jueves, 29 de marzo de 2012

BLOOMBERG GOVERNMENT INSIDER:Health Reform's Small Business Confusion

Bgov_smallbiz13__01__630x420

Since Lake Michigan Mailers began offering workers health insurance in the early 1990s, the company has considered the benefit as essential as paying wages. Now, David Rhoa, president of the direct-mail business his parents started, doesn’t know if he can afford to offer coverage beyond next year. Like many small businesses, the Kalamazoo (Mich.) company must contend with rising health-care costs and big questions about the reform law intended to keep them in check. “We told our people flat out that we’re having to take it on a year-to-year basis,” Rhoa says. “I’m 50-50 on whether or not we’re going to be able to do it. That’s troublesome to me.”
Starting in 2014, companies with 50 or more employees will have to provide insurance or pay a penalty, but a lot of the details haven’t been worked out. The law doesn’t penalize businesses with fewer than 50 “full-time equivalent” employees for not offering coverage. The government considers 30 hours a week to be full-time. Lake Michigan Mailers, which has more than $10 million in annual revenue, has 55 workers, 37 of them full-time and the rest part-time. By Rhoa’s math, he expects to hit the threshold. He’s also hiring, so even if the company isn’t yet big enough to face penalties, it might be when they kick in two years from now.
Rhoa faces another uncertainty: He’s not sure whether the plan he offers will meet the law’s requirements. If it doesn’t, he doesn’t know whether he can afford to buy one that does.
This year, Lake Michigan Mailers switched all its employees to a high-deductible health plan to lower costs. The company pays 79 percent of the premiums, and workers pay the remaining $55 per month. Employees get free physicals and many screenings and then pay up to $4,000 in out-of-pocket expenses before coverage kicks in. Most workers contribute to a health savings account to pay for care.
Rhoa moved to this arrangement reluctantly when more comprehensive coverage became too expensive. Whether it will be enough to help him avoid penalties is unclear. Employers “don’t know yet what is going to be considered an adequate offer of affordable coverage, so it’s a little hard to be making that determination,” says Gary Claxton, a vice president at the Kaiser Family Foundation, a health policy research group.
To pass muster with the law, employer plans must be “affordable” and provide “minimum value.” Congress let regulators set both those bars. Affordability means premiums can’t cost workers more than 9.5 percent of their family income, a threshold Lake Michigan Mailers surely meets. (At contributions of $55 per month, Rhoa’s workers would need to earn less than $7,000 per year for the plan to be considered “unaffordable.”)
The “minimum value” part of the equation is trickier. That requires the insurance plan to pay for at least 60 percent of medical care covered; that way workers won’t be so burdened by co-pays, deductibles, and other expenses that they can’t afford care even with insurance. Companies are waiting on a detailed proposal from the U.S. Department of Treasury to clarify whether the law also sets requirements for what a plan must cover.
If Lake Michigan Mailers’ plan doesn’t meet the requirements, Rhoa calculates it will be cheaper to pay the penalties, which he estimates at $42,000, than to buy a more comprehensive plan. He’d prefer to keep offering the benefits the company can afford. If he drops coverage, workers may get subsidies to buy their own plans in insurance exchanges. “I’ll end up paying a fine and irritating my employees at the same time,” he says.
Alden Bianchi, who leads the benefits practice at the Boston law firm Mintz Levin, doubts that many companies already providing coverage will drop it. “It’s not like employers are going to save a boatload of money by shipping people off health care” and shifting them to insurance exchanges, says the attorney, who advised Mitt Romney’s administration when Massachusetts passed its 2006 health-reform law.
Despite all the hand-wringing, Bianchi expects that employers will quickly adapt to the new law with little trouble. He recalls that the Cobra law, passed in 1986 to allow workers to temporarily keep health coverage after leaving a job, prompted initial howls from companies. “Within two or three years, it’s like, ‘Yawn, yeah, I do the Cobra thing,’ ” he says. “Things like this go through three stages: impossible, difficult, easy.”
Rhoa can’t wait to get to the easy part. He and his managers have spent more than 100 hours studying the law, attending seminars, and trying to plan the company’s benefits. He’s frustrated that he can’t project his health costs or guarantee coverage to his workers. “I need to attract and get good people,” he says. “I also need to keep my costs under control, and I need to have some predictability on what those costs are going to be.”
The bottom line: With some rules not yet in place, small companies are struggling to figure out how health-care reform will affect them.
By  on March 22, 2012
  (Tozzi covers small business for Businessweek.com)

Como Establecer un Negocio en la Florida



Como Establecer un Negocio en la Florida
 Jueves 29 de Marzo 2012
5:30 pm - 6:30 pm
Costo: $10, Cupo Limitado. Se recomienda registracion previa 
por internet. $15 en la puerta. 

Lugar: SBDC Miami, Festival Plaza,  
8500 SW 8th Street, # 224, Miami FL 33144 
 

viernes, 16 de marzo de 2012

End of Days for Independent Pharmacies? Tomado de Bloomberg BusinessNews

0308_pharmacy_630x420

Brett Barker, a pharmacist and director of clinical services at NuCara Pharmacy in Nevada, Iowa, says his personal relationships with patients help him catch dosing errors and recommend low-cost generics over expensive drugs whenever possible. NuCara, a $30 million business with a dozen locations and 175 employees, sorts medications into daily-dose packages for seniors and hand-delivers them every Friday.

Barker, Woods, and other pharmacists say independent pharmacies that frequently anchor traditional downtowns around the country could vanish if a merger of two mammoth corporations wins approval from the Federal Trade Commission. They and their counterparts have banded together to wage a ferocious battle against what they insist would be a death knell for community pharmacies.

What has them up in arms is Express Scripts’ (ESRX) $29.1 billion acquisition of Medco Health Solutions (MHS). The deal was announced last July, but is pending FTC scrutiny. Pharmacists and advocacy groups expect the FTC to make a decision by the end of this month, although FTC public affairs specialist Mitch Katz won’t speculate on any timetable for action. The corporations combined would become the country’s largest pharmacy benefit manager (PBM), which is a third-party administrator that manages drug benefits for employer-sponsored health plans and insurers.

If the deal goes through, Express Scripts’ patient roster is expected to rise 50 percent, to 135 million individuals. CVS Caremark (CVS), which would become the second-largest PBM in the U.S., currently serves 85 million people. Having one company gain such a large market share could put an unacceptable squeeze on reimbursement rates for independent pharmacists and encourage PBMs to shift patients into preferred-provider pharmacy networks and their own mail-order drug dispensaries, says pharmacist Douglas Hoey.

Hoey is the chief executive officer of the National Community Pharmacists Association, a trade and lobbying group of 23,000 independent pharmacies who together represent $93 billion in U.S. annual health-care spending and dispense nearly 40 percent of all retail prescriptions. Both the community pharmacy group and the National Association of Chain Drug Stores oppose the Express Scripts-Medco merger.

Hoey says independent pharmacies have held their own over the past decade, after many were driven out of business when big-box and chain retail pharmacies proliferated in the 1980s. About half of independent pharmacies are located in cities with populations of 20,000 or fewer. Today, “the single biggest challenge to our financial success is the pharmacy benefit managers, multibillion-dollar Wall Street companies that have wedged themselves in as middlemen between employers and pharmacies,” Hoey says. Although most Americans might be hard-pressed to identify which PBM processes their prescriptions, he says, they exert enormous influence over the pharmaceutical industry.
PBMs “dictate reimbursement terms and cash flow” to small pharmacies on a take-it-or-leave-it basis, he says: “The PBM is a competitor that can poach and cherry-pick the most profitable prescriptions, and they have made the [pharmaceutical insurance] payment system so convoluted it’s hard to pinpoint how they make their money.”

Express Scripts was founded 25 years ago, when PBMs were a new concept. Government studies have shown that PBMs reduce prescription costs, particularly when patients use PBM-owned mail-order dispensaries for 90-day supplies of regular medications.

Express Scripts’ spokesman Brian Henry disputes the doomsday fears around the proposed merger and says his company provides cost-effective benefits, works to drive down costs and medication errors, and values the role of small, independent pharmacies. The $45 billion corporation employs 14,000 in the U.S. and Canada.

“One-quarter of the 750 million prescriptions we managed in 2011 went through independent pharmacies, and we’re very proud of the relationship we have with them,” Henry says. “We understand that they provide critical care in certain rural communities, and we are accelerating what we can do to help them.” Mail-order accounts for a very small segment—about 8 percent—of Express Scripts’ overall volume, he says.

Independent pharmacy owners like Woods and Barker worry nonetheless. Although, like many independents, both pharmacists offer such medical services as respiratory therapy and prosthetics fittings, neither sell enough over-the-counter items to make up for a major loss in prescription revenue.

“I’m a pharmacy first; I’m not a retail giant. If I don’t profit on prescriptions, I go out of business,” Woods says. It also hurts when their education, skills, and patient relationships are devalued in favor of computers and mail-order: “People call me all hours of the day and night. They know where I live, and they come to my house if they need me,” says Woods, who employs seven full-time workers and for decades has trained pharmacy interns from Arkansas universities. “I cannot handle the competition from the pharmacy benefit managers who set rates I cannot control. I can complain, but it does no good whatsoever. And in a town of 3,000, I cannot make it up on volume.”
 
Karen E. Klein is a Los Angeles-based writer who covers entrepreneurship  and small-business issues

martes, 13 de marzo de 2012

Workshops from SBDC



Procurement Power Tools for Women
      
Where & When          
Date: March 14, 2012       
Time: Noon - 1 pm
Location: SBDC Miami 
8500 SW 8th St, # 224
Miami, FL 33144
 

 Financing For Your Business  




Monday, March 19, 2012 11:00 AM to 12:00 PM
This workshop will cover the financial options available to small businesses.     
                                                       
Cost: $10 if pre-register, $15 at the door. Credit Card preferred
Speaker: Camilo Lopez-Niño, Certified Business Analyst,  
Location: SBDC Miami-Dade, Festival Plaza, Miami 


Going Global: Introduction to Import and Export

Import Export

                                                                     
Thursday, March 22, 2012 10:00 AM -12:00 PM                                                                                      
Going Global: Introduction to Import and Export: This workshop provides the fundamentals of international trade, understand the general import and export requirement, the regulatory requirements and payment mechanisms. 

Cost: $15 if pre-register, $20 at the door.                         
Speaker: Nancy Orozco, Certified Business Analyst,
Location: SBDC Miami-Dade, Festival Plaza, Miami


Financiamento para su Negocio  




Monday, March 26, 2012 11:00 AM to 12:00 PM

El objetivo de este seminario es
  1. Entender los requisitos de los Bancos  
  2. Identificar posibles fuentes de financiamiento para su negocio.  
  3. Entender la función del SBA.                                                  
Costo: $10, Cupo Limitado. Se recomienda registración previa. $15 en la puerta.
Orador: Camilo Lopez-Niño, Certified Business Analyst, 
Lugar: SBDC Miami-Dade, Festival Plaza, Miami 


Financiamento para su Negocio  

Como Establecer un Negocio en la Florida  

Open own biz

Thursday, March 29, 2012 5:30 PM 6:30 PM.  
                                                                         
Conozca las cualidades requeridas para tener su propio negocio, aprenda las ventajas y desventajas, aprenda a seleccionar un negocio, aprenda los requisitos básicos, y conozca las características para el èxito.  

Costo: $10, Cupo Limitado. Se recomienda registración previa. $15 en la puerta.
Orador: Lilian Urbandt, Certified Business Analyst,
Lugar: SBDC Miami-Dade, Festival Plaza, Miami 


SBDC at Miami
8500 SW 8th St
Miami, Florida 33144
305-261-1638
Register Now GREEEN



lunes, 12 de marzo de 2012

This week: from Bloomberg BusinessWeek...

Growing Home Care Industry May Have to Raise Pay

The fastest growing jobs are also the least glamorous. The United States will add 1.3 million health and personal care aides by 2020, according to Labor Dept. projections released this month. That represents a 70 percent jump, greater than any other occupation. Such workers make about $20,000 per year.

If these are the jobs of the future, who are the employers? They’re overwhelmingly small businesses. There are about 22,000 home health care establishments, and the largest control less than 5 percent of the market, according to an analysis of the industry to be released Wednesday by FranData. The Arlington, Va., company produces market research reports for the franchise industry.

Franchisors, who license a brand and a business process to independent operators, are clamoring to capture the business of assisting senior citizens who want to remain in their homes. There are more than 60 brands selling home health care franchises, according to the report. Many of them have been franchising for only a few years.

How those companies will treat their growing workforce is a big question for the industry. The report notes that “many direct-care workers involved in personal care lack the training and support necessary to provide quality at-home care, such as administering medications. The poor working conditions and low salaries, at a national median of $8.8 [per hour] … contribute to a high staff turnover rate.”

Employers in many states have been exempt from providing home care workers minimum wage and overtime pay under a 1975 law that considers them “companions.” The Obama administration wants to repeal that exemption. In its proposal, the Labor Dept. notes:
Studies have shown that the low income of direct care workers including home care workers continues to impede efforts to improve both jobs and care….
Moreover, the workers that are employed by home care staffing agencies are not the workers that Congress envisioned when it enacted the companionship exemption, i.e., neighbors performing elder sitting, but are instead professional caregivers entitled to [Fair Labor Standards Act] protection.

For-profit placement companies not associated with hospitals or other care providers have come to dominate the industry, from 2 percent of Medicare-certified agencies in 1975 to 68 percent in 2006, according to the Labor Dept. As FranData also notes, they’re overwhelmingly paid with public funds.

Three-fourths of home health care revenue comes from public programs like Medicare and Medicaid, and pressure to control the cost of those programs could cut into the industry’s profits, the FranData report warns would-be franchise buyers.

Industry groups such as the National Association for Home Care and Hospice want Congress to preserve the labor law exemption, arguing that increasing wages without increasing reimbursement could make care unaffordable.

Fears that raising worker pay will reduce access to home care are overblown, says Rebecca Givan, an assistant professor at Cornell University’s ILR School. “It will raise wages for the very, very lowest paid of these home health care workers,” Givan says. They’re mostly women who are the main earners in their households, she says, and “many of them are relying on public assistance.”

Many home health care agencies already pay their workers minimum wage and overtime, though. “There are many high-road employers that this won’t affect at all,” Givan says.

The businesses using the exemption are essentially being subsidized three times by the government: they get paid by public programs, they pay workers wages that would be unlawful without the “companionship” exemption, and those workers in turn depend on government aid to supplement their low pay. If wages rise and reimbursement rates don’t, that may jeopardize profits for those companies.

“It’s generally some of the highly profitable staffing agencies that may be affected,” Givan says.
Tozzi covers small business for Businessweek.com.