Employer Sponsored Onsite Medical Clinics

Friday, July, 13 2012

Is the “company doctor” making a comeback? At one time in our history, the company doctor was a standard fixture along with the company store and company housing. In mill, mine, and factory towns all over 19th century American, employers provided workers with a doctor who was paid by the company to deliver medical care to its employees and their families. Sometimes the care was free to employees, at other times the employees paid a modest fee for medical services. Increasingly today, employers are rolling out job site medical clinics for employees as another tool in their battle over high health care costs. In some cases clinics are located on the employer’s property, at other times they are mobile facilities in the form of vans. Onsite clinics and mobile facilities are intended to provide a primary level of care and not to replace specialty or hospital care.

The advantage of an onsite clinic for employers and employees are several: Less down time away from the workplace for employees, ability to deal with medical issues on the spot, a degree of control over the care delivered, and the costs of that care. Onsite Clinics, a website focused on the topic of workplace medical care, reported in May, on a study conducted by Price Waterhouse Coopers (PWC) on trends in mobile health care. In the PWC report, “Healthcare unwired: New business models delivering care anywhere”, PWC explores emerging trends in how, when, and where health care is being delivered. The premise is simple: The technology that gave us the Internet and cell phones has the ability to deliver medical care in a similar manner. The how, when, and where of health care delivery could mean the workplace or the home or somewhere in between. Physicians often draw conclusions based on diagnostic tests which are performed in their offices. Onsite clinics and remote monitoring devices allow physicians to monitor medical parameters throughout the day under varying conditions of physical and mental stress.

In a March report on Bizjournals.com, Hospital Corporate of American (HCA) and Gaylord Entertainment, operators of Nashville’s Opryland and hotels in Florida, Texas and Washington, D.C., announced an agreement for HCA’s Health to You (H2U) subsidiary to provide onsite medical services to Opryland’s 4,500 employees their families and Opryland guests. H2U’s COE Yonnie Chesley, was quoted as noting both “convenience and productivity” as big incentives for Gaylord’s decision along with an expected ROI of $3-$2 to $1 projected by HCA. Along with “wellness, primary and urgent care”, the clinic is expected to deliver “occupational health, chronic disease management, labs, screenings, physicals and a pharmacy.”

Isleta Pueblo’s Hard Rock Hotel and Casino provides an onsite clinic to some 1,200 employees at its facilities located south of Albuquerque, New Mexico, which is operated by ABQ Health Partners. Without an onsite clinic, employees who became ill at work would face travel time to an urgent care facility or several hours waiting at an emergency room. The employee could face the loss of pay and the employer could face potential premium time pay for a replacement worker.

The level of care provided by onsite and mobile clinics is primary and urgent care; life threatening emergencies are referred to the appropriate facilities. InHouse Physicians, which manages various workplace clinics worldwide, provides services for worksite health centers, flu and adult vaccinations, medical support for meetings, biometric screenings, workplace wellness programs, certified health coaches, and employee wellness education.

As with any situation, all service providers must be fully vetted. While other employers may recognize significant costs savings with onsite and/or mobile facilities, each employer is different and should evaluate their economics on their own merits. Internet and cell phone technology has changed the way many everyday activities are conducted in today’s business. That same technology has the potential to make radical changes in the delivery of health care, for better or for worst.

Workplace Obesity: A question of Responsibilities

Friday, July, 06 2012

Hardly a day goes by when we are not reminded by health, government, and business leaders that Americans have become overweight and in many cases obese. The problem is not that many workers are just overweight and obese, they are also unhealthily and at risk for several diseases including Type 2 Diabetes, heart disease, high blood pressure, musculoskeletal, and other weight related disorders. Workplace obesity is a concern for employers, since overweight and obese employees have higher rates of absenteeism, lower productivity, and higher medical costs than their normal weight counterparts.

Due to the issues mentioned, employers certainly have a stake in promoting healthily weight management through educational wellness programs. Some employers have gone so far to introduce walking programs; others have begun to offer discounted fitness program memberships as a means of maintaining and improving worker health. Of course none of this works unless the individual employee is engaged enough to participant in the programs. With the passage of the Patient Protection and Affordable Care Act (PPACA), employers are permitted to provide a financial incentive to workers who participant in workplace wellness programs. Currently, that incentive is capped at 20% (30% in 2014) of the cost of employee health care, but can increase to as much as 50% with the discretionary approval of the Secretary of Health and Human Services in 2014 and beyond.

Aside from any financial incentives, workers have a self-interest in improving their own health and well being. Unfortunately, there are many perceived barriers to maintaining a healthy lifestyle, however, simple changes in what we eat (more fruit/vegetables), when we eat (no mid-night meals), and getting more exercise, can make meaningful changes in our health and well being. Even when at work, we can make small changes by walking the stairs rather than taking the elevator, avoiding the vending machine treats by selecting healthier alternatives, and foregoing that double cheeseburger and fries at lunch.

Clearly the responsibility to manage our health and lifestyle is in the best interest of health, government, and business leaders and employees themselves. With health care costs taking a larger portion of employer revenues and employee paychecks; money spent on health care related to poor health and lifestyle habits could find its way to both the employer’s bottom line as well as employee’s take-home pay.

Lost Talent: Job Candidates Reject Job Offers

Friday, June, 29 2012

The leading sentence from a recent CareerBuilder survey read “Despite high unemployment rates, more than half (56 percent) of employers who recruited new employees in the last year reported that a candidate rejected their job offer.” While there are a number of reasons why any given candidate would reject an offer, it does beg the question as to how the hiring organization got to the point of making an offer without an understanding if the candidate would accept or reject the offer. The organization must have felt confident that the candidate processed the necessary skills if they were ready to extend an offer. The survey went on to dispel a number of myths including that the outcomes of candidate recruitment has no impact outside of the recruitment process. Consider that a candidate is in fact a “consumer”, and as a consumer their “experience” will be shared with other similar consumers, both good and bad. Their experience will influence whether or not others, with similar skills will seek employment with an employer. Yes, we are still in the middle of high unemployment, and job candidates should be lining up at your front door willing to take any job, at any salary, and under any conditions with no questions asked. However, apparently a number of candidates did not get that message.

We have seen these headlines for several years now. “A Sea of Job-Seekers, but Some Companies Aren’t Getting Any Bites”, “HR Staffs, Recruiters Overlook Qualified Job Seekers”, and “Jobs for skilled workers are going unfilled”. The story is the same for hundreds of employers who simply cannot find qualified job candidates with the necessary skills. And while it is true that many candidates are willing be to be trained, most employers are not set up to train a person who lacks the basic skills required.

It is easy to look to our school systems as not providing the basic skills required in today’s work place. However, many individuals recognize that they are missing, math, computer, communications, and other skills and take action to correct those deficiencies through self-development on their own. It is easy for most job candidates to expect employers to provide training and skills development. However, the truth is that for most jobs employers expect and require candidates to arrive on the job with basic and job skills in place. Even though most businesses have been using at least word processor and spreadsheet software since the late 1980’s, employers are still seeing candidates who cannot setup basic business letters or simple spreadsheets.

The real issue is that many candidates who go from application to application and who have the skills required are being overlooked or are turning down job offers. Candidates who have had bad experiences during the application process reach a negative conclusion about the employer long before an offer is extended. Organizations that look at candidates as a commodity with the expectation that they can treat candidates as such may find themselves with fewer applicants and lost opportunities to acquire the talent needed.

Background Checks: Potential Risk

Friday, June, 22 2012

Background checks are commonplace for most organizations as a means of verifying employment, education, licensing, credentialing, credit, and criminal histories. In an era when COE’s (Scott Thompson), coaches (George O'Leary), and even medical doctors (Dr. Paul Shrode) misrepresent themselves on resumes and other official documents; background checks are a powerful tool to validate qualifications.

As an organization, hiring or even promoting someone based on falsified qualifications could lead to a nightmare of public relations, unnecessary and excessive expenses, and potential legal actions. On the surface it seems like a straightforward process, you search the court records, educational institutions; licensing and credentialing boards, run a credit report, and check out the various social media sites. So, does your organization’s application process provide the appropriate disclosures and permissions granting your organization authority to take these actions? If you find a questionable item, what is the organizational process to authenticate your initial findings? When do you run background checks, before an offer, upon a conditional offer, after hire? How do you address a situation with a background reference that develops well after an employee has been hired? Have you vetted your process and action steps with your internal or external counsel? Do you periodically review and update the organization’s background verification process? Has your processes been validated in every state and city in which your do business? Have you vetted your process and action steps with your internal or external counsel? Even if you outsource the process, your organization could be at risk for any disparate actions.

Consider, in a number of states it is currently considered legal to reject an applicant who users tobacco products. How do you authenticate the applicant’s tobacco use status? Do you use a written attestment from the applicant or do you perform a chemical analysis? What do you do if you somehow discover that 1 year after hire the applicant is found to be smoking? Do you offer a smoke cessation program, refer them to your EAP, and take disciplinary actions?

TechMediaNetwork operates a website which reviews various services including background checking services under the banner, TopTenREVIEWS. As with any vendor, you should thoroughly vet anyone providing services to your organization. Remember, even if you outsource background checking services, your organization may still have exposure if the background checks are found to be invalid or in error. There are a lot of John Smiths out there!

Free Preventive Health Care Is Not Free

Friday, June, 15 2012

While everyone wants something for nothing, that something is never free. In order to encourage the use of preventative health screenings such as annual well-health physicals, check-ups, and exams many organizations provided such coverage with no or reduced out-of-pocket co-pays, co-insurance, and/or waived the deductibles. As applied to preventive screening, most health care professionals would argue that when appropriate, both children and adults should be screened for those illnesses for which they are at risk. This includes vaccinations as well as screenings.

Under the Patient Protection and Affordable Care Act (PPACA), preventative screenings listed as class “A” or “B” by the U.S. Preventive Services Task Force (USPSTF), an agency of the U.S. Department of Health & Human Services, are to be provided at no out-of-pocket cost to most insured members. In a periodic publication of nearly 300 pages, the USPSTF reviews and recommends or discourages the use of various medical procedures designed to provide “preventive” health care for adults and children. While individual physicians are not mandated to follow such guidelines, they frequently do unless the member’s age, gender, personal medical history or other factors indicate a deviation should occur. Prior to PPACA, most health insurance plans covered preventive services recommended by the USPSTF when considered “medical appropriate” but usually imposed an out-of-pocket co-payment, co-insurance, and/or deductible.

The theory behind providing for preventive services is simple; it is cheaper to prevent an illness than to cure it. Unfortunately, not all physicians agree on the use or frequency of all preventive screenings. One example is mammograms. The National Cancer Institute suggests that women age 40 and above should have a mammogram every 1 to 2 years. However, the USPSTF’s 2009 recommendation for females younger than age 50 is,”Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.” Another example is the Prostate-Specific Antigen (PSA) test, used to identify males with highs levels of PSA as a possible indicator of prostate cancer or other prostate disorders. The American Cancer Society recommends men as young as age 40 should be screened for prostate cancer based on ethnicity, personal and family history. Men with an elevated PSA level should be screened every two years. However, in its October 2011 update, the USPSTF concluded, “that many men are harmed as a result of prostate cancer screening and few, if any, benefit.”

The theory of out-of-pocket cost-sharing arrangements such as member co-payments, co-insurance, and deductibles is to provide “skin in the game” for covered members by requiring those who actually use the services to pay a portion of their costs. This is true for auto, home owners, as well as for health insurance. Under a “fee-for-service” payment method, when out-of-pocket cost-sharing arrangements are removed, unnecessary service utilization increases which increases overall premium costs for all insurance members. A $20, $30 or $50 co-payment may seem insignificant, until it is considered that hundreds to thousands of those co-payments must be absorbed by members who never use the covered services. Finally, without some form of control, excessive utilization will without a doubt be seen in next year’s rate increases.

The Devil Inside the Boss

Friday, June, 08 2012

We have all had one or more bosses who, we knew must have been hatched from some demon spawn. No matter what you did, it was wrong, was not fast or soon enough or was just unacceptable. But you need a job and you have to learn how to deal with them. In order to do that you need to understand what drives this person to behave so badly. This is not just an issue between the subordinate and the mis-behaving boss. Loss of morale, productivity, production, sales, and even workplace law suits are just some of the fallout from bad bosses.

First, it is usually not the employee; of course there are exceptions to every rule. A bad boss got this way because their behavior was tolerated, rewarded, and maybe even admired by their superiors at some point in their career and for some time. Subordinates have little control over the rewards and admirations in this situation, but inappropriate behavior does not have to be tolerated. To make this point clear, a demanding, hard-driving boss does not necessarily make a bad boss; it’s all in the execution. There is nothing wrong with a boss who sets high expectations, demands quality work, and provides the supports and tools to achieve a high level of performance. Bad bosses, however are often accompanied by behavior such as threats, bullying, rude, crude, derogatory remarks, insults or public humiliation.

Second, many bad bosses lack the technical skills of their subordinates and are therefore dependent upon others to actually complete the assigned task. Subordinates who are masters at their role have the ability to build a relationship with even the worst boss. Even a bad boss understands that there is a quid pro quo between themselves and their most talented employees. An employee has to be careful not to over extend this relationship; nevertheless, a skillful and tactful employee can build a connection which clearly sends a strong message that they are a professional and expect to be treated as such.

Third, most business managers are not totally oblivious to how employees are treated by their bosses, especially if that treatment results in high turnover or lost production and sales. While it may take time, business managers will come to recognize that they may have placed the wrong person in a role as a supervisor. Even top performing bosses to have to account for high turnover rates. Excessive turnover can be an indicator that something is just not right within an organizational unit. Turnover often translates into excessive cost and lowered production, measures which normally captures the eye of higher level managers.

Alice Walton writing for The Atlantic on February 25 2012 in an article titled, "The Impact of Bad Bosses", related several studies which link the work environment to the health of employees.  In one study at Baylor University it was discovered that work related stress and tension impacted employee’s relationships outside of work, including every member of the family.  A Swedish study found a relationship between fatal and non-fatal heart attacks, angina and death from heart disease and a negative work environment while studying 3,100 men in research sponsored by Karolinska Institute's Department of Public Health Sciences.  Research at the University of Arizona, Department of Economics identified that unique areas of the brain are affected in different ways when individuals experience cooperation vs. guilt. The study concluded that most individuals want to please others and thus avoid feeling guilty.  Research at IBM and the University of Michigan found a relationship between the organizational culture and the overall health of workers and their families while studying 22,000 IBM employees and their families.

Finally, how an employee chooses to react to a bad boss or a negative work environment is partly under their control. Eventually, individuals will need to decide if to stay or quit.

US Health Care Treads Continue to Slow

Friday, June 01, 2012

Price Water House Coopers (PwC) reports that for the fourth year in a row the annual US health care rate is expected to trend lower. Since 2010, PwC’s Health Research Institute national survey of employers has indicated another year of relatively flat trend in health care plan costs.

Medical trend is significant since it makes up the most important factor in determine employer and employee health insurance premiums for the coming year. In addition, medical trend can be broken down into its constituent components allowing employers and policy makers to determine which aspects of health care are moving faster or slower. PwC attribute the slow-down in medical trend to:

                                  • Medical supply and equipment costs

                                  • New forms of primary care delivery

                                  • Price transparency

                                  • Generic drugs

                                  • Economic correlation

PwC believes the decrease in medical supply and equipment costs are related to an increase in the employment of physicians by hospitals, on-going consolidation of hospital systems, and governmental trenchancy rules. The result is that hospitals have been able to leverage their increased purchasing power to drive down costs, while governmental transparency rules have made physician honorariums more visible.

As deductibles for traditional and high deductible health care plans have increased, members have chosen alternative forms of primary care delivery. Care delivered in on-site and retail walk-in clinics are significantly less expensive than physician offices.

With the up-take in high deductible health care plans, price transparency has taken on added importance. Currently, over 75% of states have some form of health care price disclosure laws in place. Increasingly, organizations such as Health Advocate, Change Health Care, Castlight, and others are providing members with pre-procedure price information allowing members to informed decisions.

One area of high visibility is that of pharmaceutical costs. In the last several years and projected for the next several years the conversion of numerous brand name drug to generic equivalents is expected to have a significant cost impact. PwC expects the sales of brand name drugs to fall by over 30% between 2011 and 2014.

While not commonly considered discretionary spending, health care consumption does correlate closely to the overall state of the economy. The lingeringly and slow recovery has had a suppressive impact on some medical procedures, including preventative screenings.

While a medical trend rate of 7.5% is still several multiples of general inflation, compared to 9, 10, 11 or 12 percent, it does represent an improvement. However, even at 7.5%, health costs can be expected to double in just under 10 years. Which means that both employers and employees can see significant increases to come.