on the health status of employers or their employees are at businesses with less than 50 or 100 workers, depending on the state. Rather, the rates will be announced on government-run health insurance marketplaces, or online exchanges, which are meant to extend the additional costs of insuring higher-risk policyholders, like those with prior sicknesses or pre-existing medical conditions.

A survey conducted in April by The Wall Street Journal and San Diego-based executive mentoring group Vistage International Inc., found that 12% of 783 businesses with less than $20 in yearly revenue believe their insurance premiums will be cheaper or stay roughly the same under the ACA. Similarly, a survey by eHealthInc. done in February found that 11%of 259 small business employers, most with less than 10 workers employed at their businesses, said they think their rates will go down next year.

Some business owners say costs could go down if the exchanges produce cheaper rates on individual plans, which would lead some employees to drop their employer-sponsored plans completely.

Both early renewals and self-funded plans will end up keeping more groups off the exchanges, which will reduce the savings for high-risk policyholders. Besides that, any savings from the exchanges will be contingent on whether they’re up and running by Oct. 1, the deadline for offering coverage that will be effective come January.

The federal government’s own health-insurance exchange for small businesses, called the Small Business Health Options Program, or SHOP, which it will supervise in 33 states, isn’t expected to be fully operational and available until 2015.

Obamacare Greatly Boosting Areas of Healthcare Staffing

Obamacare has been receiving plenty of criticism due to accusations that the health care law will hurt employees by eliminating positions or reducing hours to part-time. While the actual effects are still relatively unknown, staffing recruiters and HR professionals are confident that Obamacare will help drive job growth in certain areas.

Since PRN Funding works with numerous healthcare staffing companies, let’s take a look at the positions that are prepping for fast growth in the healthcare realm.

1. Nurse practitioners and physician assistants
Due to an increased demand for routine checkups and preventative medicine, physician services are set to increase at least 2 to 3 percent by next year. Nurse practitioners and physician assistants can perform similar services for the fraction of the cost of a doctor. Not to mention, general physicians are still in short supply and take much longer to enter the workforce. The Bureau of Labor Statistics (BLS) predicts the demand for PA’s will swell by 30 percent and staffing for registered nurses will increase 26 percent by 2020.

2. Medical billing coders
Healthcare IT staffing will be huge. Combine the requirements for healthcare facilities to transition to electronic health records and comply with a new medical coding system (ICD-10) with millions of newly insured patients and you have a recipe for lots of jobs to fill.

The International Classification of Diseases (ICD-10) will include a staggering 69,000 diagnostic codes and physicians will be required to submit claims with the new codes starting Oct. 1, 2014 if they want to get paid. Lots of healthcare IT staffing will be necessary to build these codes into the electronic health records software. According to Staffing Industry Analysts, medical coding is one of the hottest jobs right now.

3. Occupational therapists
Occupational therapists make appropriate modifications to the homes and workplaces of the disabled to accommodate their mobility needs. Since Obamacare prohibits insurance companies from denying coverage, more disabled people will be able to take advantage of health insurance coverage. The BLS forecasts a 43 percent spike in occupational therapy employment by 2020.

4. Wellness and fitness coaching
The need for health education specialists is expected to rise by 37 percent in 2020, according to the BLS. Many employers will want to encourage healthy lifestyles, so the demand for workplace wellness programs will skyrocket.

Aside from healthcare staffing, Obamacare is also expected to help spur career growth for payroll service providers, computer programmers, lawyers, insurance consultants, customer service reps and human resources professionals.

5 Ways the Healthcare Industry Benefits from Social Media Marketing

Social media marketing is not just for businesses looking to expand their reach and reputation – the healthcare industry can also benefit from utilizing social media. Here are 5 ways that healthcare providers and service organizations can benefit from social media marketing:

1. Patient education and outreach
Posting information about seasonal sicknesses, ways to stay healthy, and other pertinent health information is a great way to stay connected to patients or connect with potential ones. Chicago’s Sherman Health, a multi-hospital system, even worked with Demi & Cooper Advertising in Illinois to tweet a live surgery. “Twitter is an amazing platform if you look at it as we do. We see Twitter as a multi-device real-time messaging system. Sharing information from an OR is not a new idea. Twitter is a perfect medium for distributing information from an OR because it allows time for messages to be worded correctly. We were looking for new ways to help Sherman connect with their community, to provide information, and help people become more familiar with the hospital. We found that Tweeting the surgery was an excellent way to help potential surgical candidates become more comfortable with Sherman,” said associate creative director Marc Battaglia.

2. Patients participate in their own care
A recent study found that patients who are regularly online are more likely to accept patient-centered care and take part in their own care.
“When medical professionals attempt to gauge how much information to provide patients or try to decide how much they should involve patients in medical decision-making, they may be better off if they base their decisions on patients’ Internet use frequency rather than age, per se,” said the researchers from the University of Texas, the University of Florida and the University of Maryland.

3. Feedback and improvement
Social media allows your hospital to monitor what its patients are saying, which will let you identify issues and problems and give it the opportunity to improve. Facebook and Twitter have also become outlets for people to vent, so a hospital can identify patient frustrations and determine how to best solve patients’ problems with their care or service.

4. Patient interaction
With social media sites, patients are able to post questions for doctors and staff to get answers or advice quickly. This interactive method makes more sense than the patient scheduling an appointment to ask a question or wait on the phone for someone to be able to answer.

5. Building your healthcare organization’s reputation
Potential patients looking up your facility will look online to see what others are saying about your institution and services. It’s imperative to take control over your online presence. Responding to both negative and positive concerns proves that your organization is dedicated to serving the needs of patients. It’s better to proactively manage your online reputation than let it run rampant across social web.

“Social media isn’t going to go away, and ignoring it isn’t really a viable option. The best way to manage your reputation online is to participate,” said Battaglia. “Ignoring it is a short-lived strategy. Hospitals and healthcare facilities need to become involved and present helpful, safe, and accurate information.”

New Legislation May Fix How Medicare Pays Doctors

A new bipartisan bill in the U.S. House of Representatives seeks to base more physician reimbursement on performance and quality measures to remedy a flaw in how physicians are paid through Medicare.

House members seek to repeal Medicare’s sustainable growth rate (SGR) reimbursement formula that caused significant cuts to doctor payments from Medicare.

The bill would increase payments by 0.5 percent each year through 2018. Come 2019, Medicare will start tying payments to quality measurements such as clinical care, patient and caregiver experience, population health and other factors. To determine any bonuses in pay, physicians will be evaluated against their peers against various measures by the U.S. Secretary of Health and Human Services.

The American Medical Association and other groups expressed their support of the payment models because they will lower healthcare costs while providing better quality care.  A Forbes article stated that the SGA model would have hit some healthcare businesses by as much as 25 percent and large cuts like that would negatively impact patient care. It also noted that since not all medical services are the same, it’d be illogical to base reimbursement rates on the profit margins earned by different provider segments.

Read the final draft of the Medicare legislation here.

Patients Paying More for Hospital Care

According to new data from TransUnion, patients are paying even more for hospital care out-of-pocket, and access to credit that would help pay for treatment has diminished for some consumers. The agency analyzed data from 200 hospitals across the U.S. and compared it with their proprietary financial numbers.

The report found that the average patient payment responsibility on crucial medical procedures has increased practically 22% in the last year, from $1,678 in 2011 to $2,042 in 2012. The cost encompassed all of a patient’s inputs, including co-payments, co-insurance, and deductibles. The average deductible grew to $1,032 from $405, while average co-pays jumped to $117 from $65.

“Most people understand that healthcare costs have been increasing during the last decade, but TransUnion wanted to specifically take a look at the impact of those costs on the consumer wallet,” said President of TransUnion Healthcare Milton Silva-Craig. “Hospitals are discovering that data, analytics technology and improved infrastructure are needed to ensure they understand the payment behavior of patients, through a consumer lens, as they strive to better manage their reimbursement processes.”

Over the same period, credit accessible to the average consumer through credit cards, store cards and home equity loans was low, decreasing marginally to $34,301 from $34,430. TransUnion found that at the end of 2011, for every $100 in health care costs, consumers had $2,050 in revolving credit to make their health care payments. But at the end of 2012, the ratio dropped to 16.1 to 1, or $1,680 in available credit for every $100 of health costs.

“In the short term, it appears consumers on average have been able to successfully manage their increased out-of-pocket medical expenses with their existing credit facilities,” stated Silva-Craig. “But as those costs continue to rise, there is a concern that consumers — particularly those in the nonprime credit tiers, already strapped for cash — may find themselves in a tight position financially, as healthcare costs compete for a larger share of their disposable income.”

Even those with top-tier credit scores saw their access to revolving credit rise, but subprime borrowers, with the riskiest credit profiles, saw it fall. That caused concern that consumers may have trouble finding the means to pay for hospital care, as health costs use up more of patients’ disposable incomes.

“With more and more people struggling to make payments, healthcare organizations must ensure they are doing all they can to engage their patients in an open and transparent manner in determining the best method in which to make payment or assist them in qualifying for some type of benefit,” said Silva-Craig.

Medical receivables factoring is a solution for medical providers waiting on slow-payment. If your healthcare facility bills third-party vendors such as Medicare, Medicaid, HMOs or commercial insurance companies, medical factoring can get you the cash you need today.

Employer Mandate is Delayed, but Individual Mandate Stands

The employer mandate provision of the Affordable Care Act (ACA) has been delayed by a year, but the individual mandate still stands as law. The individual mandate portion of the ACA states that uninsured individuals must have insurance by January 1, 2014 or face penalties (most likely 1% of family income). The uninsured will be eligible for federal subsidies of up to $5,000 depending on income to purchase insurance on healthcare exchanges. Those in the very low income brackets could qualify for Medicaid.

House Republicans are pushing for an individual mandate delay, but won’t likely get very far when it comes to overturning this portion of the law. Most major physician groups stand behind the Obamacare individual mandate because requiring everyone to have insurance lowers healthcare costs for all.

The employer mandate delay leaves about a million people to find insurance coverage to meet ACA requirements, according to the Urban Institute. A source at the Urban Institute noted that the point of the employer mandate was to make sure that employers offered coverage rather than forcing employees into the state-run insurance exchanges, but that’s pretty much the case due to the delay.

AMA Declares Obesity a Disease – The Impact for Employers

The American Medical Association has voted to reclassify obesity from a condition to a disease “requiring a range of medical interventions to advance obesity treatment and prevention,” according to an AMA statement. Essentially, physicians will be professionally obligated to diagnose and treat obesity.

Obesity increases risk factors for many serious conditions like heart disease, high blood pressure, stroke and type 2 diabetes. Nearly 30 percent of US adults are considered obese. Since most forms of insurance don’t cover obesity, the policy could improve access to obesity treatment such as nutritionists and trainers. Insurance may even begin to reimburse the time doctors spend talking to patients about nutrition and exercise. The bill would also increase obesity treatment options for Medicare patients and expand the types of providers allowed to offer obesity counseling.

Not only will the AMA decision impact patient care, it may also impact the staffing and employment industry. As of now, the Americans with Disabilities Act (ADA) does not prohibit employers from discriminating on the basis of weight. Staffing agencies should watch carefully as the ADA deems nearly all diagnosed medical conditions as “disabilities.” Could it mean that employers will have to make reasonable accommodations for employees who fall into the obese category? Could obese employees seek additional protection from discrimination and terminations based on weight? An article on Workforce.com believes so.

According to Forbes magazine, the new classification may even make employers more hesitant to hire obese workers, especially since health insurance coverage is required under the Affordable Care Act. Some employers may also try to lower wages to offset the higher health insurance costs of obesity. It also may impact workplace wellness programs that offer financial incentives tied to weight management and obesity.

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