Study Finds Healthcare Sector among Most Obese

In a seemingly ironic twist of circumstance, the American Journal of Preventive Medicine reported that the healthcare industry is among the top 10 most obese industries.

The data analyzed came from the 2010 National Health Interview Survey as well as self-reported personal statistics from employees. All healthcare workers are included in the overall “healthcare” sector, but a breakdown of health service employees versus practitioners indicates that the former are more at risk for obesity than the latter.

Researchers correlate risk for obesity in the job sectors listed to job factors such as stress, long hours, and working conditions that minimize movement and activity. In that respect, healthcare practitioners such as doctors and nurses benefit from time spent on their feet going between patients.

Long hours and shift work can make it difficult for workers to fit exercise into their schedule or to prepare and eat healthy, balanced meals – after all, a trip through the drive-thru is faster and less labor-intensive, thus more appealing to an employee coming off of (or heading into) a 12-hour shift. Also at issue are differences in pay that can prevent some workers from choosing healthier options.

One possible contributor to obesity in the healthcare setting that is not discussed, but that has interesting implications, is a shift toward banning smoking by healthcare employees. Healthcare employees who quit smoking may compensate by eating more, either to fill the time or because of the lack of cigarettes’ appetite suppressant effect.

Obesity can be a significant contributor to health care costs. With that in mind, understanding the prevalence of obesity in the healthcare industry – as well as its causes – can help healthcare employers adapt their working conditions and employee benefits to promote healthier lifestyles. For example, a hospital may offer free or subsidized memberships to gyms or weight-loss programs, or tie the achievement of health goals to lower premiums.

PRN Funding offers invoice factoring to the healthcare industry, which can improve your cash flow and allow you to invest in your employees’ health. Contact PRN Funding to learn more about your healthcare factoring options and to fill out an application today!

ACA: The Cost of Non-Enrollment

With the March 31 enrollment deadline looming, the Obama administration is working overtime to encourage uninsured Americans to purchase coverage in state or federal marketplaces. Approximately 50 percent of uninsured consumers plan to remain uninsured for a number of reasons, raising the important question: what is the cost of not enrolling in a valid healthcare plan?

Required Coverage

ACA-compliant health insurance policies must meet the law’s requirements for minimum essential coverage, which includes all government-administered plans as well as new and grandfathered employer plans and coverage offered by universities. While other plans may also meet the minimum essential coverage standard, consumers who hold non-compliant policies will be subject to the same penalty as uninsured consumers. Vision and dental-only plans, workers’ compensation, and healthcare savings accounts do not qualify as compliant policies.

Most consumers are required to carry a compliant healthcare plan; however, the ACA provides a number of exemptions for consumers who are unable to afford a qualifying plan or who fit other criteria.

How does the penalty work?

The 2014 penalty for uninsured consumers is the greater of $95 per adult/$47.50 per child, up to $285 per family, or one percent of your family’s gross adjusted income above the tax return filing threshold. (If your income is not high enough to require a tax filing, you are exempt from the individual mandate.)

Despite the focus on the $95 flat fee, more consumers earn more than the $19,650 that matches the $95 fee and will be required to pay a higher amount. For example, a family earning $50,000 annually would have to pay $297, or one percent of their eligible AGI – $12 more than the flat fee maximum. Though penalties are capped at approximately $9,800, many families do not make enough to meet this cap and will be on the hook for their entire penalty.

Can I enroll after the March 31 deadline?

Your ability to enroll in the federal marketplace after the deadline depends on a number of conditions. Currently, consumers who have attempted to purchase a healthcare plan prior to March 31 will be granted a limited extension to complete their enrollment. Once extensions have ended, you must wait until the next open enrollment period unless you have a change in life situation that qualifies you to enroll.

If you signed up for a policy before March 31 that features a gap in coverage (i.e. does not start immediately), you will not have to pay the penalty. Also, if you are without insurance for less than three months after the deadline you will not have to pay the penalty. For periods longer than three months but less than a year, you will be responsible for each month’s portion of the annual penalty for as long as you are uninsured.

For questions about your specific healthcare needs and plans that are available, visit Healthcare.gov.

With Deadline Looming, ACA Enrollments Fall Short

One week from today marks the Affordable Care Act deadline for individual consumers to have an ACA-compliant policy from their employer or the online health marketplaces. Consumers who have not enrolled in coverage by March 31 will face a penalty on their taxes and will be prevented from signing up for subsidized healthcare until next year.

However, despite the time crunch only a quarter of Americans at this point had accessed the exchanges by January and many thousands of others are still uninformed about their responsibility to obtain coverage. Unfortunately, the majority of uninformed consumers are those who would benefit the most from tax credits and subsidies.

Misinformation is a major source of public reluctance to use the online health exchanges. The political debate over the Affordable Care Act is well-documented, and additional state laws governing the implementation of the individual mandate have further complicated the process.

The Obama administration is elbow-deep in a campaign to inform consumers and encourage them to apply for insurance. Volunteers are contacting households via phone banks, email, and door-to-door canvassing with pamphlets and applications. Canvassers hope that by educating consumers they will be able to dispel some of the myths surrounding the cost of health care plans and demonstrate the importance of having a compliant policy by next week’s deadline.

PRN Funding offers factoring services to cover expenses such as health insurance premiums for companies that work with hospitals and other medical facilities. To learn more about healthcare factoring, contact us today.

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Young Consumers Not Using Healthcare Exchanges

According to reports from the Obama administration about healthcare enrollment in the online marketplace through January, only 25 percent of consumers who have purchased healthcare plans fall into the critical 18-34 demographic. The figure is far lower than the number of young consumers who have created accounts on the exchanges.

Many experts and administration officials have touted the importance of young consumers using the healthcare exchanges to balance the cost of care for older patients. While insurance companies can vary costs to a certain degree based on age, it is not enough on its own to control the difference in healthcare needs between the two demographics. A continued slump of young enrollees could prompt insurance providers to raise premiums significantly within the coming years, which would put a strain on the entire system.

One potential explanation for the lack of enrollment in the younger demographic is its overlap with another provision of the Affordable Care Act which allows parents to keep adult children up to age 26 on their own health insurance. The overlap affects nearly half of the exchanges’ target demographic, specifically college students and young post-graduates.

The federal government is not alone in fretting over low enrollment; states running their own exchanges, such as Minnesota, are also experiencing enrollment that skews toward the older demographic.

If you fear rising healthcare costs could threaten your company’s cash flow, consider healthcare factoring through PRN Funding. We can create a customized factoring program to fit your company’s needs and offset your cash concerns, with approval in as little as 3-5 business days. Apply now to get started.

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ACA: Employer Mandate Receives New Extension

Earlier this week, the IRS released its final rule on the employer mandate. Among provisions regarding employee transition periods and how to classify employees for counting purposes was a new extension of the employer mandate.

After a previous extension moved the start date to January 1, 2015, the mandate is now postponed until 2016 for employers with 50-99 full-time employees. In addition, while large companies with more than 100 employees are still subject to the mandate in 2015, they only have to offer coverage to 70 percent of their full-time workforce for the first year the mandate is in effect.

The Obama administration explained the extension as an effort to give affected companies additional time to come into compliance with the mandate. Two percent of U.S. companies are classified as mid-size and two percent are large, but those companies employ as much as 70 percent of the total labor force in the United States.

Criticism of the announcement centers on frustration that the individual mandate, seen by many to be more of a burden than the employer mandate, went into effect on its originally schedule date of January 1, 2014. Consumers still have six weeks, until March 31, to enroll in a qualifying healthcare plan. The delay of the employer mandate could push a number of those consumers to the online marketplaces if they are unable to obtain a policy through their employer.

The staffing industry is also frustrated with other provisions of the IRS final rule, which limit staffing agencies’ ability to classify their employees as variable-hour or to take advantage of look-back periods to determine their status for insurance purposes. This could potentially raise healthcare costs for these agencies if they are required to provide coverage to employees who are later determined to be variable-hour or part-time.

If you have a nurse staffing agency or work in the medical field and are worried about rising healthcare costs, PRN Funding’s healthcare factoring program can help you turn your receivables into immediate cash. Learn more about healthcare factoring and contact us to get started today.

Does Medicaid Expansion Increase ER Visits?

A study of Oregon’s 2008 Medicaid expansion has been touted as a huge blow to President Obama’s claims that Medicaid expansion through the ACA would reduce ER visits, but a parallel study of California’s 2010 Low-Income Health Program suggests that the situation is not so simple.

Medicaid expansion

Oregon: Medicaid expansion drives up costs

The Oregon study, published in Science by economists Amy Finkelstein of MIT and Kate Baicker of Harvard, measured emergency room visits of more than 20,000 residents living in the Portland area – one group of patients without insurance, and one group newly enrolled in Medicaid. Researchers determined that the Medicaid patients visited emergency rooms 1.4 times over 18 months, while the uninsured group visited 1.02 times in the same period. They further determined that nearly half of the increased visits were for complaints that could have been treated by a primary care physician (PCP), or were for emergency complaints that could have been prevented by PCP care.

Overall, ER spending in the Oregon study was estimated to have increased by $120 per covered patient. The researchers attribute this to a structural flaw in Medicaid’s design that reduces cost-sharing for covered patients to zero or near-zero, encouraging more unnecessary visits and raising state spending for Medicaid claims. State governments have responded by drastically reducing their reimbursements to medical providers, and PCPs have further responded by turning away new Medicaid patients.

Their conclusion is that Medicaid patients are more likely to visit the ER than to search for a PCP who will accept them, which then raises the cost of care even more.

San Diego: ER visits appear to be falling – with patient education

However, Paul Sisson of the San Diego Union-Tribune reported yesterday that a similar expansion of California’s Medicaid programs in 2010 has resulted in a two percent decrease of emergency room visits from July 2011 to September 2012. Nearly 50,000 San Diego-area residents enrolled in California’s Low-Income Health Program from mid-2011 to the end of 2013. There is only about a year of available data, and ER administrators have not noted significant changes in visits, but the results thus far are encouraging to doctors and health care researchers in the state.

A key difference between San Diego’s program and Portland’s is the access enrolled patients have to PCPs. In San Diego, new patients in the LIHP were counseled about their healthcare options and connected to a local PCP with whom they had a preliminary visit. These visits were designed to build a relationship so the patient would visit their doctor instead of the emergency room in the event of an illness.

In addition, county employees reached out to the community clinics where they sent their patients to make sure they were able to make same-day appointments. The UCLA Center for Health Policy Research studied ER use by LHIP participants and noted that their ER visits decline as they become accustomed to having insurance.

In Oregon, on the other hand, there is no record of patient education to suggest that patients knew about or had access to alternative healthcare options. As stated by UCLA Center for Health Policy Research director Gerald Kominski,

That behavior of seeking primary care in the ER has been reinforced for a period of years,
and it doesn’t change immediately just because you give somebody an insurance card.

Long-term effects of Medicaid expansion remain to be seen (as do short-term effects in states that have just implemented their own expansions), but these two contrasting studies make a compelling argument that patient education is necessary to fully reap the potential benefits of expanded low-income insurance programs.

Is your cash flow suffering because of slow hospital payments? PRN Funding’s healthcare factoring programs can help you close the cash flow gap and keep your business running smoothly. Learn more about invoice factoring with PRN Funding and contact us today to get started.

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Merry Christmas, Happy Holidays!

merry christmas

As we prepare to observe Christmas celebrations with our loved ones, we at PRN Funding want to wish you a joyful and prosperous holiday season – whatever your holiday.

We give special thanks to the nurses, EMTs, and other healthcare staff who will work through some or all of the holiday to keep others safe and healthy. May the hours move quickly so you can be home with family and friends.

Take the time to reevaluate your company’s goals for 2014, to form new ideas and get rid of old ideas that are not working for you. Make a plan to pursue even greater success, or to overcome the greatest challenge facing your company today.

Finally, regardless of your company’s position, consider gifting yourself with peace of mind from money concerns. PRN Funding is here to help you beat your cash flow woes with a flexible healthcare factoring program perfect for a variety of services and industries. Of the gifts under your company tree, factoring is the gift that will deliver continued success year-round.

Merry Christmas, and Happy Holidays!

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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”.

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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.

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