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.

In the last 15 years, PRN Funding has provided comprehensive alternative funding solutions for healthcare companies. To learn more about the benefits of healthcare factoring and medical receivables factoring, contact PRN Funding today.

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”.

Many Employers to Offer “Skinny” Insurance Plans in 2015

According to a survey by the National Business Group released earlier this month, as many as 16 percent of large employers will seek to minimize their healthcare costs next year by offering low-benefit, or “skinny”, plans to their employees.

The companies that will offer skinny plans versus fully ACA-compliant plans were not identified by their industries in the survey; however, traditionally companies with a high percentage of low-wage employees have taken the most advantage of those plans. Skinny plans are considered “minimum essential coverage” by ACA standards by virtue of being employer-provided, but are often lacking other key features that roll into that distinction.

Skinny plans allow employers to avoid a penalty by simply offering a plan, and purchasing one allows the employee to avoid individual mandate penalties by enrolling in a healthcare plan with lower premiums. Unfortunately, the benefits to individuals end there. Some plans cover nothing but preventive care, and all plans feature exorbitant deductibles that can make actually seeking care an unaffordable option should the employee ever require it.

Another significant blow to employees at these companies is that they will not qualify for subsidies to purchase better coverage on state or federal exchanges because their employer offers an ACA-compliant plan, regardless of whether they enroll in that plan or not.

The effect of skinny plans on healthcare costs to providers and vendors remains to be seen.

PRN Funding offers a variety of customized healthcare factoring solutions to healthcare vendors in order to cover operating costs – including providing insurance. To learn more about healthcare factoring or medical receivables factoring and apply for service, contact PRN Funding today.

What’s Ahead for Home Healthcare Staffing?

What’s ahead for the home healthcare employment?

Plenty!

The home healthcare industry remains one of the fastest-growing in the United States, with no signs of slowing down. The US Department of labor estimates the profession will grow by almost 50% by 2022, which is close to five times faster than the average for all occupations.

Most home care positions require little training and often don’t mandate a high-school diploma, which can be an attractive option for those looking to break into the healthcare field without the time and cost of college. Home healthcare has its rewards, but there are also lots of cons. Low wages (median yearly wage is about $20,000), physically demanding environments, lack of full-time hours and no health benefits plague workers and lead to an extremely high turnover rate. A recent article in the Wall Street Journal notes that home healthcare turnover averages around 50% each year.

The primary contributor to industry turnover is pay. Demand for home healthcare staffing is strong… and getting stronger. To keep up with the pace, the homecare industry needs to make itself more appealing – starting with better pay and job stability.

Starting on January 1, 2015, the U.S. Department of Labor will require all direct care workers employed by staffing agencies and home care agencies to be covered by minimum wage and overtime protections. This sounds like a solid plan on the surface; however, this could backfire and actually cause home health workers to lose money. Caregivers often work lots of overtime to boost their paychecks, but the new law may cause homecare agencies to enact shorter shifts and cut back on overtime hours due to higher costs.

Even with minimum wage protections in place, the home health industry may still struggle with significant turnover while trying to appease increasing demand. Improved training opportunities may be another solution to reducing the turnover. If agencies provide non-medical caregivers with opportunities for additional training, employees may be motivated to use their home health experience as a stepping-stone to a more specialized career in the healthcare industry.

One thing is certain – the home health boom is coming. If better pay isn’t in your agency’s budget, now is the time to develop new and innovative ways to attract and retain the top caregivers.

Working capital to meet rising home healthcare staffing demands

Accounts receivable factoring for home healthcare is quick funding solution that helps home care agencies cover payroll on-time, every-time. Rather than worry about delayed payments from slow-paying customers, Medicare, Medicaid or HMO’s, factoring home care receivables can get you the funding you need to manage your growing business.

CHS Data Hack: Is Your Company’s Information Secure?

While the tech security industry’s discovery of the Heartbleed bug in April made few mainstream headlines, its impact on information security became front-page news this week. Community Health Systems announced a massive security breach in which hackers gained non-medical information about approximately 4.5 million patients in their database.

According to a source “close to the CHS investigation”, the group responsible for the breach gained access by exploiting an unpatched occurrence of the Heartbleed bug in a Juniper device used by the hospital group. Once in, the attacker logged in via a VPN and was able to move deeper into the network.

The Heartbleed vulnerability was discovered in April in networking equipment distributed by Cisco and Juniper – unarguably two of the largest names in business networking equipment. The bug compromised the security of data encryption on IP networks, both internal and external. A patch was quickly developed, yet by June more than half of the infected sites on the internet had failed to apply it.

Security breaches are troublesome in every industry due to the potential for financial loss and identity theft, but in the healthcare industry there could be legal repercussions as well. Healthcare providers and vendors could be in violation of HIPAA regulations governing patient privacy even if the information compromised does not include details of their care.

Is your company’s information secure? Below are some best practices to ensure security now and in the future.

Make sure you’re secure.

Conduct an audit of your security as soon as possible. If you don’t have in-house IT professionals, schedule an appointment with a reputable third-party consultant to review your system. The IT professional will identify areas of potential vulnerability to address, as well as best practices to employ moving forward.

Educate your staff.

Human error accounts for a large portion of security breaches, so be sure that your employees are vigilant about information security. Remind them of basic protocol, such as not opening email attachments from unfamiliar email addresses, and advise them to be careful when downloading any extraneous programs onto their system. (In fact, you may simply prohibit the use of non-work-related software.)

Staff adherence to security procedures extends to their use of company hardware outside the workplace. Emphasize the importance of keeping work computers and devices safe when they are in the employee’s personal possession – after all, if a work laptop is stolen from an employee’s car then your information is equally at risk.

Use multiple layers of security.

Use different passwords for different programs, and give them an increased level of complexity – letters, numbers, and characters combined will help to thwart “dictionary attacks” run on the words within passwords. There are a number of passcode generators that you can use for a string of random characters. Reset your passwords regularly, and don’t write them down.

Update your anti-virus and antispyware software regularly to benefit from new definitions, and use an intrusion detection program to identify and block illegitimate attempt to access the system.

Encrypt your data

Protect the information in your network no matter where it goes. For communications including sensitive information, use an email encryption to secure the data against prying eyes.

Back up your data!

Always have a working hard copy of your data that you can use to restore the system in case the information is lost or compromised in a security breach. There are reputable online backup services that you can use as well, but the best practice is to also have a copy offline that you can access manually.

Protect mobile devices connected to your network.

If you work away from your office, either on a home network or a mobile device (laptop, tablet, phone), make sure that the security settings on those devices are also up to date. If it is an option, restrict the use of business-related information to devices that are owned and distributed by the business.

Have an updated security policy.

All of the above tips should be regular practices in your security policy, which you should always follow and periodically reevaluate. Other policies to consider may include:

  • Restricting who can access your network via VPN and when
  • Prohibiting staff from sharing security information over the phone, no matter what
  • Requiring that work hardware not be taken off the premises without authorization

Information security is a large investment of both time and money, but it is one of the most critical investments you can make in the longevity of your business. While you may not be able to thwart every potential attack on your data, having established security practices and following them will help you to recover more quickly and minimize the damage that an attack can cause.

If you lack the cash flow to invest in information security, PRN Funding can help. Our comprehensive healthcare factoring and medical accounts receivable factoring programs help healthcare companies from nurse staffing agencies to medical billing companies and more turn their open invoices into working capital that they can use to support their business – including its information security. Contact PRN Funding to learn more about healthcare factoring and medical accounts receivable factoring services.

Should Voluntarily Uninsured Patients Lose Charity Care?

Now that the Affordable Healthcare Act’s healthcare marketplaces and policies are in effect, hospitals are considering whether those who decline health coverage should benefit from charitable care.

The issue of whether to discontinue charity care for the voluntarily uninsured is tricky and, according to some, more a question of whether their denial of insurance indicates unwillingness to pay or an inability to pay. Some patients fall into the gap between Medicaid coverage and affordable subsidized care, while others who may be eligible for subsidized insurance are still unable to afford the high deductibles featured in lower-tier plans.

Other questions include whether patients were aware of available coverage options or if they were able to sign up during open enrollment. On the other hand, a significant though unsubstantiated concern about charitable care programs is that uninsured patients will be dissuaded from enrolling in a healthcare plan if they know that charitable care is an option. This could result in greater financial difficulty for hospitals receiving less government assistance to cover uninsured patients, particularly in states that declined Medicaid expansion.

For the moment, many hospitals are considering the effects of a change and have therefore not made any updates to their charitable care policies. Hospitals that have changed their programs have done so in a number of ways:

  • Reducing income threshold for additional assistance
  • Requiring a “nominal” contribution for care
  • Requiring patients to apply for coverage before they can benefit from charitable care (note: this is an existing practice in most hospitals)
  • Disqualifying aid to patients that refuse to enroll in coverage for which they are eligible (including Medicaid)

Regardless of hospitals’ decisions, all hospitals are required to clearly state their charitable care policies in compliance with the ACA and they must make “reasonable efforts” to qualify patients for aid before pursuing them for collections.

As hospitals absorb the financial changes of full ACA implementation, healthcare vendors must be prepared for any changes in payments. PRN Funding’s dynamic healthcare factoring options help healthcare vendors working with hospitals, doctors’ offices, and other healthcare facilities to shore up their cash flow by converting open invoices into immediate cash. Contact PRN Funding today to learn how healthcare factoring can help your company and to get started right away.

Walmart: Rolling back prices…on healthcare?

It started with a discount prescription medication program, offering generic drugs to patients for as little as $4 or even for free. It expanded in recent years to include retail clinics in conjunction with local hospital systems and partnerships with leading national hospitals. Now, it could be a tipping point for the future of accessible health care.

“It” is Walmart’s deepening involvement in health care, marked by the opening of five primary-care clinics in Texas and South Carolina – right in the store. They plan to increase the number to approximately 12 by the end of 2014.

At $40 for a walk-in visit (less for employees), Walmart clinics boast a lower price point than most primary-care clinics. In addition, they are open longer: one clinic in Texas, for example, is open for 12 hours on weekdays. The clinics are staffed by nurse practitioners in an agreement with QuadMed.

A number of experts have pointed out the wisdom of Walmart’s primary-care strategy and its consistency with other corporate strategies. The company has opened clinics slowly, after significant planning, and has begun developing clinics in areas that are in the greatest need of affordable health care.

Texas and South Carolina both have cost-related problems with primary care access: neither state approved a Medicaid expansion, leading to a larger uninsured population, while both states have higher percentages of poverty and other adverse contributing factors such as obesity and substance abuse. In these environments, clinics that provide not only easy but low-cost access will likely prove to be competitive with their traditional healthcare counterparts.

The initial incongruity of Walmart’s involvement in healthcare is actually a reflection of a new trend toward retail healthcare, which we touched on briefly in our last post on bidding for medical procedures.

In order to remain competitive as health care and insurance change in the coming years, healthcare vendors must be prepared to adapt and seek out new opportunities for providing care. PRN Funding offers a number of dynamic healthcare factoring options to help you build the working capital to expand your operations. To learn more or complete an application, contact PRN Funding today.

Patients can Shop Online for Medical Procedures

Consumers can shop online for cars, clothes, and even romantic partners – but medical care?

Yes, medical care.

Medibid, an auction site founded by Ralph Weber, offers patients the opportunity to solicit bids for a variety of medical procedures from doctors enrolled on the site. For a tiered subscription fee, patients and doctors alike can either place or bid on single requests or unlimited requests. Once the patient accepts a bid that covers the full cost of the procedure, they make arrangements directly with the physician and pay for services by cash or credit card in full.

Proponents of bidding for medical service, including Weber, argue that this development is an organic evolution of the online marketplace that will allow consumers to take control of their healthcare spending in a way that insurance providers and hospital systems do not. Medibid providers, who are largely in small practices or run their own surgery centers, are able to charge lower fees without compromising their profit margins because they can skip the costly step of billing insurance plans.

However, a number of critics point out several drawbacks to the online auction approach to medical care despite acknowledging the difficulty of navigating (and paying) hospital prices. Red flags include fewer regulations of physician-owned outpatient centers, lack of “quality indicators” to support the doctors bidding on procedures, and the potential for complications that are not covered by the Medibid agreement.

Hospitals may be getting the message – a number of hospitals around the country are beginning to post their procedure prices (minus surgeon’s fees) on their Web sites. The aim of hospitals that choose to do so (and the states that have mandated the practice) is to help patients make the best decisions for the care based on price and quality.

PRN Funding offers a number of healthcare factoring options to help healthcare vendors close the cash flow gap. Learn more about healthcare factoring solutions for your company and apply today.

Technology is Changing Healthcare as We Know It

Technological advances in healthcare have been touted as game-changers: advanced equipment for better results and faster care. For every updated practice that truly improves efficiency and lowers cost, however, there are a handful of other developments that simply raise the cost to patients without creating better solutions.

Unfortunately, inefficient and expensive advances have created new revenue streams by complicating the care process for patients and making more follow-up appointments necessary. On top of that, many healthcare systems pass on the cost of large equipment to their patients by raising the cost of different procedures.

All of that could change as the economics of healthcare change. New technologies such as exam adapters for mobile devices and 3D printing are already in production and may be the new wave of efficient and low-cost patient care, but in order to embrace these technologies and remain relevant in a value market hospitals and health care systems will need to completely transform the way they do business.

In hospital fee structures that move away from the traditional fee-for-service format, for example, practitioners will have to shift their focus to doing what works best to treat a patient rather than doing what they can bill more for. Moreover, the entire infrastructure of care must be adapted to incorporate new technologies so they are not only accessible but also secure and compliant with federal privacy regulations.

That said, if hospitals and medical groups choose to move toward integrated technology they have the potential to make healthcare not only less expensive in the long run, but truly better.

PRN Funding provides immediate working capital to help healthcare vendors cover expenses and invest in new technologies. Learn more about how healthcare factoring can transform your company and request a free factoring quote now.

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