Would “Copper” Healthcare Plans Actually Be Worthwhile?

Several months ago, Senator Mark Begich (D) of Alaska proposed that the Obama administration add a new tier to the Affordable Care Act’s available healthcare plans. While the administration and other legislators weigh the benefits, significant potential issues have presented themselves.

The new “copper” plans would feature lower premiums than those for bronze plans – currently the least expensive full coverage available – and would cover 50 percent of consumers’ health costs. Patients would be required to pay the balance out of pocket. Copper plan subscribers would likely have a higher spending limit on out-of-pocket expenses than the current $6,350 individual/$12,700 family cap but would also be eligible for tax credits and subsidies.

Higher out-of-pocket costs are just one major concern with the idea of copper-level plans. Another associated issue is whether copper plans would be able to offer lower prices and still offer the comprehensive coverage required by the ACA. Jay Angoff of the Department of Health and Human Services questions whether passing on half of the cost of care to consumers can legitimately constitute “decent coverage”.

Furthermore, enrollment statistics through the March 31 deadline this year indicate that consumers are not particularly fond of low premium-high deductible plans. Approximately 65 percent of consumers chose subsidized or unsubsidized silver plans in the marketplace, while only 20 percent enrolled in bronze plans. Enrollment in catastrophic plans was even lower, at only two percent.

Copper plans would also pose a threat to healthcare spending in facilities and systems, turning back the reductions in spending reported by many systems thanks to newly enrolled patients. As copper plans are meant to attract young adults and others who have found even the bronze plans to be unaffordable, the risk of defaulting on higher deductibles is akin to the risk of non-payment by uninsured patients.

If the administration allows the creation of copper plans, consumers should expect to wait until at least the 2016 enrollment period to see these plans for purchase on the marketplace.

Does your healthcare company need more working capital to provide quality health coverage to your employees? Healthcare factoring helps vendors working with hospitals and other healthcare facilities to close the cash flow gap and invest in their business and employees – including in their health. Read more about PRN Funding’s healthcare factoring programs and contact us to begin today.

2015 Health Insurance Rates Vary by State

As health insurance companies begin establishing premium rates for the 2015 enrollment year, some insurers are pursuing substantial hikes while others are proposing modest increases and even some reductions.

Increases proposed by CareFirst in Washington, D.C. range from as little as four percent for higher-tier plans to more than 24 percent for a catastrophic plan. Other providers are also proposing mixed updates to increase certain plan premiums and reduce others. At the same time, UnitedHealthcare is proposing a reduction in all of their rates. Meanwhile, the average increase in New York is around 13 percent according to the state’s Financial Services Department.

Rate proposals in these and other states appear to be heavily tied to a number of factors, including the number of buyers who chose plans on different tiers during this year’s open enrollment period and the rising cost of medical care. Many insurers are attempting to compensate for larger populations of sick patients who use more care and for differences in health care markets.

However, some states’ proposals are more encouraging for consumers. Georgia, for example, has one statewide provider on their healthcare exchange but will welcome two more for the 2015 enrollment period. In addition, the current provider – Blue Cross and Blue Shield – has proposed statewide rate decreases.

Initial rate proposals are typically revised downward during pre-approval reviews by state regulators, so it is unlikely that the highest rates among those reported will go through as proposed. Also, patients who qualify for federal insurance subsidies through the healthcare marketplace will likely see those subsidies rise to match any rate increases.

Small business owners are likely to see at least modest increases in healthcare rates for 2015, among other rising costs of care. If you need a boost in working capital to meet these expanded operating costs, healthcare factoring with PRN Funding can close the gap. Explore the many healthcare factoring options for your company and contact us today to get started.

Bundled Payments May Be the Future of Hospital Billing

If you reside firmly in the 21st century you are likely very familiar with bundling. You can bundle your car insurance with your home and life insurance policies, your cable with internet and phone services – even your soda with your pizza. Hospital billing is picking up on the trend, and soon bundled hospital bills may become the norm.

Typical hospital billing involves individual charges for each element of a given stay or procedure, down to individual doses of ibuprofen. Provider services are billed separately. In a bundled billing plan, however, hospitals would consolidate these charges to a single fee for everything involved in a typical procedure.

Not only do bundled payments offer savings to patients, but they also provide an incentive to hospitals to provide efficient, high-quality care. Hospitals would keep the net funds remaining after a procedure completed under cost, but would be required to absorb any additional costs for extra care or complications.

Medicare is working with more than 300 health care organizations to provide bundled hospital payments for large-scale procedures such as heart surgeries, and other facilities are expected to follow. In the future bundled payments may include those for chronic conditions as well. Rob Lazerow of Advisory Board Co. points out bundled price tags can help hospitals “compete on cost and quality” for patients shopping around.

Hospitals that shift toward bundled payments will need to work with high-quality vendors to provide the best care to their patients. If you want to expand your healthcare company to work with these hospitals, PRN Funding’s healthcare factoring programs can provide the working capital you need to get everything in order. Contact PRN Funding to learn more about healthcare factoring in every sector and to get started today!

Healthcare Sector Adds Jobs in May

Despite nationwide reports of healthcare systems eliminating jobs, the sector added 34,000 jobs last month according to the Bureau of Labor Statistics.

The healthcare sector has added jobs for 131 consecutive months, or nearly 11 straight years, despite the recession and fears that the Affordable Care Act would cause the sector to shrink. Last month’s growth was twice the standard rate at nearly three percent, most of which was concentrated in ambulatory services.

One element of continuing job growth is the increase in demand for services created by larger numbers of insured patients. At the same time, the decrease in uninsured patients due to marketplace policies and Medicaid expansion has reduced healthcare spending for charity care and covering self-pay patients.

Year over year spending has dropped significantly from 2007-2008 levels, but has remained consistent over the last several years.

PRN Funding offers healthcare factoring solutions to a variety of companies in the healthcare sector. If a lack of working capital is keeping your company from hiring the staff you need, learn how healthcare factoring can transform your cash flow and help your healthcare company compete. Contact us today to get started!

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Insurance Premiums Will Rise in 2015 – But Not by Much

Virginia insurance carriers have already filed their plan adjustments for 2015, indicating expected rate increases.

Early predictions of 2015 insurance rates had insurers raising premiums by exorbitant amounts to compensate for higher costs and restrictions imposed on their fee structures by the Affordable Care Act, as well as the greater health needs of previously uninsured enrollees who obtained healthcare during the open enrollment period. However, if Virginia filings are representative of how the nation will go then average rate increases will fall short of expectations.

Average increases will not apply equally to policyholders across the board, and range from just above three percent to nearly 15 percent depending on the provider. Those averages, meanwhile, will vary greatly in their individual application. Some providers are adjusting for average enrollee ages that skew higher, as age is one factor that allows them to differentiate. Providers are no longer able to price their premiums based on the enrollee’s current health unless s/he is a smoker.

Some states such as Washington may release their 2015 rates within the next several weeks, though most will complete their projections by the end of the summer.

Rising insurance rates are nothing new but may precipitate slow payments and other rising costs of healthcare. If you need to close the gap between service and payment in your healthcare company, consider PRN Funding’s comprehensive healthcare factoring programs. We work with healthcare vendors providing services to hospitals and other medical facilities – learn more and apply to get started today!

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Survey: ER Visits Increase During Early 2014

A survey completed by the American College of Emergency Physicians shows that emergency room visits have increased since January 1.

Approximately 46 percent of ER respondents noted an increase in patient visits and another 27 percent reported constant rates. Nearly a quarter of respondents reported decreased patient visits. According to the survey, the patient demographic is shifting toward fewer patients with private insurance but more patients with Medicaid coverage. The increase is also not restricted to certain states or any geographic area.

While proponents of the Affordable Care Act hoped that the law would decrease ER visits by expanding insurance coverage, studies of Oregon’s and California’s healthcare system overhauls in the last several years indicate that the expectation may have been unrealistic. At the same time, the survey suggests that the ACA has in fact played a role in the shifting numbers over the last three months.

The first and most significant reason is that coverage does not equal or lead to access. Many newly insured patients have little access to a primary care physician or clinic for regular care, either because they are not informed about their options or because PCPs in the area are already overwhelmed with volume. The Association of American Medical Colleges estimates that the PCP-patient gap will reach 30,000 next year and continue growing after that.

Emergency care is equally difficult to access in many states. The American College of Emergency Physicians released their 2014 Report Card which gave 21 states an F rating in the “Access to Emergency Care” category.

That said, patients who do have access to emergency rooms – insured or uninsured – may choose the setting because they cannot be turned away; because they are experiencing potentially serious symptoms; or because they need immediate care when other providers are unavailable (that is, on evenings and weekends).

A potentially significant drawback of the ACEP’s survey is the limited number of respondents: many states had too few responses to register as a percentage of the total responses, and in the top participating state – California – only 10 percent of facilities submitted responses. This indicates a great deal of missing data that could impact the survey’s findings. In addition, the survey’s focus on only the first three months of 2014 makes it insufficient to make any far-reaching assumptions about continuing trends.

If ER visits continue to increase it could create greater demand for healthcare vendors to cover staffing and equipment shortages. PRN Funding’s healthcare factoring programs can prepare your healthcare company for future growth by giving you immediate access to working capital. Learn more about our healthcare factoring services and apply today to get started!

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Nurse Group Pushes for Nurse Staffing Ratio in D.C. Hospitals

National Nurses United has joined a Washington, D.C. nurses’ union in calling for the renewal of a 2013 bill intended to mandate nurse ratios at the District’s hospitals.

NNU and the local union argue that understaffing in D.C. hospitals puts patients’ lives at risk, citing 215 separate occurrences when patients were “endangered” because of nurse staffing levels. One example describe a labor and delivery unit in which three nurses of a shift of ten were left to care for ten women in labor when five nurses were pulled away for two C-sections and a hemorrhaging patient.

The original bill would establish a minimum ratio of nurses to patients on every shift at every District hospital. Facilities in noncompliance would face a $25,000 daily fine; required overtime and averaged ratios would be banned.

While some Council members support the legislation, which mirrors legislation enacted in California ten years ago, hospitals argue that the bill fails to consider the unpredictability of staffing needs and unnecessarily raises their cost of labor.

Increased labor costs can slow down hospitals’ payments to their vendors. If slow hospital payments threaten your healthcare company’s cash flow, PRN Funding’s healthcare factoring programs can help. Contact us today to learn how healthcare factoring for your specialty can help you thrive.

Medicaid Expansion Reduces Uninsured Hospital Visits

States that chose to expand their Medicaid services under the Affordable Care Act are seeing significant reductions in uninsured hospital visits.

A review of publicly traded hospitals’ earnings calls by The Washington Post shows that uninsured (self-pay) hospital visits dropped between 28 and 33 percent at some of the largest hospital systems in the country in states that took advantage of the federally-funded Medicaid expansion. At the same time, Medicaid admissions increased anywhere from 4 to 22 percent at those same facilities.

The story is less encouraging in the 24 states that refused Medicaid expansion. Non-expansion states saw upticks in both self-pay ER visits and uninsured admissions, and some actually had decreased Medicaid admissions. Hospitals have pushed for Medicaid expansion, arguing that even Medicaid’s lower reimbursement rates are better than what they (often do not) collect from uninsured patients.

Many states have also dragged their feet in preparing for the ACA’s broader implementation of presumptive eligibility, a system by which hospitals can preemptively enroll families with qualifying income in a Medicaid program to provide them care up-front. The state Medicaid agency then processes the complete application, putting many otherwise uninsured families on the path to coverage.

There are troubling financing implications for the uneven expansion of Medicaid around the country. The increase of self-pay patients in non-expansion states increases the amount of potentially uncollectible funds owed to those hospital systems and facilities, which also raises the risk to a healthcare factoring company.

Factors collect from insurance, Medicaid, and Medicare, but not from individual patients; therefore, more self-pay accounts reduce the number of valid invoices that a hospital can factor to offset the gap in federal reimbursements. If the above numbers continue their current trajectories, there is a very real possibility that healthcare factoring companies may tighten their requirements for working with clients in non-expansion states – or decline to work with them altogether.

We will continue to provide updates on Medicaid expansion and its impact on facilities in both expanded and non-expanded states.

PRN Funding offers healthcare factoring services to vendors providing a variety of healthcare services to hospitals and other healthcare facilities. Learn more about the different healthcare factoring options we provide and fill out our easy online application to begin.

Medicare Payments Concentrated in Few Specialties

Medicare’s 2012 payments to providers were largely concentrated in a few specialties, according to recent disclosures.

An analysis of federal physician billing data illustrates that 14 percent of disbursements went to the top one percent of physicians, with the bulk of payments concentrated in oncology and ophthalmology.

Without information about individual patient cases, though, physicians argue that the raw data lacks the necessary context to be applied effectively. Billing data was off-limits from 1979 until 2013 due to an injunction filed by the AMA for this reason, among others. Many physicians are also concerned that patient and physician privacy could be at risk now that billing data is available.

That oncology and ophthalmology top the list of highest-paid specialties is unsurprising given that Medicare patients aged 65 and older are their primary demographic. Much of the money paid out to ophthalmologists covered many common eye drugs that the physicians purchase up front and prescribe for little profit. On the other hand, last year CMS reduced payments for cataract surgery to reflect updates to the procedure.

Economists hope to use billing data to identify physicians who perform high-revenue procedures with little value to the patient in order to increase their billing. The greatest concern posed by the information as presented is the possibility that some seniors may go through unnecessary treatment simply for a higher paycheck. The AMA cautions that the data released do not illustrate the value of services provided, however.

PRN Funding is a leading provider of invoice factoring services to healthcare providers. To learn more about healthcare factoring, visit our Web site and fill out an easy online application.

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ICD-10 Delay: What Should We Do?

The news of ICD-10’s delay until at least October 2015 has prompted a range of responses from vendors and providers, mostly predicated on whether or not they were prepared for a transition to occur later this year. With a delay signed into law and a new deadline yet to be announced, many organizations are lamenting the dollars and hours they have spent to be ready and the money they will now have to invest in waiting out the delay.

There are two paths of action that providers and vendors can take in the minimum 18-month waiting period now facing them: stay ahead of the game, or catch up.

If you’re ready, stay on the ball.

ICD-10’s delay unfortunately has the collateral effect of punishing companies that worked to put new systems in place well ahead of the latest deadline. Many of these companies have invested money into software, employee training, and testing procedures and are reluctant to invest even more to maintain an indefinite ready state.

For these companies, professionals advise to keep forging ahead. Unless there is an announcement down the line that ICD-10 will be skipped entirely, prepared vendors and providers can stay ahead of the curve by continuing to test their updates and train coders to comply with ICD-10. In addition, you can cease dual coding once your ICD-10 accuracy reaches acceptable levels and simply translate ICD-10 codes to the less specific ICD-9 codes for billing until the new standard is officially implemented.

If you’re not ready, get there.

The minimum eighteen-month delay is a significant reprieve for providers, vendors, and payers that are not on track for a timely transition, including the Centers for Medicare and Medicaid Services. For these companies, it is critical to make the best use of the extension they have been given.

Companies that have found ICD-10 preparation to be a heavy financial burden should make and implement a plan to invest in the necessary training and software with enough time to undergo full testing. If companies choose to drag their feet further and squander the added time, it could result in hundreds of thousands of wasted dollars and more delays down the road. The Medical Group Management Association (MGMA) is pushing for CMS to take the lead on end-to-end testing, though CMS has no plans to conduct their own testing until at least July of this year.

If the ICD-10 delay is causing cash flow problems for your company, PRN Funding can help. Our healthcare factoring programs give you immediate access to cash that you can invest in infrastructure, training, and further developing advances such as the ICD-10 transition. Contact us to find out more about healthcare factoring services and to receive an application today.

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