Despite Obama’s statement about reforming Wall Street being an “army of lobbyists already arm-twisting members … to reject these reforms”, the president has promised to use everything at his disposal to achieve.  In fact, he devoted his weekly radio address on March 22 the financial reform bill, which he said was essential.

Senators will today begin thrashing out legislation to overhaul the US financial system as the Senate Banking Committee starts a week of meetings on a draft financial reform Bill.

Republicans on the committee refuse to support the draft Bill created by Senator Christopher Dodd, the Democrat committee chairman. President Obama is particularly keen to see creation of a new consumer financial protection agency, a proposal that Republicans have criticized as creating further bureaucracy and that the financial industry has fought hard against, most recently with a multimillion-dollar advertising campaign.

Ben Bernanke, the Fed Chairman, also urged the Senate Banking Committee to support the proposed reforms. On March 20, he said that the existence of “too big to fail” companies was pernicious and a barrier to competition.

“It is unconscionable that the fate of the world economy should be so closely tied to the fortunes of a relatively small number of giant financial firms,” he said.

Timothy Geithner, the Treasury Secretary, will take up the argument for Senator Dodd’s bill today, when he is scheduled to address the American Enterprise Institute on the legislation.

Senator Dodd created the Bill alone after he failed, despite months of discussion, to come up with a bill in partnership with Senator Richard Shelby, the senior Republican on the committee.

The Republicans have filed about 400 amendments to the draft legislation. Both parties have agreed that reform is needed to prevent a repeat of the financial crisis, but Republicans are opposed to key elements in the draft Bill.

They would prefer that consumer protection powers be given to existing regulators rather than create a new protection agency.

The Republicans disagree over the need for a $50 billion fund that banks would contribute to in case regulators needed money to liquidate a failing company.

And a number of committee members are unsure about the President’s so-called Volcker rule, which would outlaw proprietary trading by banks.

Senator Dodd is under pressure from the White House to get his Bill passed. The President set out his plans last June for the biggest overhaul of US financial regulation since the Great Depression.

The Democrats only have 59 votes in the House and not the 60 required to pass legislation, which means they will struggle if the banking committee is unable to come up with a bipartisan bill to present to the Senate.

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My Take: Why can’t our government agreed on anything amongst themselves?  It seems that the only time politicians do not argue is during elections season.  Then they just point fingers at the other guy and say he’s wrong or tell people what he’s done wrong.  Other than that, they worry about their office furniture.  I bet they even worry about their home office furniture and we pay for it.

Maybe the men that are in Congress should take a hint from the women in Congress and take a long hot bath with candles.  It’s called aromatherapy and it can be very relaxing.  They have a large variety of products online so they shouldn’t have any problem getting the products.  Then again, that is probably too feminine for those macho men.

One thing they could do to help this country financially is to take a pay cut themselves!  But, that’s too easy!  They would rather require police officers and fire department and teachers to take pay cuts while they vote for a new pay increase at the beginning of the next session.

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The family of an 11-year-old boy killed in a vehicle crash that was caused by an aged tire was awarded $18 million by a California jury.  A Southern California tire chain store, American Tire Depot, put a tire on the Ford Explorer involved in the accident and was found negligent for doing so because the tire old.

In May of 2006, 11-year-old Willie Moreno was killed when his family’s Explorer rolled over on a highway in Riverside, California. The left rear tire had experienced a catastrophic tread separation, and it was later found that the Firestone tire was 12 years old at the time of the accident.

Attorneys for the Moreno family alleged that ATD was responsible for rotating the 12-year-old spare tire onto the Explorer when the vehicle was brought in for replacement tires. They said that the family went to ATD to replace its two rear tires, and that ATD sold them one tire and told them to rotate the spare in.

As reported by ABC News, aged tires can present a hidden danger even if their treads are unworn and they haven’t been driven a mile. According to consumer and industry sources, as tires age the rubber can deteriorate and become brittle, leading to a possible tread separation. Automobile and tire companies have issued bulletins recommending “shelf lives” for tires ranging from six to 10 years.

During the trial, the jury was presented with evidence showing that both Ford and Firestone have issued bulletins on aged tires. In 2005, Bridgestone Firestone sent out a technical bulletin to its dealers that said, “It is recommended that all tires (including spare tires) that were manufactured more than ten (10) years previous be replaced with new tires.” Also in 2005, Ford Motor Co. issued an advisory about aged tires, stating, “Tires degrade over time, even when they are not being used.” Ford recommended replacing tires “after 6 years of normal service.”

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“This tragedy could have been easily prevented,” said Roger Braugh, one of the attorneys representing the Moreno family. “The facts of this case showed very clearly that American Tire Depot did not offer even a minimum of professional attention to tire safety.”

William Delhagen, the defense attorney for American Tire Depot, said he was “disappointed” by the decision, and that ATD had presented evidence showing the company was not responsible for installing the tire in question on the Explorer. According to Delhagen, the jury “allowed sympathy to overwhelm a careful evaluation” of the case.

Currently there are no federal standards setting an “expiration” date for tires. Tire industry trade groups have come out strongly against such a measure, arguing that factors such as excessive use, and poor maintenance and storage are more important in determining whether or not a tire will fail.

A bill was passed last year by the California assembly that requires tire dealers to disclose the age of a tire in writing to consumers prior to sale or installation of the tire and it was supported by the regional family.  However, that bill was withdrawn before to be voted on by the state Senate by its sponsors because of strong industry opposition.

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My Take: There must have been evidence that proved that one of the tires put on the rear of that SUV was done so by ATD.  Otherwise, they wouldn’t be paying $18 million.  One thing is for sure, they must have had a good TX wrongful death lawyer and he is going to get pretty good fee for such a good job.  At least they didn’t need a Houston construction accident lawyer.

I feel for the family and their loss.  It is always a tragedy when a child dies.  Many parents cannot take the strain and end up divorcing.  That means they look for NJ divorce attorney.  Some parents may even look for a Fort Lee NJ divorce mediator who might be able to resolve the situation.

I do not know how LA court reporters can sit in the courtroom and listen to the evidence presented in cases like this.  If I were a Los Angeles court reporter I would have to learn how to control my emotions.  Otherwise, I would be sitting there crying during the whole trial.

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On March 10 the Senate passed a $149 billion jobless aid and tax breaks package in an effort to lower the 9.7% unemployment rate before congressional elections in November.

Barack Obama

The measure, approved by a vote of 62 to 36, now heads to the House of Representatives, where many Democrats have pushed for more aggressive job-creation measures in the face of the worst U.S. economic downturn since the 1930s.

President Barack Obama said the vote would help small businesses and jobless workers, and expressed thanks for the bipartisan support that it attracted.

“I am grateful to senators in both parties who took one more step forward today in getting our nation back on a solid economic footing,” he said in a statement.

Democrats say job creation is their top priority this year as they head into an election season that could possibly cost them control of Congress.

Both chambers have now passed two job-creation bills, but they have yet to resolve their differences and finish legislation that Obama can sign into law.

Democrats passed an $863 billion stimulus measure last year to battle the recession. That effort created up to 2.1 million jobs, according to the nonpartisan Congressional Budget Office, but the high price tag has prompted a growing voter backlash.

The bill passed on Wednesday by the Senate largely continues existing government policies. Jobless workers would see their unemployment benefits and healthcare subsidies extended to the end of 2010, while businesses would once again benefit from $25 billion worth of tax breaks that expired at the end of 2009.

The bill’s $149 billion in new spending is partly offset by $37 billion in revenue raised by closing tax loopholes.

That could conflict with Obama’s plans to use the new revenue to help pay for his proposed healthcare overhaul.

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HELP FOR STATES

Cash-strapped states would get $25 billion to help cover their portion of the Medicaid government-run healthcare program for the poor.

More help could be on the way for states, which face yawning budget deficits and, unlike the federal government, must balance their budgets each year.

Representative George Miller, a senior House Democrat, introduced a bill on Wednesday that would give state and local governments an additional $98.5 billion to help avoid layoffs of teachers, police officers and other public employees.

Other House Democrats say Congress should boost transportation spending to put more construction workers back to work.

Both the House and the Senate have approved a $13 billion payroll tax cut for businesses that hire unemployed workers, but the Senate needs to approve the measure again before Obama can sign it into law.

White House economic adviser Christina Romer said on Tuesday that a similar hiring credit proposed by Obama would generate 250,000 jobs at a cost of $13 billion.

The U.S. economy has shed 8.4 million jobs since entering the recession in December 2007, though the pace of job loss has slowed since the recovery began in the second half of last year.

More than 40 percent of unemployed Americans have been out of work for at least six months, the usual cutoff for jobless benefits. Congress extended the program to cover those out of work for nearly two years in some high-unemployment areas, but millions could still exhaust their benefits starting next month without a further extension.

Unemployment aid does not directly create jobs, but economists say it is a cost-effective way to stimulate the economy because recipients spend the money quickly.

It is going to cost $70 billion to extend benefits to the end of the year, which means it is not going to be chief.  Republicans, who already voted against the measure, argued that spending in other areas should be cut to cover its costs.

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My Take: Well, if the government would stop robbing Peter to pay Paul, they wouldn’t be in this mess.  It’s like their clunker program, people would junk a car just to get the money and now they’re finding out they can afford the payment on the new car they bought.  On the other end those that buy junk cars made a mint.  At least somebody made some money.

The politicians could also save money by using group hotel rates instead of staying in suites when they travel.  They could also take advantage of cheap airfare instead of flying first class.  Of course, that would be a miracle!  If they would like to perform a real miracle, why don’t they take a pay cut instead of making police, fire department and teachers take pay cuts?

I am sure that every politician has phone answering services filled with complaints every day.  Maybe if they would listen to some of the complaints on their answering service, they would have a little more insight into what their constituents really want.  But then that would require them to do a bit of work, wouldn’t it?

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As of March 11 according to Standard & Poor’s, the US dollar still rules as the most important world currency.  However, they added that the rising level of US debt and dependence on foreigners for financing could pose risks to the currency’s supremacy.

Without a credible plan to rein in fiscal spending, the agency said external creditors could reduce dollar holdings, which could put pressure on the United States’ ‘AAA’ credit rating, which keeps government borrowing costs low.

For now, the credit ratings agency said the size of the U.S. economy — the world’s largest — and the depth of its financial markets mean the dollar will continue to dominate global trade and foreign exchange transactions.

Those advantages helped the dollar retain its top status despite the financial crisis of 2008-09, which began in the United States, S&P said in the report.  The agency also said the dollar’s role is an important factor supporting the United States’ AAA credit rating — the highest investment-grade rating.

The main risk to the dollar’s status comes from the growing amount of U.S. government debt, S&P said, particularly the share held by foreign central banks and sovereign wealth funds.  It also said widening U.S. fiscal deficits were a risk, adding “without a medium-term fiscal consolidation plan that the market views as credible, external creditors could reduce their dollar holdings, especially if they conclude that euro zone members are adopting stronger macroeconomic policies.”

China held 23% of outstanding U.S. debt in 2009 and Japan held 21%, the agency said. Overall, 46% of U.S. government debt held by the public in 2009 was owned abroad — by both official and private investors.  That amount has increased nearly every year since 2001, when foreigners held 30%.

The U.S. budget deficit is forecast to be near 11% of output in fiscal year 2010, while the ratio of net general government debt to gross domestic product will have reached 82% by 2013, more than double its 2007 level of 38%, the ratings agency reported.

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“In our opinion … inflation figures, trade volumes, foreign exchange volatility and the current account will be the leading indicators if the dollar’s role were to diminish,” the report said. “Such a scenario could even weigh on the ‘AAA’ rating of the United States.”

Some of the largest U.S. creditors, including China and Russia, have complained about U.S. fiscal and monetary policies over the past year and talked about future alternatives to the dollar.

So far, however, there have been few indications that investors or governments are shying away from the greenback.

S&P noted that the U.S. dollar still accounts for about 62% of foreign exchange reserves at central banks, down only slightly from about 72% in 2001.

“Any decline in the dollar’s share … will most likely continue to be steady, gradual and protected over many years,” the agency says.

The dollar still accounted for 86% of foreign exchange transactions in the fall of 2009, S&P said, off only slightly from 90% in 2001.

The dollar still seems to dominate world ready while the euro has made some inroads when it comes to cross-border financing.  The report also stated that for every country surveyed, the share of exports invoiced in US dollars exceeded the US share of the country’s exports, often by a wide margin.

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My Take: I do not know about anybody else, but I don’t like the idea that almost 50% of the US debt is held by China and Japan.  One country we practically destroyed in World War II and the other we have been at odds with because they are a communist country.  Am I the only one that sees a problem with this?

It’s not like country just can dial-up and get a commercial mortgage financing or something.  Can a country go bankrupt?  I can just see the president scrambling to get loan restructuring just to pay the debt.  Yeah, right!  That would be about as bad as playing online poker with somebody else’s credit card.  The US deficit is one of those political points that no politician wants to talk about.

The politicians would rather spend their time at casinos online than talk to people about how much the US owes to foreign countries.  The funny thing is, they did bring that deficit down real quick by taking a 10% wage cut themselves.  There are total of 435 politicians.  Can you imagine how much money would be saved if they did take a cut in pay?

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Problems with Your Drivers License

You might try taking a NY defensive driving program to remove some of those points from your record.  In fact, with all the advancements in technology and the Internet, you can take a NY online defensive driving course that will do the same thing.  Another fact of taking a course like this, your insurance rate could be reduced.

An indication of a slower pace of the economic recovery is a reduction in the sales of previously owned homes in the United States that was unexpected in four months as of August.  However, this was overshadowed by David indicating a pall in the number of new jobless benefit claims in the US in September.  At the same time, sector banks in Europe and the US scaled-back their massive injections of dollars into the banking system as a markets stabilize after the worst global financial crisis since the “Great Depression”

The National Association of Realtors (NAR) said sales of existing U.S. homes fell 2.7% to an annual rate of 5.10 million units, disappointing market expectations for a rise to a 5.35 million unit pace. That was the first fall since April.

Another report from the U.S. Labor Department showed new claims for unemployment benefits unexpectedly fell 21,000 to a seasonally adjusted 530,000 last week. Analysts polled by Reuters had expected initial claims to rise to 550,000.

The housing report did little to change views that the economy is recovering from its worst recession in 70 years but raised doubts about how long the rebound will last.

“Everyone knows the third quarter (economic growth) is going to be very good, the question is how sustainable is this recovery and will the housing market be able to fly on its own once the emergency government aid is removed,” said Zach Pandl, an economist at Nomura Securities International in New York.

The Federal Reserve, the U.S. central bank, on September 23 acknowledged activity had picked up and noted the improvement in the housing sector when it left its key overnight lending rate near zero.

A top White House economic adviser, Christina Romer, said on September 24 the U.S. economy was “back from the brink”, but warned policy-makers against removing fiscal and monetary stimulus too quickly.

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Stocks on Wall Street dropped on the homes report and worries that authorities might be curbing stimulus too soon. Government bond yields fell as the data strengthened perceptions the economic recovery could falter once stimulus from government spending fades.  Leaders of the G20 group of rich and developing nations were gathering in Pittsburgh to discuss ways of rebalancing the world economy to prevent another banking crisis and recession.

SELF-SUSTAINING RECOVERY SOUGHT

U.S. home sales have been boosted in recent months by an $8,000 government tax credit for first-time buyers and an improving economic picture as well as the lowest prices and mortgage rates in decades.  The tax credit expires at the end of November and NAR chief economist Lawrence Yun said the industry group was lobbying to have it extended into next year to avoid what he called a double-dip recession for the housing market.

A housing sector collapse was the main force behind the recession, which started in December 2007.

“The housing market is close to reaching a point of self-sustaining recovery. We are pushing for the extension of the tax credit so that we achieve this,” Yun told reporters.

The decline in August sales was a minor retreat after a strong rise in July, Yun said, and issues related to appraising home values could have led to delays or cancellations of contracts to buy homes. Pending sales contracts rose in July.  Despite the monthly decline, Augusts’ sales pace was the second-highest in 23 months, and sales of previously owned homes rose 3.4% compared to August last year.

The August national median home price of $177,700, off 12.5% from August last year, continued to be weighed down by distressed properties, which accounted for 31% of sales last month.

The inventory of existing homes for sale in August fell 10.8% to 3.62 million units from July, the NAR said. Augusts’ sales pace left the supply of previously owned homes on the market at 8.5 months from 9.3 months’ worth in July.

“Supply is getting close to the level of 7.5 months that has historically been consistent with stable house prices,” said Paul Dales, U.S. economist at Capital Economics in Toronto.

“That said, home sales remain 30% below their peak and the fall back in August illustrates that the recovery is going to be gradual and patchy rather than quick and firm.”

Stubbornly high unemployment continues to cast a pall over the strength of the economic recovery, which many economists agree is already under way.  While fewer workers submitted applications for unemployment benefits last week, analysts said initial claims had to fall below 500,000 to signal a recovery in the labor market.

“The labor market is stabilizing. We’re not quite down to the level that would signal that the economy is creating more jobs than it is losing, but we could reach that point later this year or early next year,” said Gary Thayer, a strategist at Wells Fargo Advisors in St. Louis, Missouri.

What is considered a better gauge of the labor market trends is the four-week moving average of new claims, which has dipped to 553,500 the lowest since January according to the Labor Department.  After the initial week of benefits, the number workers drawing unemployment after the first week of benefits fell 123,000 to 6.138 million in the week ending September 12.  Ace any decline in jobless claims on a weekly basis bodes well for September’s US nonfarm payrolls report that is due out October 2.

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My Take: Well, some good news comes out of Washington DC.  It would be nice if they extended the tax break for first-time homebuyers.  It might give those that are only dreaming about owning a house a chance to fulfill that dream.

That would mean that people who are utilizing suburban property management companies to maintain the houses they own would be able to sell one if they wanted to and get the money they are worth.  The recession has caused house prices to go down so many people have even turned to Maple Grove home rental services just to pay the mortgage on their first house because they could not sell it.

Another people seem to be going back to work, they will also be able to board the house that they have.  Everything gets me about unemployment is affected many people will not take the “shit” jobs because they do not pay enough.  The jobs I’m talking about or like McDonald’s or Burger King.  The idea is to have income and be able to put food on the table for your family, not the shame of having to take such a job.

Places like McDonald’s, Burger King, and Taco Bell also need to stop and think about who they are hiring.  I have seen many of these types of companies not hire someone because they are overqualified just to hire a teenager instead.  Yes, the overqualified person may not be there long, but you at least know that at the get-go.  A teenager, you never know how long they are going to stay and if they will even be able to do the work as directed.  I am sorry, I would rather hire 10 overqualified people then 3 teenagers.

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It is a fact, that healthcare organizations can accelerate their revenue cycle by installing point-of-service payment processes.  There are many factors squeezing the revenues of hospitals and healthcare systems today that include shrinking patient volumes and decreased donations.  These factors also take a toll on providers need to make sure that they are efficiently collecting the money they are owed for services and treatment they provide as well as maintaining and enhancing patient relationships and satisfaction.

An area ripe for improvement in many healthcare organizations is the collection of the self-pay portion of payments, the out-of-pocket part of patients’ payments that falls outside of their insurance coverage, or the total payment for the growing number of uninsured consumers.

Today’s economy has caused consumer responsibilities to change. Consumers now have a greater financial risk associated with medical treatment as demonstrated by higher copays and deductibles. Also, according to a Healthcare Informatics Webinar, increased consumer financial responsibility does not equate to higher revenues for healthcare providers. To translate increased consumer financial responsibility into faster payment collection and avoid potentially decreased revenues, providers need to increase the ways and means of collecting payments from consumers, both in-person prior to treatment and online after treatment.  By improving the point-of-service process, providers may be able to reap more tangible financial benefits.

Capturing Payments

The increased need for point-of-service payments can be tied to the providers’ desire to receive payment prior to treatment, along with other trends such as a greater number of immigrant and uninsured patients who pay out of pocket, a growing contingent of companies that bypass their insurance providers and pay directly for their employees’ healthcare needs, and the increased use of high-deductible health plans and health savings accounts.

Payment types that can be collected at a point-of-service location fall into four categories. The three expected categories are the following:

1. cash and nonconvertible checks (travelers checks, corporate checks, drafts) that cannot be converted into electronic transactions at the point of sale;
2. checks that can be converted into electronic transactions at the point of sale; and
3. debit and credit card payments with real-time authentication.

And a surprising fourth one:

4. payroll deductions for employees, one of any healthcare facility’s largest constituencies.

To accept these point-of-service payments, providers need to have specific hardware and software in place. Electronic payment processing requires devices attached to workstations for swiping credit and debit cards and check scanners that convert checks to electronic transactions. To process cash payments, virtual cash drawers, department vaults, vault aggregation bank deposits, and cash reconciliation, including management and recording of over/shorts, are necessary.

After accepting payment from patients, the point-of-sale system submits payment information in posting files for both the patient accounting and general ledger systems so that all activity is automatically prepared for direct input. Point-of-sale information is also available for reporting and reconciliation processing for researching transactions, making adjustments, balancing bank deposits, and reconciling accounting systems posting files. Administrative features, such as creating departments and cost centers and reviewing inventory if used to handle non-patient payments, give hospital management the ability to monitor user activity.

Cash payments can be a real headache for healthcare facilities because cash must be manually handled, counted, and deposited. Cash registers for payments in retail environments are generally expensive and focused on higher volume transactions—something most hospitals do not require. Increased emphasis on the self-pay portion of bills places greater demands on cash-handling best practices, such as sufficient separation of duties.

Utilizing a user-specific real or virtual cash drawer system with master vaulting to track monetary assets, starting from the moment of receipt of cash to bank deposits, ensures that payments cannot be lost, misplaced, or stolen. To protect the security of cash payments, providers will install more safes, placing them out of public view and bolting them to the floor.

Credit card and check payments that can be converted into electronic transactions are both easier to deal with at point-of-service locations than cash. Electronically capturing card and check payments reduce “float,” speeds the inflow of funds to the bank account, and simplifies the entire deposit process.

Card swipe and check reader machines process credit card payments instantaneously and convert paper checks into electronic transactions for transmission through the automated clearinghouse network. Offering patients multiple payment methods, including deductions for hospital employees, makes the point-of-service process more like other commerce transactions that are well known by consumers.

Payroll deduction is an interesting point-of-service payment process because serving employees is big business for providers. It’s generally known throughout the industry that healthcare workers are among the biggest consumers of services because their familiarity with how to take proper care of their health leads to more demand.

Setting up payroll deductions from the point-of-service to support this demand involves verifying employee eligibility and creating payroll deduction orders that are fulfilled either once or on a recurring basis. (Recurring deductions need to be sensitive to payroll cycles.) A maintenance method also needs to be implemented to create alerts about payroll changes that affect how automated deductions are executed.

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Discovering Benefits

Benefits for this service touch many aspects of an organization, including streamlining payment processes, improving customer satisfaction, assisting with fundraising, and reducing systems training.  Point-of-service systems offer providers the following front- and back-office operational benefits:

• standardized payment processing across multiple healthcare entities;
• strengthened internal controls;
• reduced training costs;
• decreased printing and postage costs;
• detailed receipt content and sequential numbering;
• increased payment processing efficiencies through a paperless environment;
• reduced “touch” points for each transaction through integration with the general ledger, patient accounting systems, and other tracking systems such as incentive reporting; and
• reduced transaction service time by handling cash, cards, checks, and employee payroll deductions, including the conversion of eligible checks into electronic transactions.

A point-of-service system streamlines payment processing by standardizing the process and reducing the rekeying and rehandling a payment receives as it moves through deposit and posting—a major plus for multi-facility healthcare organizations that may have had disparate collection processes.

Accepting patient payments for any location creates additional collection opportunities. An ideal point-of-service system gives providers knowledge of whether a patient has unpaid bills at another facility and also provides a way to handle interorganization transfers.

Another service finding its way into the point-of-service process is the establishment of financing or payment plans prior to treatment. By creating these accounts ahead of time, providers can accelerate 60 to 90 days ahead of the current billing cycles that wait for adjudication and traditional paper billing to run its course.

Processing non-patient payments has a role as well. Items such as equipment rental fees or class registration can be similar to accepting patient payments except they post to the general ledger instead of the patient accounting system.

Accepting non-patient payments is also useful for processing charitable donations. Some organizations have used a virtual point-of-service system to process donations directly at galas and other fundraising events away from the traditional locations inside the healthcare facility.

In addition to organizational benefits, consumers respond positively to improved point-of-service payment capabilities. Take, for instance, refunds that can be processed electronically through the system rather than through a manual check process. Patients enjoy receiving refunds on the spot as opposed to waiting two to three weeks.

Implementation

Implementing a point-of-service payment system consists of setting up the organization records for specific regions, entities, and departments; establishing the general ledger accounts for offsets and over or short entries; and setting up and training users. Implementation can be tackled in phases, such as one facility at a time, to allow for infrastructure changes to be properly supported and absorbed before tackling the next entity.

The average cost of an implementation for a healthcare facility depends on the number of terminals purchased. For example, a combination check reader and card swipe device costs about $225, while a card swipe reader alone will cost about $85. Add another $200 per terminal for set-up and system configuration, plus there may be minimum fees and training expenses to consider as well.

Removing the analog phone line—which costs about $10 per month—that was used for dial-up credit card authorization terminals can often offset the cost of new devices in two years or less. Meanwhile, the ongoing operation costs consist of maintenance and payment click fees. These fees vary based on hospital size or number of users.

Studies indicate a small hospital (approximately 100 beds) can expect a 169% return on investment after three years. A medium hospital (300 beds) can expect a 288% gain, while a larger enterprise can see as much as a 360% windfall. The larger enterprises generate more savings because they frequently have more than one point-of-service payment process that can be centralized. Eliminating the additional redundancy ends up producing more savings.

Contributing to the successful return are the following factors: a reduction in the cost of taking payments, reduced training expenses, a decrease in exceptions and back-end processing and, naturally, accelerated cash flow. In addition, there are indirect benefits such as improved customer service and a higher quality of work/life for staff.

Avoiding Common Pitfalls

Moving forward, capturing and handling payments needs to occur in a more structured, streamlined manner in healthcare facilities. Proponents of real-time adjudication want to see the practice incorporated in this area because an adjudicated claim means the self-pay portion is now revealed. Furthermore, if the patient is to be fully empowered to review the financial impact of care prior to treatment, then the current method of insurance claim, adjudication, and settlement is in dire need of reform. This conclusion is not surprising due to the fact that the process is based on an antiquated batch-processing model conceived well before the Internet and the idea of real-time, peer-to-peer communication.

In the future, using point-of-service payment collection will be most effective when paired with real-time adjudication and transparent pricing. Lacking real-time adjudication, organizations created their own internal claim databases that forecast the self-pay portion based on the financial outcome of similar treatment. Healthcare organizations that provide reliable prices to consumers prior to treatment know what to collect at the point of service and can subsequently improve on how it is achieved.

Doing more with less staff is another concern for finance departments. The economy puts financial departments at a greater risk of staff cuts, especially among hospitals with 500 or more beds. Streamlining the payment process by automating point-of-service transactions and integrating them with other systems saves time and enables organizations to devote manpower to other areas.  Organizations must also remember that changing processes at the point of service cuts a wide swath. Be sure to leave enough time to prepare, plan, train, and implement changes.

Obtaining executive buy-in is an important step to beginning the path to more efficient point-of-service operations. However, it should be one of the easiest to achieve because of the obvious benefits in expense, control, and operations. Preparing a return-on-investment report can uncover numerous examples of waste that manual procedures have slowly layered into existing processes. Simple items, such as eliminating analog phone lines used for dial-up swipe terminals, all contribute to greater financial success.

Obtaining employee buy-in should likewise be easy to achieve. Consider that when an employee can improve customer satisfaction with the healthcare process, then job satisfaction is similarly improved. Surveys taken where customer satisfaction is measured on a formal basis reflect that automated point-of-service systems can result in a 15% improvement in how patients view their experience at a healthcare facility.

Introducing and actively using point-of-service payment collection processes can lead to a more efficient billing process and customer service satisfaction—two areas that can generate money and time savings.

Point-of-Service Self-Assessment

1. The following questions assess a healthcare organization’s ability to collect payments prior to or at the time of service:
2. Do you capture sufficient patient and, when necessary, guarantor contact information during the point-of-service process?
3. Do you share a list of prices for treatments and services with patients?
4. If you are a part of a multi&facility healthcare system, are you able to accept patient payments at any entity?
5. Can you accept non-patient payments, such as equipment rental fees or class registration, as you would patient payments?
6. Can you convert check payments into an electronic transaction at point-of-service locations?
7. Do you have separation of duties for staff members who accept payments and reconcile payments?
8. Do you have measures in place to protect cash payments?
9. Are you promoting the collection of payments at the point-of-service to your staff and the general public?

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My Take: I think it is strange that the healthcare industry has not embraced point-of-service before this.  I know they have been accepting credit cards for years, but the system seems a whole lot better.  It saves them money and can also save money for the patient.

For example, a retail business that needs new office equipment, but instead gets used copy machines to save money and then passes that savings on to their customers.  Used photo copiers are definitely cheaper than brand-new ones.  It is the same principle that the healthcare industry should be using.

It is going to take a long time for the healthcare industry to revamp itself.  They are trying to initiate EHRs, which would help patients across the country.  They are trying to reorganize health care insurance so that everyone has medical coverage.  This type of payment system would help alleviate a lot of their financial problems at least.

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