Colorado Furor Over Internet Software Tax Bill

The Colorado legislature has many high technology companies and consumers up in arms over the passage of HB 10-1192, which in effect imposes a sales and use tax on downloaded software in the state of Colorado. This may have some impact on Colorado companies that sell healthcare software over the internet to consumers in Colorado.

The bill taxes downloads of “standardized software,” which the bill defines as “computer software, including prewritten upgrades, that is not designed or developed to the specifications of a specific purchaser: or Computer software designed and developed to the specifications of a specific purchaser but then sold to another purchaser.”

The legislation has been met with load outcries of alarm from the Colorado technology community and those actively engaged in economic development in the state. The original bill has been modified with an expansive legislative declaration that the bill is ‘not intended to alter, other than the designation of standardized software as tangible personal property, the tax treatment of what is known in the industry as “digital goods”, “application service providers”, software as a service” or “cloud computing”‘.

This bill was designed to reach the “Turbo Tax” crowd. The idea is to eliminate the perceived inequality in tax application when software is sold in shops from where it is sold over the internet and downloaded. It is one of a series of bills where the legislature is reaching to tax on line product sales. Although the bill is self described as the repeal of an “exemption” in truth there was no “exemption.” There was no tax in the past because the tax is on “tangible personal property” and software is an intangible, except when it sold on DVD. The legislative solution is to change the definition of “tangible” to include what is “intangible.” Just redefine “white” as “black.” Problem solved. “Down” is the new “up.” Is this a wonderful country or what? This may be an example of that wonderful definition of statutory law as “common sense as amended by the legislature.

Ensuring Operational Efficiency and Effective Cost Cutting in Healthcare Settings – Best Practices

Operational efficiency has become paramount in healthcare systems with the ever increasing patient base, and the challenge inherent in rising up to the demand for unique patient care services. Healthcare organizations looking to cut down administrative costs find it to be a really testing task and are constantly on the lookout for potent cost cutting strategies. The efforts to cut costs should not prove detrimental to care providers’ vested objective, i.e. ensuring patient and employee satisfaction. Another vital consideration is that no strategy can be successful unless the administrative as well as clinical staff in an organization works in coordination.

Using outsourced services has proven beneficial for many healthcare and other businesses looking to save valuable dollars. While it is a known fact that cost cutting is the primary spur for the rise of outsourcing, at present outsourcing has moved much beyond a mere cost saving strategy. Outsourced services such as medical billing and coding services, medical website design and medical website optimization are provided by BPO companies that work side by side with their client healthcare providers. Apart from ensuring cost savings in the range of 20% to 30%, outsourcing is also a way of achieving easy scalability within a short period of time.

The Banner Health Model

A recent HBR (Harvard Business Review) blog highlighted how Banner Health, a prominent health system in the US successfully achieved efficiency as well as cost reduction through a successful strategy. Banner Health had lost hundreds of millions of dollars as a result of plummeting patient volume and reduced reimbursements during the recession. However, they were able to secure $70 million in savings during 2012 – 2013. It is expected that by the year 2017 Banner Health will have $256 million contributed each year to its bottom line by this savings. How did this $5 billion nonprofit system achieve this?

They assiduously followed a sensible cost reduction policy, while always keeping in view their core values.

Banner Health avoided adopting industry benchmarks in their cost-cutting endeavor and focused on a savings target based on their own performance.

They educated employees of the inevitability of cost cutting measures and the need for a process redesign across the system to improve patient care. They were able to remove the fear of impending layoffs from the employees’ minds. They also convinced the employees how cost cutting would help them invest in new constructive initiatives aimed at better coordinating, standardizing and integrating care provision.

People from across the health system were asked to collaborate in cost reduction efforts. This definitely helped them to identify tens of millions of dollars in savings and at the same time ensure support of staff and frontline leaders. Banner’s team invited recommendations from the team to reduce the general and administrative (G&A) costs.
The senior leadership reviewed 123 recommendations, of which 116 (valued at $104 to $133 million annually or 18 – 24 percent of Banner’s G&A expense) were approved. These recommendations included opportunities to save at least $8 million through insourcing second physician reviews of inpatient charts, $4 million in human resource administration by implementing more self-service technology in collaboration with a shared services organization, and $3.5 million by creating an internal facility for drug compounding and packaging. This strategy was successful since by the latter half of 2012, Banner Health could recover $31 million in G&A savings.

The team went on to work on its clinical operations as well, beginning with Banner Good Samaritan Medical Center in Phoenix. The physicians at the hospital were included in the team and they were asked to contribute their ideas. Banner Health’s strategy was effective because physicians are a necessary component of any team working to ensure optimum patient care and at the same time bring about significant cost reduction. Clinicians are knowledgeable in clinical functions and operations; they can drive revenue generation and are directly involved in patient care services. Here again the health system could reduce the cost structure by 15% and secured $15 million in direct savings over the next 12 months. Banner North Colorado benefited from the same strategy that was set in motion there as well, capturing more than $13 million in annual savings the first year itself.

Banner Health implemented a system-wide optimization program covering all of its 23 acute care hospitals and healthcare facilities. Their success lies in the fact that they were able to create an awareness regarding the significance of cost control throughout the workforce.

A Case for Outsourcing

With the healthcare reform and related requirements, healthcare providers and health plans are finding it advantageous to outsource information technology, business processing and call center tasks. Outsourcing will allow a more efficient and potent combination of capabilities and resources. Expert observers endorse the fact that third party collaboration will help ensure better performance, increased efficiency and of course cost reduction. While physicians can make use of an outsourcing service to handle medical billing and coding requirements, there are service providers that use technology to connect payer and provider in real time. With this, providers can check for patient eligibility, referral policies, limits on service and the financial responsibility of patients. Providers can also submit claims in real time.

Outsourcing will prove to be a wise investment if it is assigned to a firm that follows the required standards for accuracy and turnaround time. Consider the references and talk to clients using the same company so that an informed decision can be made. It is true that outsourcing involves loss of control to a certain extent, and that is why it is vital to choose a reliable and reputable outsourcing partner.

It is apparent that in these tough times, cost cutting has become a necessary measure for all businesses including those involved in healthcare provision. Banner Health’s example proves how all members of a healthcare system can be constructively involved in cost saving efforts. Identifying and implementing best practices in cost reduction, including the use of healthcare outsourcing services is the need of the day for health systems striving to bring about a sea change in the quality and cost of care.

CNA Classes in Colorado

CNA classes in Colorado prepare you for a career that offers job security. Job openings for CNAs are on the rise, with predictions of CNA careers boosting significantly until 2020. CNAs are needed in Colorado to care for people of all age groups who are in many types of health care settings. CNAs provide personal care for patients under supervision of a registered nurse.

Training Options:

There are many CNA training programs to choose from in Colorado. Research a few classes before enrolling in one to make sure you find a program that will fit your schedule and meet your educational needs.

Community and Technical Colleges in Colorado offer state approved CNA programs which prepare you to take the state competency exam for licensure.
Many Nursing Homes in Colorado offer in-house CNA programs at no cost, in order to train and retain CNAs for their facility. These programs are state approved and render you eligible to take the competency exam upon completing the program.Students are required to work at the facility for a certain amount of time after graduation and some nursing homes pay students an hourly wage while they are training.
The American Red Cross is known for its CNA program that prepares students to work in long-term care facilities. This is a state approved program which prepares students to take the competency exam for licensure. Check with your local American Red Cross to see if they offer this program.
Job Corps offers a CNA program which prepares students to work in different health care settings. Job Corps is a federally funded program for young people age 16 to 24 which offers free education. They also offer free room and board and a living stipend.

CNA Schools in Colorado

Arapaho Community College offers a part-time Nurses Aid program which is designed to be completed in one semester. The program is also designed so students can continue to work at their day job while studying. Upon completion of this program, students are eligible to take the CNA competency exam and will be able to work in many types of healthcare facilities.
Front Range Community College offers a rigorous full-time CNA program which includes theory and clinical rotations. This college is known for its comprehensive programs which covers more than the average CNA program. Front Range Community College has a 91% pass rate of graduating students who take the competency exam.

Online Studies

Online studies are available for students who can’t attend a traditional class setting because of work or family obligations. Once you’ve estabished how to find CNA classes, always check with your State Board of Nurses Assistants to be sure the program is acceptable and learn if you have to take additional testing before testing for licensure.

Global Healthcare Billing – Coming to Your Community Soon

In Colorado, Oklahoma, New Mexico, and Texas, the Center for Medicare and Medicaid Services (CMS) has begun a demonstration grant process to look into global fees, in which CMS will contract with a group of providers to accept a single fee for all medical services delivered for a single episode of care.

In January 2009, approximately 20 cities will participate in the Acute Care Episode (ACE) Demonstration Project, where a single group of physicians and hospital(s) accept a global fee for up to 37 Medicare-Severity Diagnostic Groups (MS-DRGs) in cardiac and/or orthopedic surgery.

The implications are that global fees will create two classes of providers: those that can adapt to the new system and thrive and those for whom the bathtub water is swirling. For those who thrive, my seminar participants believed that the successful providers will realize that:
o Global fees are an opportunity to improve physician-physician as well as physician-hospital communication
o Physicians and hospital leaders must pay at least as much attention to enlarging the pie as dividing it
o Shared values, based on the needs of the community, will eventually dominate the discussion
o What is right for the community will transcend who is right
o Physician advisory groups, comprised of physician champions who have earned the clinical respect of their colleagues, will lead the discussion
o New physician leaders will emerge through this process
o The practice environment will improve for other MS-DRGs as a result of the process
o When physicians are treated as adults, with access to data and authority to participate meaningfully in clinical priority setting, they behave like adults, with active participation and sensible recommendations
o Through the process of discovery, physicians can begin to act as responsible stewards (and perhaps owners) of scarce community and hospital resources.

New Healthcare Law Adds New Protections For Nursing Mothers

The recent healthcare reform law, known as the Patient Protection and Affordable Care Act, contained a provision which amended the Fair Labor Standards Act (“FLSA”) to require an employer to provide reasonable break time for an employee who is nursing to express breast milk for her child for one year after the child’s birth each time such employee has a need to express milk. Further, the law requires that the employer provide a place, other than a bathroom, for the employee to express breast milk. Some employers, already covered by state laws dealing with breast feeding mothers at the workplace, establish what are called lactation rooms to be used by nursing mothers who need to express breast milk during the work day.

This amendment to the FLSA does provide that the employer is not required to compensate an employee receiving reasonable break time for any work time spent expressing breast milk. However, this provision may pose practical difficulties for employers. Employers will have to decide how or whether to take advantage of this provision, with respect to keeping accurate records of time worked by employees.

The new amendment also states that if complying with this new law would impose an undue hardship on employers which employ fewer than 50 employees, then the employer need not comply with the law. However, since this provision allows an exception to the law, small employers should expect that when the Department of Labor issues regulations interpreting this law, this exemption will be very narrowly construed.

This amendment to the recent healthcare legislation is intended to further a public health goal of the United States Center for Disease Control to increase the proportion of mothers who breastfeed their babies in the early postpartum period to 75 percent by the year 2010. Health professionals and public health officials have promoted breastfeeding to improve infant health. These health professionals believe that mothers and children benefit from breast milk. Breast milk contains antibodies that protect infants from bacteria and viruses. Breast fed children have fewer ear infections, respiratory infections, urinary tract infections and have diarrhea less often. Infants who are exclusively breast fed tend to need fewer health care visits, prescriptions and hospitalizations resulting in a lower total medical care cost when compared to children who have never been breast fed.

It is also believed that mothers who breast feed also receive long-term preventative health effects, including an earlier return to pre-pregnancy weight and a reduced risk of pre-menopausal breast cancer and osteoporosis. According to the Centers for Disease Control and Prevention, approximately 70 percent of mothers start breastfeeding immediately after birth, but less than 20 percent of those same mothers are breastfeeding exclusively six months later.

When this new law took effect at least 24 states, including, Arkansas, California, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Maine, Minnesota, Mississippi, Montana, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming, had some type of state law offering protection to nursing mothers who were breast feeding and needed to express milk while at work. The breast feeding amendments in the federal healthcare law build on these existing state laws by providing that any state law which is more protective than the federal law takes precedence over the federal law. Thus, employers in states with breast feeding laws that go beyond the new federal requirement need to ensure that they are complying with state law. All employers need to review their policies and practices with respect to nursing mothers to ensure that they are in compliance with state or federal law, whichever is applicable.

Colorado Individual Health Insurance – Affordable Plans Online

Deciding on which health plan to buy is not an easy task. Health insurance companies are rolling out new types of plans everyday. Whether you’re looking for an all-inclusive type plan, or the bare bones type of plan, it’s there for you online.

Affordable Colorado Individual Health Insurance Plans

Health insurance plans in Colorado vary widely. You can find low cost plans that cover major medical events, or you can get a plan with coverage from top to bottom. Many plans can even be customized with only the coverage you want.

One popular method starts with a basic hospitalization plan. Many of these basic plans offer (pick and choose riders) that you can add-on to a basic policy, this way you only pay for what you want in medical coverage. It could be a routine doctor visit rider, or it could be a small emergency rider that you add-on to your basic hospitalization insurance plan.

By searching out your options in health insurance, you’ll soon find many variations of health insurance plans at all price levels. One off the most popular is a (Managed Health Care) type of plan. This type of plan provides quality health insurance coverage at the lowest possible cost. This type of plan relies on a network of healthcare providers in your area.

Most Insurance companies have a list of available providers listed on their web sites. Always be sure to check the list of providers in your area. Some areas have many choices and other areas have fewer choices.

Colorado Health Insurance Information and Quotes

Shopping for health insurance plans, information, and quotes is easily done online. There are websites chock full of information about health insurance plans in Colorado. All you need to do is browse a few of these websites, to find everything you need to know about buying health insurance.

Colorado Health Insurance Companies

As the healthcare requirements of citizens are increasing, so is the cost of treatment for a number of diseases. Colorado health insurance companies are targeted to meet the specific needs of individuals and groups of employees by offering various health insurance plans.

In Colorado, Applied Financial Strategies Inc. (A.F.S.) is focusing its attention on reaching out to small businesses and individuals to help with their insurance needs. An independent insurance company, A.F.S. represents a variety of insurance companies. You can find them on the Internet, and it’s easy to get information and apply online. A.F.S. can deliver complete coverage at a reasonable cost. They will give you insurance quotes, coverage information, and the personal attention by a licensed health insurance professional. They offer individual medical HMO (Health Maintenance Organization), (PPO Preferred Provider Organization), and major medical health insurance plans for you and your family. They also offer group health policies and short term medical.

Many companies offer HAS accounts. This is a health savings account in Colorado that seems to be a cure for America’s health care concerns. There are two parts to HAS: The first is a high deductible major medical insurance program, and the second is a pre-tax bank account used to pay medical expenses when you need it. This type of arrangement works out for those individuals and families with additional income who can save for their future health requirements. Members will be able to make use of dollars saved in the account to pay the medical expenses and enjoy the tax benefits at the same time.

When trying to choose a health insurance plan the most important things to consider are the coverage and premium. Also, make sure that the doctor you have is covered under the policy you are looking at. Should you have a pre-existing condition, check on the Underwriting practices of the insurance company you are considering. Always check out and weigh the differences between several different companies.

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Colorado Health Insurance Policies

Colorado health insurance policies are designed to provide health cover to individuals, self-employed, group of employees, the elderly and students. These policies are mainly intended to provide coverage to insured members in meeting their costs towards treatment, doctor visits, physician consultation, investigation, and operations besides the hospitalization costs.

If you are interested in an Individual policy, in Colorado you are subject to a medical review, and there is no guarantee that you will not be accepted. The insurance company may request your medical records from doctors and may exclude certain pre-existing medical conditions. They can also decline insuring you. Many plans will not cover maternity care, but you may be able to add it as a rider to the regular coverage. This will cost you more, but it’s worth it. Without this coverage, the huge expenses involved in maternity care can really scare away expectant parents and the joy may soon turn into a burden. Coverage for pre-existing conditions vary and depend on what condition you have and what insurance you are looking for.

Group insurance policies are guaranteed and there is no medical review. A qualifying business has to be accepted by providing tax information and other documents requested. Acceptance of a group policy is contingent on qualifying as a business, and being able to provide the necessary tax and other documents requested by the carrier.

Health Savings Accounts (HSAs) have been in effect Colorado since January 1st, 2004. This allows for a high deductible medical insurance policy with a special tax-deferred “Health Savings Account.” Anthem, Rocky Mountain Health plans, Fortis and United Healthcare, are just some of the Carriers that offer HSA compatible policies and many more are expected in the coming year.

When deciding on PPOs or HMO remember the differences. In an HMO your primary care physician is the one who has to refer you to specialists or other doctors. PPOs allow you to see other physicians without a referral. But, the doctor you see must be listed in the PPO network. PPOs are more expensive than HMOs. They both have pluses and minuses.

Tips For Buying Colorado Health Insurance

Getting your hands on the best Colorado health insurance you can afford may seem like a daunting task, but it doesn’t have to be when you know what you’re doing. Read on for some tips to help you find the best Colorado health insurance plan for your budget.

Know your options

To obtain a plan, you can either buy individual health insurance or you can get group health insurance through your employer. There are several kinds of plans to choose from. Here is a brief primer.

FFS (Fee-for-Service) – A fee-for-service plan will pay a specific amount for each service rendered by your health care provider. There are limits, called “allowable amounts”, that the plan can pay. You should clarify these limits and other details with your insurance company. FFS plans are not very popular in Colorado because, in general, we have good access to PPO and HMO networks. As such, you can usually get a better value by opting for a PPO or HMO plan.
HMO (Health Maintenance Organization) – In this plan type, you are limited to the health care providers within the HMO network and often times are assigned to a primary care physician (PCP). Your PCP helps to “manage your healthcare”.
PPO (Preferred-Provider Organization) – This plan resembles that of an HMO, except that you may use providers outside of the network, although at lesser rates and benefits than any of the preferred providers. In addition, with a PPO you generally have the flexibility to see any specialist without first having to get a referral from your PCP.
HSA (Health Savings Account) – A Health Savings Account (HSA) is a tax advantaged savings account that allows you to set aside money for health care. This savings account is paired with a high deductible health insurance plan – the result being affordable yet comprehensive health coverage.

Study and compare plans

Given that you have a wide variety of plans to select from, don’t just get what your neighbor, co-worker, or best friend got. Each person has different needs and your insurance should be capable of meeting those needs when the time comes. Ideally, you should base your choice on these criteria:

the quality of the medical care you will receive
the coverage of your plan
how much your premiums will cost

Consider all these factors and weigh the cost with the benefits. Don’t shortchange yourself by getting affordable health insurance but with mediocre coverage – when the worst happens, you’ll be the one left holding the bag.

Look for alternatives

Having a hard time getting insured? Getting adequate health insurance in Colorado depends in some ways on your current health, family, and employment status. If you find that you have been denied or can’t afford health insurance, don’t despair. There are several programs you can turn to.

Medicaid – You may qualify for this if you already have a pre-existing condition and are in a low income bracket. Find out if you are eligible for Medicaid by contacting the Colorado Medicaid Program at 1.800.221.3943 or 1.800.659.2656.
Child Health Plan Plus (CHP+) — Colorado provides plans for children from low income families through the CHP+. There are several rules pertaining to income brackets and family sizes.
Medicare – Another program you can turn to if you have a pre-existing condition or disability. Normally you would have to be 65 years of age or older to qualify, but you still can access this program if you have a condition that is expected to last more than one year or is considered fatal.
CoverColorado — This is a state-run program that sells health insurance to a select number of high-risk individuals–people turned down by other Colorado health insurance companies due to a serious medical condition or disability.

Get Expert Advice

Let’s face it, health insurance policies can be hard to comprehend without some guidance. In Colorado, as anywhere, the right advice can give you the coverage you want while saving you hundreds (or thousands) of dollars a year. You can get advice from two sources: a good agent or a health insurance website.

You can source a good agent from friends and family members. As a criteria, a good agent won’t just help you find the right policy; they will provide service before, during, and after the policy has been sold. That means helping you helping you update your plan, being upfront about the rules and limits of your coverage, and helping you sort out claims issues if and when the need arises. In addition, a good agent will monitor your policy over the years to ensure that you are still getting the best value for your premium investment.

Understandably, some people don’t have time to go from agent to agent. If that’s the case, a health insurance website is the way to go. Look for an insurance website that is backed by a well-established insurance agency that offers a variety of services, and who are tried and tested experts on Colorado health insurance.

Read Your Policies

In the end, its all about knowing what you own. Don’t rely on blind faith that you’re getting the right health plan for your money. If you’re not sure about the terms, clauses and limits in the document, talk to an expert about it. And finally, don’t be afraid to say no. As Warren Buffett said, “If you don’t feel comfortable owning something for 10 years, then don’t own it for 10 minutes.”

Chosen well, your health insurance can save your life and preserve your family’s standard of living. It’s worth doing and it’s worth doing right.

Top 2 Schools for Sonography Students in and Near Colorado Springs, Colorado

People who live in Colorado Springs, Colorado say they would not live anywhere else. Situated at the foot of Pikes Peak, the city has a fascinating history that includes an eclectic mixture of the “Wild West”, Native American culture and military installations. It is also one of the most scenic areas of the country and offers a wide range of outdoor activities that include skiing, horseback riding, and hiking. Diagnostic Medical Sonographers in Colorado Springs play an important role in helping residents maintain good health.

Sonography Education in Colorado Springs, Colorado

Students looking for the best sonography education, in order to qualify for the best ultrasound jobs, should attend a program accredited by the Commission on Accreditation of Allied Health Programs (CAAHEP). Scholarships can help pay for the cost of the program, if necessary. The CAAHEP accredited programs have didactic and clinical training requirements that ensure students get the best education possible.

As of 2014, the nearest accredited medical sonography certificate program to Colorado Springs is offered at the University of Colorado Hospital in Denver, Colorado which is only 70 miles from Colorado Sprgs. The certificate program offers a general concentration. The nearest CAAHEP accredited degree program is in Cheyenne, Wyoming, which is approximately 169 miles from Colorado Springs. The Laramie County Community College offers an Associate degree in Diagnostic Medical Sonography with a general concentration. There are almost 50,000 students attending school in institutions of higher education in Colorado Springs. That number includes 31,000 students enrolled at Colorado Technical University Online.

Salary and Job Outlook for Sonographers in Colorado Springs, Colorado

Diagnostic Medical Sonographers are paid well in Colorado Springs and above the national average for this occupation. The Colorado Springs average annual wages for sonographers in May 2013, per the federal government, was $73,980 or $35.57 per hour. This is a 10 percent higher rate compared to the national rate of $67,170 for the same time period. To qualify for most jobs it is necessary to have ARDMS certification.

Colorado Springs has one of the strongest economies and job markets in the country, and that includes the health care industry. There is a network of hospitals and clinics, and Memorial Hospital serves as the regional center for neonatal intensive care and high-risk pregnancies. The online job placement services always have dozens of ultrasound technology positions available at any one time, indicating strong demand for sonographers. With the economy improving, medical centers expanding, and the national healthcare implementation, the future employment outlook is extremely bright.

A List of Best Schools for Diagnostic Medical Sonography Study in and Near Colorado Springs CO

2 cities near Colorado Sprgs., CO with accredited sonography programs in 2014. Since the Western U.S., including Colorado, has vast amounts of land that has mountains, deserts, and other uninhabitable space, there is a great distance between many cities. For this reason, there are not as many options for students who want to commute to school from home.