Domestic Medical Tourism

Friday, January 27, 2012

Domestic Medical Tourism: It seems counter intutive to pay for an employee or covered family member to travel to another locale in order to have a less expensive medical treatment. This travel often includes the transportation and lodging costs of a companion caregiver, such as a spouse or other adult relative to accompany the member. However, many large companies often include a domestic medical tourism option within their health care plans. While financial savings is one of the objectives, in other cases those procedures which are most likely to have the highest positive outcomes may only be available in another city or state. Furthermore, it is often the case were both financial savings and positive outcomes come together for the benefit of the plan sponsor as well as the member.

Domestic medical travel is frequently associated with medical centers of excellence which specialize in a limited range of disease conditions, yet employ leading edge treatment modalities. These centers are generally located in metropolitan areas throughout the nation, sometimes in conjunction with research and teaching hospitals. Facilities such as the Cleveland Clinic, Mayo Clinic, Johns Hopkins, and MD Anderson Cancer Center are among the several institutions touted as being recognized for their frontline treatment procedures for diagnosing and treating especially difficult medical conditions.

While expenses associated with travel, transportation, and lodging do not make financial sense for routine and uncomplicated medical conditions; treatment for unusual and rarely seen illnesses may confound local providers, even if they are a specialist. Misdiagnoses, unnecessary care, repeated or incorrect procedures may only exasperate the medical situation, resulting in lost productivity, wasted dollars, time, as well as ageist on the part of the member and family. Negative outcomes could result in long term or permanent disability and/or even untimely and avoidable death.

Organizational policies connected to domestic medical travel must be clearly and comprehensively documented within carrier contracts, Schedule of Benefits, Summary Plan Descriptions, as well as general and specific documents and policies addressing paid, unpaid, and FMLA leaves. Unless the organization retains internal or external medical expertise, it is best to rely on the recommendations of the member’s specialty care provider(s) in consult with the carrier as to whether or not domestic medical travel is warranted.
                  

Special attention should be paid as to who is permitted to travel with the member as a companion caregiver; this could include a spouse, domestic partner or an adult relative. Non-adult children should be excluded. In the absence of a related or domestic partner companion, an organization may want to consider the use of a medical or home health aide to assist the member before, during, and after the travel period. Again, it is best to rely on the recommendations of the member’s specialty care provider(s) when it comes to what type of companion would be required.

If the organization retains an EAP, it may be appropriate to make the member aware of and provide information about such services as requested. The EAP is in the proper entity to provide assistance with legal and other services to address issues dealing with durable power of attorney, advanced living directives, wills, and living wills.

Worker Misclassification: A Continuing Employer Issue

Friday, January 20, 2012

Worker misclassification by employers as “independent contractors” continues to be a focus of the Internal Revenue Service, U. S. Department of Labor as well as the States Departments of Labor. On September 21, 2011, the IRS announced IR-2011-95, Voluntary Classification Settlement Program (VCSP) designed to allow non-compliant employers to pay a penalty of one percent of wages paid to reclassified workers during the prior year. Interest and penalties will be waived, and employers will not be subject to payroll tax audits for these workers for prior years.

On December 5, 2011 Colorado became one of the latest states joining with Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Missouri, Montana, Utah, and Washington to cooperate with the Internal Revenue Service and the U. S. Department of Labor to combat worker misclassification by employers as independent contractors.

Even states not associated with joint efforts between IRS and DOL have taken actions to increase the oversight of worker misclassification. Both Pennsylvania and New Jersey enacted new legalization in 2011 to address misclassification in their construction industries.

So why the continued and on-going efforts to address worker misclassification by employers as independent contractors? The answer is very simple, lost tax revenue and non-compliance with state and Federal anti-discrimination and leave laws. In a time of reduced state and Federal tax revenue, lost Federal, state, and local income, Social Security, Medicare, workers' compensation and unemployment compensation taxes can be very significant. Place on top of that, recovered back wages, fines, fees, penalties, and judgments; and it is easy to see why regulatory agencies across the nation would want a piece of that pie.

In addition, as a misclassified worker, participation and contributions towards health care, pension, retirement and savings plans as well as other benefits are forgone; causing a shift in these burdens to governmental agencies. Furthermore, employers with misclassified works may find that they are also in non-compliance with Federal, state, and local anti-discrimination laws; subjecting themselves even more monetary damages.

Finally, the loss of public goodwill and brand name damage attributed to negative and highly visible and public notoriety to an organization is substantial. In one Illinois case involving five construction companies, in addition to fines, the companies were forbidden from bidding on construction projects for the next four years. It is likely that the fines paid by the five companies paled in comparison to the loss of the ability to bid on future contracts.

Talent Acquisition and the Role of Social Media

Friday, January 13, 2012

Talent acquisition, even in these days of continuing high unemployment is tough. While there appears to be some light at the end of the tunnel, many employers are still very reluctant to hire except in cases of absolute necessity.

Sourcing talent, top talent is expensive, time consuming, and can have unpredictable results. In an April, 2011 report, the Society for Human Resource Management (SHRM) polled human resource managers and others on the role of social media in talent acquisition. Not surprising, the role of social media has increased significantly and based on the SHRM poll, is going to continue to increase in the future. In the report, “Use of Social Networking Websites to Recruit Potential Job Candidates in 2011 vs. 2008”; partartpants reported that 56% of polled organizations used social media to recruit potential job candidates.

One aspect of sourcing talent via social media is the ability of recruiters to do so in a passive manner prior to inviting a prospective candidate to submit a resume or application. This allows recruiters to “window shop” potential current and future prospects, follow the development of individuals, and identify emerging leaders in their fields. While most staffing issues deal with an immediate need, social media does permit a recruiter to build and maintain an inventory of future talent. Examples of how such efforts might be beneficiary are:

● An employer wants to expand and needs to add management and technical staff over the next year.

● An employer wants to add technical staff experienced in a specific software application.

● An employer wants to acquire a junior staff with short/long term growth potential.

● An employer wants to acquire project staff for a fixed duration assignment.

The blogosphere has allowed million of persons to publish the most mundane aspects of their daily lives, however, many bloggers write on professional and technical topics of interest to others within their field of endeavor. By viewing the blog of a prospective candidate over a period of time, the astute recruiter can gain insight into the communications capability of the blogger, the likelihood that they will culturally fit into the organization or team, and their technical understanding of the blog’s various topics. Furthermore, an individual’s blog speaks to their motivational level, a blogger who writes consistently and routinely may have the motivation to stay on top of that major project. “MonsterThinking”, a new blog at Monster.com even publishes a “Top HR and Recruiting” bloggers list.

It goes without saying, sourcing through social media and networking sites is not for everyone and every organization. Recommendations posted by current and prior coworkers do not replace face to face interviews and appropriate background and reference checks. Even the most professional networking sites currently on the web are unvetted and pose a significant risk to the unwary recruiter. Legal concerns abound about the ability of a prospective employer to use posted materials to screen candidates are continuing to emerge. Just as the professional recruiter would perform due diligence in checking the job history, education, and references of a paper resume, so to would they cast a discerning eye on a candidate’s social media profile.

Employee Compensation in 2012: Pent-up Demand

Friday, January 06, 2012

During the recent recession, numerous organizations froze wages, reduced benefits and hours, and eliminated staff in an effort to remain competitive. By all official counts, the recession reportedly ended over two years ago, yet corporate compensation budgets are still very much stalled in a slump. With unemployment above 8%, many employers feel little or no pressure to increase wages or benefits. However those employees who have foregone raises or even suffered reductions are becoming restless. Yes, they were grateful to have jobs, while at the same they are beginning to question what their loyalty really bought them. Even in the best of times, a rubber band will only stretch so far before it snaps. So what options are available to an organization which needs to retain its talent in the face of little or no desire to increase costs?

First, start with being as open and as transparent as possible about why increases are not available or why they are significantly smaller than normal. If left to their own devices, employees will gravitate towards a few well worm reasons of their own: “management is just cheap”; “the bosses are paying themselves first”, … etc. Many employers have found that they are still very uncomfortable with the progress on both political and economic recovery here in the U. S. and in Europe. As political and economic issues such as debt and spending wax and wane, organizations do not want to be caught at a cost disadvantage if the U. S. or Europe fails to recover in the short run. By keeping cost in check, employers increase the likelihood that they will remain in business, even if that means fewer jobs or no compensation increases.

Second, many organizations completed their annual employee benefits open enrollment in the Fall of last year. Many organizations share in the costs of health care with their employees. Employees need to understand that most employers did not shift 100% of cost increases to their employees. The Kaiser Family Foundation reported on September 27, 2011 that for 2012 “annual premiums for employer-sponsored family health coverage increased to $15,073”. It is often overlooked that while the employee’s premium cost increased $4,129 between 2001 and 2011, however, the employer’s portion increased $10,944 over the same period. Thus, on average, employers are continuing to pay over 70% of the annual premiums for family health care. Something, of which most employees are unaware.

Finally, most organizations present their employees with numinous opportunities to develop new skills, acquire expanded knowledge of new processes or procedures, and interact with customers, clients, and vendors at all levels. While these “opportunities” do not immediately materialize as increased compensation, they do lay the groundwork for potential advancement in the future. However, at same time, employers who are developing internal talent in this manner do have to be alert not to train employees for their competitors.

Employers must recognize that at some point labor market forces will dictate that employee compensation will need to rise for some workers. When that time occurs, organizations must focus on the top performers, least they face the prospect of losing that talent to a competitor.