Hospitals Taking Steps to Avoid Patient Falls

For weak and elderly hospital patients, a fall while in the hospital can extend a hospital stay or, in some cases, cost a patient his life. Hospitals nationwide are responding to this glaring safety concern with a blended approach between technology and human care.

To reduce the number of falls, deemed “never events” (as in, they should never happen in the hospital), many hospitals are relying on high-pitched bed alarms to alert nursing staff when a patient is up from their bed. The alarms use weight-sensitive pads in a bed or chair that emit a noticeable alert when they detect a decrease in pressure.

A study led by Ron Shorr at the University of Florida late last year, however, demonstrates that reliance on bed alarms is simply not enough to reduce the number of falls in a hospital. In a blind comparison of 16 hospital units in which eight units used bed alarms and eight units relied on standard care, there was more than one fall fewer per 1,000 patients in the units relying on standard care procedures. The results are not significant enough to blame bed alarms for more falls, but do call into question the contention that they result in fewer falls.

Nurses cite understaffing as a larger concern that results in other hospital risks. They argue that there is no replacement for capable nurse care. After all, an alarm is only effective if there is a nurse to respond, and hospitals that have increased their staff and provided comprehensive safety training have drastically reduced the number of falls they experience without the added technology.

Nurse staffing agencies are uniquely poised to help hospitals add vital staff to their units, but many may find it difficult to thrive when waiting on extended payments. PRN Funding’s nurse staffing factoring program converts your open invoices to immediate cash that you can use to hire nurses, pay your expenses, and pursue lucrative new contracts with hospitals in need.

Learn more about nurse staffing factoring with PRN Funding, and contact us today to get started.

ACA Changes Mental Health Treatment

Mental health is a critical but oft-ignored component of health care. Patients in need of mental health treatment face the double blow of social stigma and lack of insurance coverage, making effective treatment an unaffordable option. Provisions of the Affordable Care Act will make mental health treatment more accessible than before, with the potential to completely overhaul the current mental health system.

Insurers have traditionally excluded mental health coverage from their health plans, citing mental issues as a pre-existing condition. With costs as high as $150 or more for a single office visit – not counting costly prescription medication – many more patients are forced to go without care in lieu of paying those costs out of pocket.

The ACA, however, includes mental health in its list of ten Essential Health Benefits and will require insurers to offer coverage on par with other medical and surgical benefits. This will not only benefit millions of uninsured Americans with mental health concerns, but also the many insured Americans whose policies do not currently provide equal mental health coverage.

Mental health providers will face a number of challenges in January when the ACA is fully implemented. One major challenge, of course, is the ratio of available providers to the estimated number of newly enrolled patients they will see. A care gap may persist as providers scramble to provide services to as many as possible.

In addition, the inclusion of insurers as payers for mental health care adds a level of complexity to providing care that will drive many solo practitioners into group practices. Solo therapists who collect cash are able to charge higher fees and often save costs associated with billing software and office space, choosing instead to work out of their homes. However, accepting insurance will require them to get up to speed with medical billing and coding and to accept lower fees per session as part of their agreement with insurers.

A larger practice offers cost-sharing benefits in which many professionals can go in together for expensive software and real estate, though working with insurance companies can take away from the autonomy that many therapists currently enjoy. Another possibility, however, is joining a traditional medical practice to create an integrated approach to healthcare. Having a mental health professional in a group practice gives general health providers another diagnostic option that will allow them to provide better – and less costly – care.

Mental health providers considering a shift in their practice can ease the burden of insurance collections with medical receivables factoring. Factoring allows you to turn your claims into immediate cash that you can invest in the necessary software, real estate, and logistics to continue providing quality treatment to your patients. PRN Funding can get you started in a medical receivables factoring program that fits your needs – contact us today to learn more.

Enhanced by Zemanta

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.

Who is to Blame for Healthcare Exchange Glitches?

The rollout of online health exchange site Healthcare.gov at the beginning of the month has been stymied with glitches preventing millions of consumers from creating accounts or completing the enrollment process, along with as many as 100 additional flaws found in the system. Testimony before a panel convened by the House of Representatives has provided an object of public blame for these glitches: contractor from Canadian firm CGI Group Inc.

Cheryl Campbell, senior VP of the unit responsible for site design, testified before the House that more time should have been devoted to end-to-end testing and refused to give a set date for the site to be fully functional. Campbell claimed that the Centers for Medicare and Medicaid Services – the Health and Human Services agency responsible for the health exchanges – made the final decision to take the site live despite inadequate testing. She also testified, however, that CGI did not make a recommendation to delay the site launch.

Other contractors testified that they were only given two weeks to perform testing, far shorter than the industry standard of months. Each contractor maintained that they fulfilled their part of the project and disavowed responsibility for the final product, and none could provide a definitive date for the glitches to be resolved.

Experts in the tech world, meanwhile, have suggested that the issues with Healthcare.gov could be a technical “black swan” event, or a project that faces out-of-control costs and extreme consequences that could spell failure – in this case, a failure for the Obama administration. President Barack Obama has publicly decried the situation, claiming “Nobody’s madder than me.”

Testimony will continue throughout the week and possibly into next week, but the administration has already appointed a contractor to repair the site as quickly as possible.

PRN Funding’s factoring programs for healthcare vendors provide necessary cash flow to invest in offering quality healthcare goods and services to healthcare providers nationwide. Contact us to find out how healthcare factoring can save your company from creating its own “black swan”.

Enhanced by Zemanta

Obamacare vs. Employer Insurance: Which is Better?

Ever since Obamacare was introduced, employees have been debating whether or not their employers’ insurance plan is the best option for obtaining affordable healthcare coverage. Although employees may have the ability to comparison-shop for better coverage plans among the new online exchanges, there are still plenty of nuances involved in the selection process. As a result, trying to sift through all the available options and picking the best plan to suit your particular situation can be a tedious task.

Although the new healthcare exchanges under Obamacare will be accessible to everyone, the marketplace will operate through two different sites, depending upon where you live. In 34 states, the exchanges will be available on HealthCare.gov, a federally-run website. However, 16 states, including the District of Columbia, will operate their own independent exchanges. Regardless, even if your employer already provides health coverage, there are no rules saying you can’t purchase coverage on your state’s exchange.

If employees decide to abandon their employers’ plan and enroll in coverage through the new marketplace, they may not be eligible to receive some of the benefits provided to the uninsured. The only instance where employees could be deemed eligible for receiving government subsidies is when their employer’s coverage is determined unaffordable or inadequate under the new healthcare law. Because these subsidies help people pay for their insurance, they are one of the most attractive incentives available with the new state exchanges.Keep in mind, employees earning over $40,ooo annually, won’t likely qualify for subsidies.

Opinions differ when it comes to choosing the best coverage plan for employees. According to E. Denise Smith, a professor of health care management at Gardner-Webb University in Boiling Springs, N.C., there really would be no advantages to abandoning healthcare plans provided by employers. She also mentioned that employers would not be required to offer payment assistance if their employees opted for an exchange plan.

A senior vice president for health policy at Jackson Hewitt, expressed a similar point of view. He believes that employees may not be able to find better coverage than their work-based plan among the new marketplaces. Additionally, he advises employees to thoroughly evaluate their current employer-based plans, and consider factors such as whether or not dental and vision care are covered. Obamacare plans are not required to cover dental and vision.

In regards to employee eligibility for Obamacare, many of the requirements imposed on employers had been postponed until 2015. However, companies were still expected to offer notice to their employees no later than Oct. 1, letting workers know whether or not their current coverage would be viewed as affordable under the new law. Despite this expectation, the U.S. labor Department said that employers would not be charged with penalties for failure to notify their employees. Regardless, the delayed employer mandates will require businesses with a workforce of at least 50 full-time employees to provide health coverage to their workers, as well as their dependent children, in 2015. However, employers will not be obligated to offer insurance to workers’ spouses.

September Layoffs Largely Concentrated in Healthcare

The once recession-proof healthcare industry took a large hit in September, reporting more layoffs than any other industry for the month.

Hospital layoffs

Healthcare providers let go more than 8,000 employees, including administrative staff as well as doctors and nurses, in an ongoing effort to reduce costs. Some notable reductions are Vanderbilt University Medical Center’s 1,000-employee cut and Cleveland Clinic’s 3,000-employee buyout plan. Reductions are projected to continue into next year, cutting into the past year’s gains in private hospital employment.

The layoffs are a response to a variety of funding cuts and changing hospital conditions, including new reductions established by the Affordable Care Act. Medicare and Medicaid reimbursements in particular have fallen sharply due to sequestration and additional penalties associated with the Hospital Readmissions Reduction Program, which cuts reimbursement to hospitals with excessive readmissions for applicable conditions. Other factors include:

  • Research funding from the National Institutes of Health was cut five percent due to sequestration;
  • Increasing numbers of patients are aging into Medicare, which reimburses at lower rates than private insurance;
  • Despite the ACA’s expansion of Medicaid, 26 states have chosen not to expand the program and accept greater funding (Vanderbilt cites this as a primary cause of their cuts);
  • Private insurance policies are paying out lower amounts, passing costs on to patients with higher deductibles and co-insurance;
  • Inpatient stays have shortened since the recession began, decreasing in length by four percent from 2007-2011.

Healthcare consultants, however, point out that hospital layoffs are a shortsighted solution that many facilities will have to reverse as more patients take advantage of their access to affordable healthcare and seek treatment they may have otherwise eschewed.

There are alternative solutions for facilities looking to shore up their cash flow. Medical receivables factoring gives hospitals immediate access to cash that they can use to meet their expenses without cutting employees they will likely need to call back in the next few months. PRN Funding has more than a decade of experience in the healthcare industry and can help meet the unique needs of providers. Apply today to learn more and get the cash ball rolling.

Enhanced by Zemanta

Up-Front Deductible Payments on the Rise

Need to see the doctor? Be prepared to pay at the door.

Up-front deductible payments

The Affordable Care Act has prompted a shift toward low-premium, higher-deductible health plans, both employer-provided and available on the exchange. In order to collect as much of the out-of-payment cost as possible, many health providers have responded by requiring up-front payment from patients before receiving nonemergency treatment. Insured patients at these facilities must pay their co-pay, co-insurance, and deductible up front, and uninsured patients are responsible for the full (estimated) cost of treatment.

Administrators at facilities currently using this practice argue that it is the most effective way to receive payment, particularly when so much of the burden is shifting to the patient. A great deal of costs for medical treatment become bad debt – in 2011 alone, hospitals provided $41 billion in care that was never paid for. Hospitals attribute this to patients’ reluctance to make their health spending a priority, and to a lack of awareness of financial assistance programs that can eliminate the strain of a single large payment.

The up-front model is an extension of one already in practice in most doctors’ offices around the country, where co-pays and co-insurance are collected at the check-in for an appointment. By implementing the practice in hospitals, administrators state that they can connect patients to financial assistance sooner and increase the likelihood of full payment.

Opponents of the idea, however, point out that up-front payments may create a barrier to receiving health care. As deductibles continue to rise, patients will be increasingly unable to cover the cost of their care and may elect not to seek treatment – in effect, creating a situation directly opposite the intended outcome of the Affordable Care Act.

PRN Funding offers healthcare factoring and medical receivables factoring services to vendors and facilities struggling to bridge the cash flow gap. Before shifting to the up-front model, contact us to see how we can help you meet your cash flow needs and continue to provide quality care to your patients.

Enhanced by Zemanta

Healthcare Providers Can Improve Patient Engagement

Due to changing rules regarding patient readmission and health technology under the Affordable Care Act, many healthcare providers are exploring their options for improving the quality of patient engagement at all levels of the health care experience. What they’ve found is that attitude is as important as innovation to achieving truly effective engagement.

Technology is rapidly becoming a key component of healthcare management. In addition to portable medical devices that reduce the amount of time patients spend in healthcare facilities, electronic health records and patient portals are streamlining a wealth of information that providers use to diagnose, treat, and follow up on patient concerns.

Improving Patient Engagement

When used properly these latter developments are critical to promoting patient engagement. Patients who are able to not only access their health records but also contribute to them in a digital dialogue gain the ability to notice trends of behavior and symptoms that they can then share with their healthcare provider. Likewise, the provider has a channel through which s/he can reach out to the patient for ongoing care – quite the reverse of the current state of healthcare, the only industry in which the provider waits for the customer (patient) to reach out for service.

Despite the potential benefits, most health facilities continue to balk at the cost of running such a system when they cannot envision the benefits. Instead they settle for a basic patient portal that allows the patient to book appointments and pay bills but does not offer access to medical history or direct communication with the provider. Part of the reluctance stems from a failure to adopt new strategies at all levels of the organization.

Healthcare providers should look more closely at their engagement strategies, however. Improved patient engagement can result in higher rates of post-discharge compliance, which will then reduce the cost of readmissions for the same health concern. In addition, giving patients the necessary tools to participate in their own care is an overwhelming show of empathy for the difficulty of the care process. Patients will have the ability to manage ongoing conditions without constantly needing to travel to the hospital for treatment.

The technology in question is already in various stages of development, but healthcare providers looking to use it in their own organizations must address patient engagement in every area. Boards of directors must actively invest resources into adopting new technologies and solicit feedback from every stakeholder – staff, patients, and outside caregivers – to assimilate all perspectives into a comprehensive engagement strategy. Finally, support must continue beyond the initial implementation and include assistance to patients and regular reporting of results.

Improving patient engagement can lead to exponential leaps in positive patient results, and is a worthwhile goal for healthcare providers. Medical receivable factoring can alleviate the cost concern by providing your facility with the cash flow you need to create and execute a viable engagement plan. Learn more about PRN Funding’s healthcare factoring program and get started today.

Older Posts
Newer Posts