Author: Tonia A. Crown

Big Business Benefit Cuts May Open New Opportunities for Small Businesses

After several years of enhancing rewards to attract and retain talent in one of the tightest labor markets ever, large and medium-sized employers are cutting perks, benefits, and staff with increasing frequency, possibly creating an opportunity for small businesses to level the recruiting and retention playing field.

The list of large employers cutting staff is growing by the day. Along with staff, perks (a.k.a. free food, on-site massages, laundry services, and on-site wellness classes, for example) and benefits are on the chopping block as big businesses try to reign in expenses to prepare for a possible recession.

Care.com’s 2023 Future of Benefits Survey found 95% of survey participants (with 500 or more employees) are “recalibrating” benefit strategies and 47% are cutting back on benefits this year. Adoption/fertility benefits; commuter benefits; financial education and wellness; health and fitness discounts; home office stipends; and learning and development programs are most likely to be cut.

What about small businesses? According to the Bank of America 2023 Small Business Owner Report, over half of small businesses that participated in a survey (53%) indicated they have added benefits and perks to retain current staff (i.e., 34% added remote/hybrid work; 34% provided cost of living bonuses; and 33% increased vacation time). To attract new talent, more than half (54%) increased base pay; over one quarter (27%) are providing additional healthcare benefits; and 27% added training and resource groups.

Why would a small business do this during a time of economic uncertainty? 51% of owners indicated they’re still feeling the impact of labor shortages, with 49% working more hours; 33% having a hard time filling jobs; 31% increasing wages to attract talent; 26% having to change their business hours; 24% reducing products and services offered; and 21% indicating they’re losing customers due to staffing issues.

Interestingly, all of the data is coming together to put a spotlight on a potential recruiting and retention opportunity for small businesses. The Morgan Stanley at Work report indicates almost 70% of employees are paying more attention to financial benefits and almost 90% “would be more invested in staying at their company if it provided financial benefits that met their needs.” Under SECURE 2.0, an eligible small business may receive a tax credit for up to 100% of startup costs for certain types of retirement plans (i.e., SEP, SIMPLE IRA, or a qualified plan like a 401(k)). The maximum credit is $5,000 for three years; eligibility and other criteria apply.

Interested in learning more? Give us a call. Our RBT CPAs professionals, alongside those from our strategic partner Spectrum Pension and Compensation, can help you evaluate whether SECURE 2.0 Act credits can help you strengthen your rewards offerings and, ultimately, your ability to attract and retain talent.

RBT CPAs is proud to say all of our work is prepared in the U.S.A. – we never offshore. As a result, you get peace of mind that your operation’s financial and confidential information is handled by full-time, local staff who have met our high standards for quality, ethics, and professionalism.

NOTE: RBT CPAs is providing this content for informational purposes only; it should not be considered advice. Since every business is different, it’s best to consult a professional (like Spectrum) and/or benefits legal counsel to determine whether new benefit plans and/or benefit changes may be advantageous for your organization.

This Is Your Chance to Tell HUD How to Simplify Program Administration: Deadline August 14

Do you have ideas about how to make U.S. Housing and Urban Development (HUD) forms and application processes easier? How about insights on ways to reduce burdens on vulnerable groups like people with disabilities or limited English proficiency? Based on your experiences, is there data and information that should be shared with the public or between agencies? Do you have thoughts on how to use automation and artificial intelligence to improve HUD processes? If so, HUD wants to know!

In mid-July, HUD issued a Request for Information (RFI). Its focus? How the agency can make programs easier to access and use. In addition to beneficiaries of HUD programs and the public, the agency is seeking input from administrators including public housing agencies, state or local governments, housing providers, Tribes, and social service providers. The deadline to submit comments is approaching fast. If you have thoughts, ideas, and opinions to share, make sure you do so by Friday, August 14.

According to the RFI, “While HUD is interested in input from all commenters, comments from organizations that provide direct assistance to individuals navigating application, reporting, and recertification processes, as well as individuals’ direct experience completing and submitting forms, may be particularly helpful in identifying both unduly burdensome processes as well as opportunities for mitigating those burdens.”

You (and your team) have the option to submit comments (or attach documents with comments) via:

Online at Regulations.gov. Click here.
Regulations Division, Office of General Counsel, Department of Housing and Urban Development at improvingaccesstopublicbenefitprograms@hud.gov.
Regulations Division, Office of General Counsel, Department of Housing and Urban Development, 451 7th Street SW, Room 10276, Washington, DC 20410–0500.

Comments should include the RFI docket number and title: “FR–6381–N–01 Improving Access to Public Benefit Programs; Request for Comment,” and indicate which of the five questions posed in the RFI you are responding to. Questions focus on how to reduce administrative burdens across HUD’s programs; data sharing; and automating, augmenting, and streamlining forms and processes. (Scroll down in the RFI to see the detailed questions.) It is important to note that the comments are public.

While you and your team are sharing your thoughts, ideas, and opinions on how HUD can do things better, you can count on RBT CPAs for all of your accounting, tax, audit, and advisory needs. To learn more, give us a call today.

RBT CPAs do not outsource work to any other country. All of our work is prepared in the U.S.A.

The Many Sides to the Value-Based Care (VBC) Discussion

Value-based care is being trumpeted as the panacea to cure all of the healthcare systems’ ills, and while it’s picking up momentum, to say there are a lot of different perspectives to this story is a gross understatement.

From medical and political organizations to investors and technology companies, value-based care is the talk of the town.

Value-based care was first introduced by Michael Porter and Elizabeth Olmsted Teisberg in their 2006 book, Redefining Health Care: Creating Value-Based Competition on Results. Since then, it has been embraced by some; criticized by others. Still, after almost 17 years, the discussion continues. In scouring numerous publications from several months, here’s a sampling of the discussions…

December 16, 2022. American Psychological Association

“The National Academies of Science, Engineering, and Medicine issued a report on implementing high-quality primary care stating that we should ‘pay for primary care teams to care for people, not doctors to deliver services.’ The report recommends a shift towards a hybrid model of payment; part fee-for-service and part capitated (per member, per month) as the default method to pay prospectively for interprofessional, integrated, team-based care rather than the fee-based system that undervalues the work reflected in primary care and behavioral health services.” (“APA advocates for value-based payment models.” December 16, 2022. APAServices.org.)

December 16, 2022. McKinsey & Company

“Providers specializing in value-based care have become attractive to investors because of the distinctive quality of care that they can provide and the investable opportunity they present, with a diversity of risk levels and business models. By building on a decade of increasing value-based payment adoption—combined with enhanced value-based capabilities across payers, providers, employers, and other healthcare stakeholders—continued traction in the value-based care market could lead to a valuation of $1 trillion in enterprise value for payers, providers, and investors.” (Abou-Atme, Zahy; Alterman, Rob; Khanna, Gunjan; and Levine, Edward. “Investing in the New Era of Value-Based Care. December 16, 2022. Mckinsey.com.)

February 7, 2023. The Commonwealthfund.org

“Studies of value-based care programs so far suggest that they can reduce costs and improve quality of care, although results have often been mixed and impact modest….Although participation in value-based care programs is on the rise in the U.S., many healthcare providers are still not in one. To encourage participation, future models in both the public and private sector would likely benefit from being more accessible and financially rewarding, particularly to those serving disadvantaged or rural populations. Moreover, further research is needed about how these programs impact patients, providers, and the health care system overall, as well as which factors are associated with success.” (Lewis, Corinne; Horstman, Celli; Blumenthal, David; Abrams, Melinda K. “Value-Based Care: What It Is and Why It’s Needed.” February 7, 2023. Thecommonwealthfund.org.)

Feb 10, 2023. Healthcare Dive

“With 48% of the eligible Medicare population enrolled in Medicare Advantage plans and, the CMS committed to having 100% of enrollees in a value-based care program by 2030, the tailwinds are pushing at-risk arrangements forward in a big way.” (Kirk, Liz. “Tipping point is in sight: Value-based care is driving meaningful financial results.” February 10, 2023. Healthcaredive.com.)

March 14, 2023. BenefitsPro

“Employers and their benefits consultants are increasingly embracing value-based reimbursement models as they – along with provider organizations, commercial payers, and government programs – seek more ways to improve health outcomes while reducing costs.” (Sharma, Rahul and Caroll, Lynn. Implementing value-based health care: Key trends shaping 2023.” March 14, 2023. Benefitspro.com.)

April 10, 2023. Bain.com

“There is still ample headroom for growth in value-based care adoption in the PCP space. As of 2021, nearly 60% of healthcare payments had at least some linkage to quality and value, but less than 20% incorporated two-sided risk (and capitated models are still under 8% of spending)…Our analysis suggests fee-for-value arrangements will capture 15%–20% market share from traditional FFS providers in primary care by 2030, creating strong macro tailwinds and supporting further investment in the space.” (Fry, Sharon; Nierenberg, Dave; Wynn, Grace; Murphy, Kara; and Jain, Nirad. “Value-Based Care: Opportunities Expand.” April 10, 2023. Bain.com.)

April 29, 2023. The American Journal of Managed Care

“…there have been many iterations of value-based programs sponsored by both government insurers and private companies… Among other challenges, a main issue that arises in value-based care surrounds attribution, meaning a patient is attributed to a provider and that provider is reimbursed based on the contract. But what is attribution? If a patient sees 2 primary care providers within a year, which provider is paid for their care?” (McNulty, Rose. “Value-Based Care: Is It Possible for All Providers to Succeed?” April 29, 2023. AJMC.)

May 8, 2023. The New York Times

“Large health insurers and other companies are especially keen on doctors’ groups that care for patients in private Medicare plans…Now, nearly seven in 10 of all doctors are either employed by a hospital or a corporation, according to a recent analysis from the Physicians Advocacy Institute…Insurers say their purchase of medical practices is a step toward what is called value-based care…” (Abelson, Reed. “Corporate Giants Buy Up Primary Care Practices at Rapid Pace.” May 8, 2023. NYtimes.com.)

May 23, 2024. Beckers ASC Review

“Three key driving forces behind the shift to value-based care are government programs and incentives, advancements in technology, and the use of data to gather information. The model has piqued the interest of companies such as CVS Health, Optum, and Amazon, as well as physician groups…Though value-based care’s popularity is growing, just 14 percent of physicians participate in the payment model, according to Medscape’s 2023 ‘Physician Compensation Report.’ The fee-for-service model is still the most popular payment model by a long shot, with 46 percent of physicians participating in it.” (Hatton, Riz. “How value-based care is squeezing its way into every corner of healthcare.” May 23, 2024. Bekersasc.com.)

June 8, 2023. Center for Medicare and Medicaid Services

“Today, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states… Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington.” (“CMS Announces Multi-State Initiative to Strengthen Primary Care.” June 8, 2023. CMS.gov.)

No doubt, this discussion is to be continued. While you are following the latest headlines shaping the future of healthcare in America, you can count on RBT CPAs to take care of your accounting, tax, audit, and advisory needs with the highest ethical and professional standards. To learn more, give us a call today.

RBT CPAs does not outsource work to any other country. All of our work is prepared in the U.S.A.

There’s Now Proof That 5G Can Transform Healthcare

In today’s media, it’s hard to tell the difference between news and marketing. Take 5G and healthcare as an example. Talk of the revolutionary nature of this next generation of wireless technology has been around for years, but in truth the uptake has been slow. So, I set out to see what I could learn about whether and how 5G is transforming health care. Here’s what I found…

First, what is 5G? It stands for the fifth generation of cellular wireless technology (1G allowed for voice; 2G – digital voice; 3G – data; 4G – streaming; and 4GLTE encompasses everything up to 4G, faster and better than ever). 5G will transmit data 20x faster than 4G; handle 100x more traffic so more devices can be connected and work more reliably; support wireless operations; speed up how quick data can be uploaded and transported; and dramatically increase the amount of data available for decision-making.

While Wi-Fi doesn’t have the bandwidth to support all of the leading-edge technologies – like the IoMT, edge computing, robots, augmented and virtual reality (AR/VR), and more – 5G can. It’s expected to transform how work gets done, driving productivity, competitiveness, quality, cost savings, profitability, smart decision-making, data security, and more.

As reported by ManagedHealthcareExecutive.com, the Cleveland Clinic Mentor Hospital – scheduled to open its doors to patients on July 11 – is the first U.S. hospital built with a private 5G network via a partnership with Verizon Communications, providing “an opportunity to explore how private 5G networks can help enable digital transformations in hospital settings.”

According to InsiderIntelligence.com, the Cleveland Clinic is already ranked fourth by Newsweek’s World’s Best Smart Hospitals 2023 (Mayo Clinic, Massachusetts General and John Hopkins take the top three spots). With 5G at Mentor Hospital, the clinic will be exploring potential use cases for asset tracking, digital displays, entertainment, check-in kiosks, AR/VR for education/assisted surgery/imaging, and more.

While looking forward to the learnings that will come from Mentor Hospital’s 5G capabilities, Samsung Medical Center (SMC) in Seoul, South Korea is already experiencing the benefits of integrating 5G with digital pathology.

HealthcareITNews.com reports 5G is helping to cut pathology time at SMC in half. They have three diagnostic reading rooms that received numerous “requests for frozen section tests.” It would take 15 to 20 minutes for someone to get to the rooms, until a scanner, analysis and interpretation software, a desktop computer, and 5G enabled access via mobile devices, reducing response time to 10 minutes. The result is quicker diagnosis and fewer surgical delays.

In April, The Wall Street Journal reported on how another hospital in Seoul is using AR technology to promote precision during surgery thanks to its private 5G network which can upload and transmit tremendous amounts of data without lags. The Ewha Womans University Mokdong Hospital’s 5G-enabled AR technology helps surgeons see the exact location of tissues and tumors when a tablet is placed above a patient’s chest. This replaces a surgeon making incisions based on CT scans.

The hospital also tested the system for a recent surgery where surgeons in different locations were able to join a procedure and exchange advice, setting the stage for remote surgeries and even physician training.

(FYI: The AR technology was developed by SKIA Co. which is applying for regulatory approval in South Korea for widespread use and subsequently plans to apply for approval from the U.S. Food and Drug Administration.)

No doubt, this is just the beginning. As The Wall Street Journal reported, “The 5G healthcare market—encompassing 5G-supported augmented-reality and virtual-reality technology services, virtual consultations, remote patient monitoring and more—was valued at $2.5 billion in 2021 and is expected to grow an average of more than 35% annually from 2022 to 2030, according to Global Market Insights, a market research firm.”

While you may be thinking about where and how 5G will impact your healthcare organization’s future strategy, please know that RBT CPAs can help free you up by handling all of your accounting, tax, audit, and business advisory needs. To learn more, visit us at RBTCPAs.com or give us a call today.

Timely Remittance: Being Late Will Cost You

No doubt, offering a defined contribution retirement plan – like a 401(k) – can have a positive impact on employee attraction, engagement, and retention. Plus, helping employees build a nest egg for the future is simply the right thing to do. Just make sure that when you take on the responsibility of being a plan manager, you’re also aware of the many regulations governing plan administration, such as timely remittance. Failing to comply violates Department of Labor and IRS regulations, and can result in significant penalties, plan disqualification, and more.

So, what is timely remittance? Once you deduct funds from your employees’ wages for contribution to a retirement plan or repayment of a plan loan (if applicable), timely remittance relates to how long it takes you to segregate those monies from general funds and remit them to the plan. Failing to remit contributions in a timely manner can be seen as taking a loan from the plan, which is a prohibited transaction.

To be timely, the process of segregating and remitting funds should occur:

As soon as administratively possible for employers with more than 100 eligible plan participants.
Within seven days of taking the deduction for employers with 100 or fewer eligible plan participants and no ERISA audit requirement.
No later than the 15th business day of the month following the end of the month that the deductions occurred (as per DOL regulation 2510.3-102).

It sounds simple, but there’s more to it. As noted by the American Institute of Certified Public Accountants (AICPA) in its March 2021 Primer Series, the 15 business days “is not a safe harbor for depositing deferrals; rather, these rules set the maximum deadline if that amount of time is the earliest that is reasonably required to be able to separate the plan assets from the employer’s corporate assets.”

If other payroll items, like tax withholdings can be segregated inside of the 15-day period, employee contributions and loan repayments must be segregated on that earlier date as well. What’s more, if the company can segregate employee contributions from general assets within three business days, for example, failing to do so can be considered late remittance. Even if the remittance process is shortened from four days to three days during the year (for example, you change payroll processors and the new one is quicker), you could be responsible for untimely remittance for the months where it took four days.

What’s the big deal? Holding onto the money for too long can result in lost earnings for the plan participants.

To fulfill fiduciary responsibilities, plan management must monitor timely remittances, regardless of whether payroll is processed in-house or by a third party. This can be accomplished with a policy that requires regular reconciliation of plan contributions according to the trust statement to payroll records, as part of ongoing internal control procedures.

If at any time there should be a delay in segregating and remitting the funds, it’s wise to document what happened in detail and hold onto any supporting records. It’s also a good idea to consult an ERISA lawyer to evaluate whether a deposit was late and is considered a prohibited transaction.

As for next steps, refer to the IRS’ 401(k) Plan Fix-It Guide and the DOL’s FAQs about Reporting Delinquent Participant Contributions on Form 5500.

In general, you’ll need to report the prohibited transaction by completing and submitting Form 5500. There are penalties for each day that a remittance was delayed. The plan administrator may also be subject to civil monetary penalties and tax liabilities for failing to report delinquencies on Form 5500 and if an auditor fails to note a missing delinquent contribution schedule.

If you have any questions on this or other accounting, tax, payroll, or audit issues, please don’t hesitate to give RBT CPAs a call. We’re a leader in the Hudson Valley and we care about getting the details right so you can focus on other things like your business. RBT CPAs: We succeed when we help you succeed. Give us a call today.

Please note: The information is this article should not be construed as legal advice. When you need such advice, it’s always best to contact your legal counsel.

Understanding the Changing Landscape of Found Money

March 10 was the deadline for businesses to file an Abandoned Property Law Annual Report. Not filing potentially increases risk of an audit, but so does filing. What’s a business to do?

Healthcare organizations may be particularly vulnerable, considering the complexities surrounding costs, who is responsible payment, and more. Whether it’s a payment to a vendor that went out of business or a duplicative payment from a patient and insurance company for the same claim, the state where the property’s owner resides may have dibs on this and other types of found money including payroll checks, direct deposits, customer credit balances, and more.

The New York State Fiscal Year 2021-2022 Annual Report of the Office of Unclaimed Funds (OUF) explains the OUF is responsible for implementing the state’s Abandoned Property Law by ensuring abandoned funds are remitted to the state; conducting audits to recover funds; increasing public awareness of the funds; and protecting the rights of owners until funds are returned.

During FY 2021-2022, the OUF collected $980 million. The Voluntary Compliance Program resulted in $8 million being found. Audit collections totaled $93 million. $404 million was returned to rightful owners. $560 million was transferred to the state’s General Fund (the state holds over $17.5 billion in unclaimed funds dating back to 1943. The Hudson Valley had the third highest amount of funds paid (following NYC and Long Island), totaling $33 million.

As reported by TaxExecutive.org, “The importance of knowing and understanding unclaimed property laws has grown in recent years, because unclaimed property is now a significant revenue source for certain states…As a result, states now actively enforce these laws to capture unclaimed property in audits, voluntary disclosure programs, and litigation or through legislation.”

Audits can result in significant assessments, interest, and penalties. Voluntary compliance programs and agreements give companies a way to avoid interest and penalties in most states. That sounds good until you consider if your company doesn’t have records for the look back period, it must use the state’s mandated methodology to estimate liability. What’s more, you’ll still need agreement from a state appointed administrator or audit firm. Even after all of that, your firm can still be referred for an audit. In recent years, more “holders” of unfound money have turned to litigation and increasingly found support.

If your company needs help understanding the laws, how they’re enforced, and your options for responding, RBT CPAs tax professionals can help. With state and auditing firms’ outreach efforts growing to uncover additional sources of potential revenue, should you receive any type of communication asking for self-disclosure or the like, be sure to give your RBT CPAs contact a call.

NOTE: RBT CPAs is providing this content for informational purposes only. It should not be construed as advice or direction. Should you need advice or direction, it’s in your best interest to talk to a tax professional (like those at RBT CPAs) or to contact your legal counsel.

IRS FAQs Clarify Eligible Expenses Under Tax-Advantaged Health Care Accounts

Health Savings Accounts (HSAs), Flexible Spending Arrangements (FSAs), Archer Medical Savings Accounts (Archer MSA), and Health Reimbursement Arrangements (HRAs) give employees the opportunity to set aside pre-tax income to pay for eligible medical expenses (rather than itemize and file for a tax deduction if expenses exceed 7.5% of qualified income). In mid-March, the Internal Revenue Service (IRS) posted frequently asked questions (FAQs) providing more details about the types of expenses that are eligible for reimbursement through tax-advantaged plans.

As noted on IRS.gov, “These FAQs are part of the National Strategy on Hunger, Nutrition, and Health. The National Strategy provides a roadmap of actions the federal government will take to end hunger and reduce diet-related diseases by 2030.”

In keeping with that line of thinking, the FAQs largely focus on costs related to nutrition, wellness, and general health, addressing questions about the cost of nutritional counseling, weight-loss programs, weight-loss food and drinks, gym memberships, over-the-counter medications, and more.

That does not mean a new pair of expensive running shoes is fair game. IRS.gov says, “Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes. They also include the costs of medicines and drugs that are prescribed by a physician. Medical expenses must be primarily to alleviate or prevent a physical or mental disability or illness. They don’t include expenses that are merely beneficial to general health.”

According to the FAQs, dental, eye and physical exams are all considered eligible expenses, as are expenses for alcohol abuse disorder programs and smoking cessation programs. The cost of therapy used to treat a mental illness is eligible, as are costs for nutritional counseling and weight loss programs to treat a specific, physician-diagnosed disease like obesity.

When it comes to the cost of a gym memberships, it’s considered an eligible expense when purchased “for the sole purpose of affecting a structure or function of the body (i.e., prescribed physical therapy for an injury)” or for treating a physician-diagnosed disease (i.e., obesity, hypertension, or heart disease).

More information about eligible expenses can be found in IRS Publication 502, Medical and Dental Expenses, and Tax Topic 502, Medical and Dental Expenses.

These clarifications follow other changes to certain tax-advantaged accounts as the pandemic wound down. For example, certain pandemic relief measures affecting FSAs (like allowing any balance remaining to rollover from one year to the next) ended in 2022, although employers can choose to allow rollovers up to annual limits — $570 for 2023 and $610 for 2024). (Cuadra Deanna. “The pandemic FSA carryover allowance is over: Here’s what’s changed.” November 11, 2022. Benefitnews.com.) Also, the Continuing Appropriations Act of 2023 allows certain telehealth benefits to be provided before a deductible is met under a high deductible health plan, without disqualifying the covered person from being eligible to participate in an HSA. (For more details, visit Fisherphilips.com.)

If you are a plan sponsor, it’s a good idea to let employees know about the clarifications provided in the IRS FAQs, as they could get reimbursed on out-of-pocket expenses that they may have thought were previously excluded.

While you help employees understand how to maximize tax-advantages available in a benefits program, RBT CPAs is here to help you maximize your tax strategy for your business. We’re a leading accounting, tax, audit and business advisory services firm serving the Hudson Valley for over 50 years. To learn more, give us a call. We would love to talk and see what we can do to help you be more successful.

Please note: We are accountants and financial experts – not benefits attorneys. We are providing this content for informational purposes only; it should not be construed as legal advice. If you are considering communicating or making changes to benefits, we strongly encourage you to seek advice from benefits counsel.

Seven Ways Health Care Institutions Are Addressing Staffing Challenges

We can all agree there is a global talent shortage and, considering the U.S. population is shrinking along with the number of people in the workforce, the issue is only going to get worse. So, we scoured publications, websites, and more to learn how health care practices and hospitals across the country are addressing the challenge. Here is some of what we found…

Upskill your current workforce.

Nothing says you value your people more than when you invest in their future. A 55,000-person healthcare system in Cincinnati, called Beons Secours Merc Health (BSMH), created Called to Grow – a program consisting of tuition reimbursement and career pathways to help employees move into higher skilled roles. BSMH partnered with a company specializing in upskilling employees. All employees – whether on-call or full-time – are eligible to participate starting their first day of work. (Hilgers, Laura. How One Healthcare System Is Addressing a Talent Shortage. February 7, 2023. LinkedIn.)

Provide 100% tuition assistance paid up front.

As part of the Called to Grow program, BSMH covers 100% of tuition – paid up front – for more than 120 clinical certifications, undergraduate and graduate degrees, and nursing degrees at 15 institutions. (Hilgers, Laura. How One Healthcare System Is Addressing a Talent Shortage. February 7, 2023. LinkedIn.)

Career planning.

BSMH has three HR internal mobility specialists to learn about employee interests, identify potential careers, layout career paths, and help employees follow them. “Someone in laundry and linen services, for example, could train to become a care companion on the nursing support team. A care companion could then train to become a patient care technician.” (Hilgers, Laura. How One Healthcare System Is Addressing a Talent Shortage. February 7, 2023. LinkedIn.)

Engage students to create a talent pipeline.

Three hospital groups in Chicago created Healthcare Forward, a program offering high school students in economically depressed areas training and the guarantee of a job interview for entry-level positions. (UChicagoMedicine. Chicago Health Systems join forces to promote careers in healthcare across West and South Sides. December 6, 2021.)

Mary Washington Healthcare in Virginia worked with a local community college to create a clinical education model that allows student nurses to support current nurses before graduation. Geisinger in Pennsylvania provides up to 175 employees $40,000 in support a year to pursue a nursing career in return for a five-year commitment to work as an inpatient nurse. (American Hospital Association. Senate Statement: Recruiting, Revitalizing and Diversifying – Examining the Healthcare Workforce Shortage. February 10, 2022.)

Children’s Hospital Colorado and Denver Health’s Medical Career Collaborative (MC2) gives high school students hands-on experiences to foster interest in healthcare careers. 96% of participants complete the program and over 70% go on to pursue a healthcare career. Some even end up working for one of the two institutions involved. (Davis, Carol. Stop Workforce Shortages: 3 Ways. June 2022. HealthLeadersMedia.com.)

Offer an Apprenticeship Program.

Trinity Health in Michigan addressed its medical assistant shortage by adopting an apprentice program that has trained 129 assistants since its start and improved retention by 76%. It pays students to go to school three days a week and work at the hospital two days. (American Hospital Association. How Some Hospitals Are Grappling with the Workforce Shortage. June 28, 2022. AHA.org.)

Succession planning & promotion from within.

Indiana University Health places great emphasis on the talent review process. Staff record short- and long-term career goals on talent profiles, their dreams, and where they are willing to live. Each employee’s leader completes a talent assessment. Then senior leaders turn to the talent pool to fill manager and senior-level positions. Two out of every three promotions go to an existing employee. (Davis, Carol. Stop Workforce Shortages: 3 Ways. June 2022. HealthLeadersMedia.com.)

Use artificial intelligence (AI) for greater accuracy in staffing needs and scheduling.

Sanford Health’s previous nurse staffing plans were accurate about 60% of the time. Its AI driven tool enables data analytics that increased nurse staffing plans to 90% accuracy. As a result, patients were cared for, and staff didn’t burn out from being overworked or unable to take time off. (Davis, Carol. Stop Workforce Shortages: 3 Ways. June 2022. HealthLeadersMedia.com.)

There is one other thing you can do – engage RBT CPAs for all of your accounting, tax, audit and business consulting needs so your staff is freed up to focus on attracting and retaining the talent needed to provide care today and in the future. To learn what RBT CPAs can do for your organization, click here.

Should You Offer an Individual Coverage Health Reimbursement Account (ICHRA) In Lieu of Group Medical Plan Coverage?

With group medical plan coverage costs projected to increase between 5% and 6% next year, employers are in a tough spot. Keep offering this valuable coverage and absorbing big cost increases as part of their overall recruitment, retention, and engagement efforts, or consider an alternative that’s growing in popularity: Individual Coverage Health Reimbursement Accounts (ICHRAs).

ICHRAs came into being in 2020 and allow employers to reimburse employees with tax-free dollars for some or all the cost of medical insurance they purchase on their own, as well as certain out-of-pocket costs like copayments and deductibles. They are similar to a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) introduced in 2017 but offer more flexibility and features. Here are some highlights:

The employer decides how much to contribute to the ICHRA. As long as that amount is considered “affordable”, an employer will meet any Affordable Care Act coverage mandate that applies.
A covered employee purchases his/her own coverage – inside the Marketplace or out – and gets reimbursed with ICHRA funds to offset some or all of the monthly premiums (depending on how much the employer contributes). This enables the employee to decide which plan has the benefits (i.e., prescription drug), network doctors, and other features that are meaningful to him/her. Employers can also contribute funds to help cover out-of-pocket costs.
If an employee chooses to purchase a plan outside of the ACA Marketplace, the employer can offer him/her the option to pay any premium amounts above the employer’s ICHRA contribution using tax-free dollars via a cafeteria plan.
ICHRA reimbursements are tax-deductible for employers and tax-free for employees. So instead of paying payroll taxes on reimbursements given, the reimbursements qualify as an employer tax deduction. In addition, reimbursements are not considered taxable income to employees.

As a result, employees are given the flexibility to choose the coverage that best meets their cost and healthcare needs. Employers can get out of the resource-intensive business of managing, negotiating, and paying directly for group medical plan coverage. Plus, they can manage costs better than ever because they set the limit on how much they’ll contribute to an ICHRA.

ICHRAs also offer a lot of flexibility to employers. For example, an employer can choose which classes of employees are eligible for the ICHRA, while still offering a group medical plan to others. So, an employer may decide to offer an ICHRA to employees in New York, but not Ohio; to full-time employees, but not part-time; etc. An employer can even decide to offer the ICHRA as the only medical plan option to all new hires (a good way to transition away from group medical plan sponsorship over time).

With ICHRAs, small businesses that couldn’t afford to offer traditional coverage now have an option that can strengthen their ability to attract and retain employees. Businesses that already offer medical plan coverage may decide an ICHRA may be a better fit for certain employee classes. All employers may view it as a viable alternative to taking on the risk of managing, negotiating with, and paying for group medical plan coverage.

According to ICHRA FAQs issued jointly by the U.S. Department of Treasury, the U.S. Department of Labor, and the U.S. Department of Health and Human Services, it is projected that “in the next 5-10 years, roughly 800,000 employers will offer Individual Coverage HRAs to pay for insurance for more than 11 million employees.”

Still, there are a lot of technicalities that need to be worked through if you’re considering making the move. For example, employees must choose between the ICHRA and health premium tax credit through the ACA Marketplace. Also, small employers must choose between an ICHRA or Small Business Healthcare Tax Credit – they can’t have both.

For more information, review Healthcare.gov’s ICHRA Decision Guide; Takecommandhealth.com’s guide; and Healthinsurance.org’s ICHRA overview.

Interested in learning more? RBT CPA affiliate Visions Human Resource Services staff is available to conduct benefit plan analysis, while RBT CPAs can help you understand the tax implications of choosing an ICHRA versus other options. Give us a call if you have any questions about this or anything related to your accounting, tax, audit, and business advisory needs. We’ve been serving businesses in the Hudson Valley for over 50 years and believe we succeed when we help you succeed. Call RBT CPAs today.

Ready to Unwind? Prepare for the End of the Public Health Emergency

Whoever gave the moniker “unwinding” to the work that will be required once the Public Health Emergency (PHE) ends must have a great sense of humor. While “unwinding” usually brings thoughts of relaxation and perhaps a sandy beach and a favorite cocktail or hobby, the “unwinding” that will occur when the U.S. PHE expires will likely be anything but relaxing, especially for those in healthcare or a related field.

So much has happened since January 31, 2020, when the World Health Organization declared a Public Health Emergency of International Concern and the Secretary of the U.S. Health and Human Services Department, Alex Azar, declared a PHE in the U.S. due to COVID. That PHE has been renewed 11 more times, for three-months at a clip, with the latest due to expire January 13, 2023. Don’t panic, yet.

First, the PHE will most likely be extended once again, since the promised 60-day notice before expiration did not occur. Second, the last extension occurred mere days before the PHE was due to end, so advance notice of an extension isn’t necessarily the norm.

While some wonder why we even have a PHE anymore, the healthcare community has to prepare for the unwinding of Federal and state COVID rules, regulations, and protocols, which impact everything from patient care, privacy, and communications to coding, billing, revenue, insurance, and more. To make things more complicated, the timeframes for unwinding vary.

Obviously, the amount of work required to unwind will be impacted based on whether you have a multi-disciplinary practice or focus on one specialty; whether you operate a hospital or medical practice; whether you lead an insurance company/brokerage or telehealth platform; and more.

Still, there’s going to be a lot of work required at the same time you’re likely dealing with the effects of the ongoing labor shortage and uncertain financial environment. As noted by Employee Benefit News, “As we move into 2023, a new sort of “new normal” will likely emerge, but it will take significant effort and communication between healthcare providers, systems, insurance carriers, employers, and employees.” (Schomer, Stephanie. “When COVID is no longer a public health emergency, what happens to healthcare?” November 7, 2022. BenefitNews.com.)

There are a few ways to start preparing to unwind that may be worth consideration now:

Review changes that took place throughout the PHE and identify which ones will impact your organization once the unwinding begins. Valuable resources include:
– KFF’s detailed summary of changes, timing and implications.
– The Center for Medicare and Medicaid Services’ roadmap for unwinding and fact sheets by medical discipline.
– Medicaid’s dedicated resources, tools and information and the S. Department of Health and Human Services’.
– Georgetown University’s Health Policy Institute state unwinding tracker links to state plans as well as communication tools, FAQs, and more.
– New York State of Health website, toolkit, and communication templates.
If you operate a practice that specializes in one discipline or industry, be sure to get on the email lists of national organizations representing your vertical. This can help you get right to the information that’s most pertinent for your practice.
Consider establishing a task force now to oversee the overall unwinding process for your organization. Define who should be on the task force, governance, objectives, timelines, milestones, and success measures. Be sure to include legal counsel for accurate interpretation and application of rules, regulations, and protocols.
Start developing a change management strategy incorporating communication and training. Identify all key constituents and audiences, their information needs, communication channels, key messages, and more. Whether you decide to institute a two-minute start of shift daily meeting to review the latest updates or add a reference page on your Internet/Intranet, using the time available to get an infrastructure in place now can help you when the PHE ends.

While you’re focusing on leading your organization through the unwinding, keep in mind that RBT CPAs can free you up by handling all your accounting, tax, and auditing needs with the highest levels of professionalism and ethics. We’re one of the largest firms in the Hudson Valley and beyond, with a legacy built on one simple belief: we succeed when we help our clients succeed. Interested? Give us a call today.