Critical compliance changes for next year: An open enrollment checklist
Keeping up-to-date with health care is one of our top priorities. From HR Morning, here is a comprehensive list of everything you need to know so far going into 2018.
As HR pros immerse themselves in negotiating plan changes for this year’s open enrollment, it’s critical to keep these new 2018 regulation changes front and center.
To help, here’s a checklist of changes you’ll need to be aware of when making plan-design moves:
1. Mental Health Parity reg changes enforced
Beginning January 1, 2018, plans that require “fail first” or “step therapy” could violate the Parity Act’s “non-quantitative treatment limitation” (NQTL) rules. Under the NQTL rules, plans can’t be more restrictive for mental health/substance abuse benefits than they are for medical/surgical ones.
Here’s an example of a fail-first strategy: Requiring mental health or addiction patients to try an intensive outpatient program before admission to an inpatient treatment if the same restriction doesn’t apply to medical/surgical benefits.
2. New Summary of Benefits and Coverage (SBC) template
Under the ACA, plans were required to start using the new SBC template on or after April 1, 2017.
For calendar year plans, that means this is the first enrollment with the new template, which includes new coverage examples and updates about cost-sharing. You can find more details on and instructions for the new form here: bit.ly/temp544
3. Women’s preventive care
The Women’s Preventive Services Guidelines were updated for 2018 calendar plans to include a number of items that must be covered without any cost-sharing. The list includes breast cancer screenings for average-risk women, screenings for cervical cancer, diabetes mellitus and more.
See the original article here.
Source:
Bilski J. (17 October 2017). "Critical compliance changes for next year: An open enrollment checklist" [Web blog post]. Retrieved from address https://www.hrmorning.com/critical-compliance-changes-for-next-year-an-open-enrollment-checklist/
IRS to reject returns lacking health coverage disclosure
Where does the IRS stand on ACA (Affordable Care Act)? It's time to know. Check out this article from Benefits Pro for more information.
The Internal Revenue Service has announced that for the first time, tax returns filed electronically in 2018 will be rejected if they do not contain the information about whether the filer has coverage, including whether the filer is exempt from the individual mandate or will pay the tax penalty imposed by the law on those who don’t buy coverage.
Tax returns filed on paper could have processing suspended and thus any possible refund delayed.
The New York Times reports that the IRS appears to be acting in contradiction to the first executive order issued by the Trump White House on inauguration day, in which Trump instructed agencies to “scale back” enforcement of regulations governing the ACA.
The move by the IRS reminds people that they can’t just ignore the ACA, despite the EO. Although only those lacking coverage have to pay the penalty, everyone has to indicate their insurance coverage status on their filing.
According to legal experts cited in the report, the IRS is indicating that although the administration may have leeway in how aggressively it enforces the mandate provision, it’s still in effect unless and until Congress specifically repeals it.
While many people thought they didn’t have to bother with reporting, and many insurers have raised rates anticipating that the lack of a mandate would lead to lower enrollments and higher costs for them, that’s not the case. Initially the IRS did not reject returns because the law was new.
The penalty is pretty steep; for those who don’t have coverage, it can range from $695 for an individual to a maximum of $2,085 for a family or 2.5 percent of AGI, whichever is higher. Not everyone without coverage would be penalized, though; if their income is too low or if the lowest-priced coverage costs more than 8.16 percent of their income, they’ll avoid the penalty.
That said, it’s not known how stringently the IRS will be in enforcing the mandate. But at least taxpayers will know whether they’re exempt from the penalty or whether they’re obligated to buy coverage.
10 signs your workplace culture is toxic (and how to fix it)
Having a positive work environment is vital to the success and engagement of your employees. However, mainting that positivity, especially during busy quarters, can be dificult or even forgotten about. Today, we wanted to provide you with an informative article on staying away from toxic environments. From HRMorning.com, here are 10 signs your workplace culture is toxic (and how to fix it).
It’s a hard thing to admit … that your work culture may be toxic. But identifying the symptoms and finding the antidotes for them can quickly improve morale, engagement, retention and productivity. Let’s get started.
Here to help is Ross Kimbarovsky, founder and CEO of crowdspring, who has some unique insights into the signs of a toxic workplace and how to remedy them.
Are your employees tired? Discouraged? Burnt out?
If the answer is yes, you may have a toxic culture at work.
That’s a problem. Unhappy workers are less productive, make more mistakes, and are more likely to seek employment elsewhere.
Work culture exists on multiple levels. It isn’t just behaviors. It’s also an infrastructure of beliefs and values. To create real and lasting change, your business must tackle cultural issues on all levels.
You must act quickly to improve a negative work environment before productivity lags and employees abandon ship.
Here’s a step-by-step guide to help you turn around a toxic work culture:
1. Identify problem behaviors
Every company is unique. There is no one-size-fits-all solution for repairing a damaged work culture.
The first step is always to examine your business’s culture to identify your specific challenges.
Start by taking a critical look around you. Before you can change for the better, you have to face uncomfortable truths head-on.
Ten common warning signs a workplace is turning toxic are:
- gossiping and/or social cliques
- aggressive bullying behavior
- poor communication and unclear expectations
- dictatorial management techniques that don’t embrace employee feedback
- excessive absenteeism, illness or fatigue
- favoritism and imbalanced working conditions (discriminatory policies/wage gaps)
- workaholic behavior that sacrifices healthy work/life balance
- unrealistic workloads or deadlines
- little (or strained interaction) between employees or employees and management, and
- unsafe or morally questionable working conditions.
You probably won’t find all of these, and you may find problems not listed here. But whatever problems you find – take note. Those issues will inform your plan to rescue your work culture.
2. Evaluate the underlying support network
A toxic culture can’t take root without a fertile environment, and its symptoms can’t survive without a supportive infrastructure.
So, it’s time to dig deeper. What shared values and actions are helping to support those behaviors?
Examine your company’s leadership and their values. Then work your way from the top of the ladder to the bottom looking for issues like:
- discriminatory beliefs
- treating employees as assets, not people
- information guarding (poor communication/unclear expectations)
- aggressive or hostile leadership styles
- belief that employees are lazy, stupid and/or expendable
- resentment of Authority
- contrariness
- lack of accountability
- lack of appreciation for (or recognition of) good work
All of these are problematic and set the foundation for a negative work culture.
3. Plan your repair strategy
With a clear understanding of the illness, you can now strategize your treatment plan.
And remember – change is hard. Don’t try to fix everything at once. Prioritize.
Tackle the problem behaviors that have the biggest impact first, and smaller issues will likely begin to right themselves. Here are some strategic antidotes to many of the most common workplace problems:
- Listen to your employees. Hear their grievances, validate their experiences and make the changes necessary to address their issues. This can come in the form of one-on-one conversations, a town hall meeting with HR, or simple blind surveys. Listen, validate, and work together to find solutions.
- Assign realistic workloads and deadlines. This means taking the time to learn what your employees actually do. What are they responsible for, and how long do those tasks take? Remember that there are only 60 minutes in every hour and assign tasks accordingly.
- Communicate transparently. Employees can’t do their jobs well without understanding the context. Having the information to do one’s job reduces confusion and frustration, making employees happier and more efficient. Hold weekly meetings, and send frequent memos or a company newsletter. Share the information they need to know.
- Acknowledge work well done. A study by the Boston Consulting Group reports “appreciation for your work” as the most important factor to job happiness. Find ways to show appreciation. Tell employees what they’re doing well – they’ll feel appreciated (and be more likely to continue doing it). Build a supportive environment by sharing employee successes and make positive encouragement a group activity.
- Treat all employees by the same rules. Playing favorites breeds resentment. Examine your company policies – do they unfairly benefit one group over others? Be open to feedback; employees may see problems that you don’t. Then even the playing field, and require all employees to follow the rules.
- Foster emotional intelligence. The BCG Study included good relationships with colleagues and superiors among the top five elements leading to job satisfaction. Banish bullying, disrespect and dismissive behavior. Prioritize emotional intelligence. Provide resources to help employees expand their emotional intelligence. Improved emotional intelligence can cure a number of ills.
While these are all great suggestions for every company, be mindful of your business’ challenges, and choose your action items accordingly.
4. Implement your plan
John Kotter of Kotter International asserts that leaders are catalysts for workplace change. If you’re in charge, you have a powerful platform for motivating change. But, be prepared to live the changes you want to see if you want anyone to take those changes seriously.
Making change easy, rewarding and socially acceptable are the keys to success. Humans have a strong drive to be a part of the group. Normalize the behaviors you seek by asking the social influencers in your business to promote those behaviors, too.
Make it easy for your employees to implement positive changes by removing barriers to success. This, again, will require that you listen to your employees to know what those barriers are.
Finally, help your employees see how the changes you’re proposing will reward them with a more positive workplace.
5. Reflect and adapt
Give your new policies and practices time to take root. Change won’t happen overnight.
After a few months, take stock. What has changed? What hasn’t?
Meet with the influencers you enlisted to help with your implementation. Reflect on how things have gone. Different perspectives can offer useful insight.
Assess your progress, and adapt your efforts as needed. Keep the lines of communication open.
Cultural change is a big undertaking; but well worth the effort. Perseverance will lead you to success.
You can read the original article here.
Source:
Guest Author (6 October 2017). "10 signs your workplace culture is toxic (and how to fix it)" [Web Blog Post]. Retrieved from address https://www.hrmorning.com/10-signs-your-workplace-culture-is-toxic-and-how-to-fix-it/
5 Health Care Terms You Need to Know
We talk about health care A TON, but sometimes it's good to refer back to the basics of it all. Do you understand the meaning of deductible, premium or HSA? If so, give yourself a pat on the back. If not, don't worry! This blog post has got you covered.
Health care is confusing, but one thing's for certain: It's expensive. And health insurance companies don't always make it easy to understand what's covered, what's not, and how much you'll be on the hook for paying.
Deductible: The amount you pay before your insurance coverage kicks in. It resets annually.
Copay: The amount you pay after you have met your deductible. It's a fixed price for services and medications, and can vary by the type of physician you visit, the class of medication you're taking, and other factors.
Out-of-pocket maximum: The top limit of what you'll spend in a year out of pocket for deductibles and copays.
Premium: Your monthly fee for health insurance. If your employer provides you coverage, then you probably pay a portion of the premium, while your employer pays the rest. A higher premium may mean a lower deductible; on the other hand, a lower premium may mean a higher deductible.
Health savings account (HSA): A type of pre-tax savings account for health expenses. Funds roll over year to year, and some accounts even gain interest.
You can read the original article here.
Source:
Health.com (4 April 2017). "5 Health Care Terms You Need to Know" [Web blog post]. Retrieved from address https://www.health.com/mind-body/healthcare-terms-coinage
Health-Care Cost Expert Kathryn Votava on Buying Long-Term-Care Insurance
Health care can be an expensive matter, especially when seeking long-term solutions. We thought it'd be beneficial to find an article from the perspective of an expert on long-term insurance, enabling those looking into the solution to have a better idea of what they're getting into. From Health.com, here is an interview from Kathryn Votava.
You can read the original article here.
"The earlier you purchase a policy, the healthier you are and the more likely you are to qualify for insurance."(KATHRYN VOTAVA)
Many people rely on family and friends to provide care for them when they can no longer do it themselves. But at some point, the care required can be too much for these informal networks to handle. That's where long-term-care insurance comes in. Caregiving expenses are usually not covered by health insurance, and they can be staggeringa semi-private room in a nursing home, for instance, can run about $70,000 a year, and in-home care can reach as high as $350,000 for round-the-clock help. We asked Kathryn Votava, PhD, assistant professor of clinical nursing at the University of Rochester in New York and president of Goodcare.com, a company that analyzes health-care costs, for advice on how to shop for the best long-term insurance policy.
Q: What does long-term-care insurance cover?
A: Depending on what kind of policy you choose, it will pay for a nursing home, assisted-living facility, community programs, or for someone to come to your home to care for you. It can offset some of the costsnotice I said some. Most people think that if they have a long-term-care insurance policy, they're covered completely. Not only is the average policy not enough to cover the cost of this type of care, but people don't take health-care inflation into account. And you will still need to pay for your Medicare Part B, Medigap plan, prescription drugs, and doctor visits just as before. Those expenses don't go away and long-term-care insurance doesn't cover them.
Q: How much coverage should I get?
A: The average policy covers $149 a day. Now, if you live in some parts of Texas or Louisiana, that might cover your long-term-care needs. But in a place like New York City, the average is more than twice that. Get an understanding of what the costs are in your area. The two big surveys of nursing-home prices are from Genworth Financial and MetLife Financial. That will give you a ballpark figure, but even those underestimate how much it actually costs. I'd call a good nursing home or home health-care agency that you might like to use eventually. Find out what the daily cost might be, for example $300 a day, and buy the coverage that's closest to that daily cost. When it comes to 24-hour care at home, you will find that a long-term-care insurance benefit will not come close to covering that level of cost, because extensive in-home care is costly. Remember that once you have exceeded two to four hours a day, seven days per week of in-home care, you will probably be paying more for long-term-care than if you were in a nursing home. Therefore, if you need more than two to four hours per day of in-home care, your long-term insurance benefit may provide more long-term-care if you are in a nursing home.
Q: How long should my coverage last?
A: You can purchase a policy that pays a set dollar amount per day for either some period of time or as a continuous lifetime benefit. I advise people that the most economical choice is to purchase a plan that provides benefits for five years. Only about 20% of people stay in a nursing home for five years or more. That's the minimum coverage you should have. If you have more money to spend, then certainly buy coverage for a longer time period or a bigger benefit so that if you're certain that you want in-home care, you will have more money to pay for it. Take the money you'll save on the shorter coverage period and buy a shorter waiting period, benefit for home care (as many policies pay out only 50 cents on the dollar for long-term-care at home), and compound-inflation protection riders. Don't give up coverage on the front end for something you are much less likely to collect on the back end. Once you have the minimum coverage, if you have more money to spend, then you can buy coverage for a longer time period.
Q: What additional features are worth paying for?
A: Get a compounded inflation rider. A "simple" inflation rider does not keep up with inflation nearly as well. One basic problem is that health-care inflation runs at 8.1% a year; the maximum inflation protection you can usually get in a long-term-care insurance policy is 5%thats the best you can do. While that 5% rate will not keep up entirely with health-care inflation, it will give you a better chance of being able to afford your long-term-care when the policy pays out. I also like to see people have a 30-day waiting period or lessthats the amount of time from when the insurance company determines that a person is eligible to use their long-term-care benefit to when the company begins to actually pay out for the benefit. All policies have some waiting period. People often get a 90-day or a 100-day waiting period because it lowers their premium, but you could end up paying thousands of dollars during the time you're waiting for coverage to start. Finally, I recommend a nonforfeiture-of-benefit rider. Typically, you're only eligible for the insurance benefits as long as you pay your premium. But the nonforfeiture rider lets you maintain some value in a policy even if you decide not to continue paying for it. That could be very important if the insurance company you're with decides to go out of this business and sells your policy to someone else who jacks up your premium so much you can't afford it anymore. The non-forfeiture rider means you will get some amount of the policy benefitnot all, but somedepending what you paid in over time. One last thing: Make sure the insurance company you choose has a solid track record. Call the National Association of Insurance Commissioners at (866)-470-6246 and get the phone number for your state health-insurance department. Then contact your state insurance department to find out if there are any reported problems with an insurance company you are considering.
Q: When should you buy the insurance?
A: At the latest, I'd say late 40s or early 50s. It's still affordable then. The premium is based on your heath status first, then your age. Generally speaking, the earlier you purchase a policy, the healthier you are and the more likely you are to qualify for insurance. People who have serious, chronic conditions may find their rates to be really high or they may even be uninsurable. The costs vary greatly from policy to policy, state to state, and person to person. Usually someone in his or her late 40s or early 50s will pay about $3,000 to $6,000 a year. That's for a very good policy. Someone in his 60s could pay several thousand dollars a year more for the same policy.
Q: When does the coverage start?
A: In order for the policy to kick in, you must have a certain level of need. Most providers define that as not being able to perform at least two of what are called "activities of daily living," in insurance-speak. Those are: bathing, eating, dressing, toileting, and transferring from bed to chair. So, you might have a hard time giving yourself a bath, and it might take you all day to do and then you're completely exhausted, but to the insurance company you're not compromised enough to use the insurance for that. The exception to that rule is folks with dementia. They may be able to perform those tasks, but they need supervision, so the insurance company will often pay out for their care.
Q: Can you run into problems collecting your insurance?
A: It's gotten better. Some of the companies that were the most difficult to deal with were on shaky financial ground, and they've gone out of business. Remember, the person who comes to do the assessment of whether you're able to perform the activities of daily living works for the insurance company, not for you. They'll be looking at your case through that lens. If you run into trouble getting them to pay benefits, you might want to enlist an advocate, like a geriatric care manager, if more than a simple follow-up phone call is necessary.
You can read the original article here.
Source:
Polyak I. (25 January 2011). "Health-Care Cost Expert Kathryn Votava on Buying Long-Term-Care Insurance" [Web blog post]. Retrieved from address https://www.health.com/health/article/0,,20456208,00.html
Collaborative Innovation Is Necessary To Advance In Health Care
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As health needs grow, it is imperative that innovation is at the frontier of change, to keep the health needs and requirements of the 21st century scalable. For innovation in health care to be sustained at an economically and fiscally responsible pace, it has to be a collaborative effort, requiring input from diverse stakeholders and key players in the industry. A collaborative health care system that includes information sharing, cross-industry cooperation and open innovation can lead to beneficial industry practices like cost reduction and time efficiency. Together, these practices set a precedent for growth and development at a more rapid pace.
An Efficient Method Of Doing Things
Toeing the line of technology advancements, innovation within the health care system has pioneered the development of cost-efficient, highly-optimized pragmatic solutions to many industry and individual health challenges. Artificial retinas, robotic nurses and gene therapy are just a few examples of plentiful recent innovations. These innovative technologies pose solutions to medical feats that, in the past, have overwhelmed medical practitioners, and thereby are expected to permit better health care delivery to patients and the global population. However, for these new advancements to be successfully implemented and established within the health care system, they must be met with collaboration and cooperation.
Creating A Synergistic Environment
Open, collective innovation like Project Data Sphere, designed to collate big data and bridge the distant segments of the health care industry, markup the necessity of innovation in the sector. In the case of Project Data Sphere, the goal is to facilitate the creation of a connected health care network bereft of the many loopholes characteristic of the system. Interoperability between key segments of the industry has always been a rate limiting factor. A unified platform capable of linking these segments together can have a significant impact on the sector.
Multiple companies are undertaking projects to build "cloud-based, big data platform" solutions that manage data to give the health industry the necessary edge it needs to manage itself. This ranges from cloud-based platforms powered by libraries of clinical, social and behavioral analytics utilized for sharing information across multiple hospitals, to using big data and advanced analytics for clinical improvements, financial analysis and fraud and waste monitoring.
Collaborating To Go Digital
Concurrent with the world’s continued adoption of digital technologies is the rapid expansion of the digital health care market — an expansion fostered by collaboration among global leaders of digital innovation in the health care industry. The partnership between major players in both the private and public sectors has engineered a growing list of innovative digital health care solutions.
Just last year an Israeli-based pharmaceutical company joined forces with Santa Clara, California-based Intel to develop wearables that routinely record and analyze symptoms of Huntington’s disease. The data collected is processed to help grade motor symptom severity associated with the disease.
Most times, singular organizations lack the human and financial resources to orchestrate grand schemes of innovation alone — but collaboration presents a practical route to overcoming the limitations that hinder novelty, leading to quicker turnarounds and advancements.
Scaling The Barriers To Innovation
If the push for innovation in the health care system is to thrive, then the complexities and obstacles that have continually stifled progress must be confronted. Aside from collaboration, other notable barriers to innovation include:
• The immediate return mentality: By default, most leaders show a preference for innovative solutions that offer immediate financial rewards. Innovative solutions with brighter prospects but long term financial incentives are in most instances placed on a back burner.
• Bureaucracy in the distributive network:Innovators have to wade through multiple third parties if they are to stand any chance of getting their products to the end user, a process that is not only daunting but financially implicative.
• Stringent regulatory practices: In addition to scaling through the bureaucracy, innovative solutions looking to make a market appearance have to pass several screenings, some of which have been tagged redundant by experts.
Innovation is a necessary tool in the health care sector that gives an essential boost to scale insurmountable obstacles and limitations. For health care to evolve into a more sophisticated and efficient system, cross-industry collaboration and inter-professional cooperation must become the norm.
You can read the original article here.
Source:
Pando A. (19 September 2017). "Collaborative Innovation Is Necessary To Advance In Health Care" [Web blog post]. Retrieved from address https://www.forbes.com/sites/forbestechcouncil/2017/09/19/collaborative-innovation-is-necessary-to-advance-in-health-care/2/#6743d07669c9
Dealing with acidic attitudes: Help for your managers
It's important to have positive attitudes at the top of your employee pyramid to promote positive attitudes all around the office. Take some time today to read this helpful blog post on acidic attitudes, and how to avoid them in your managers.
Every workplace has negative people who erode morale. They’re not always easy to pick out of a crowd, but they can do an amazing amount of damage over time.
Most of the time, these folks don’t make the big mistakes that call attention to themselves. They’re frequently pretty good at their jobs, so they’re not called on the carpet too often.
But like a virus running in the background of a computer program, their acidic personalities eat away at the goals – and ultimately the bottom line – of the company week after week, year after year.
Who are these people? They’re the employees who:
- continually find things to complain about and exaggerate the seriousness of co-workers’ mistakes
- spread gossip and start rumors that pit employees against each other
- talk behind co-workers’ backs, and
- undermine supervisors’ authority with a never-ending flow of criticism that stays under-the-radar so it’s rarely recognized and corrected.
It’s been said the only way to fix a bad attitude is through psychotherapy, religion or brain surgery. But it’s a rare manager who is a shrink, a minister and a neurosurgeon.
Still, every manager needs a strategy to deal with this constant drag on employee attitudes.
The stakes are too high to just let things slide.
Looking for answers – 4 key questions
So what’s to be done? The experts say managers should move away from the vague “bad attitude” discussion to the hard facts of employee behavior.
The key questions:
- What’s the impact of the employee’s behavior?
- How do the person’s actions differ from the standards set for overall employee behavior?
- What’s the effect of this individual’s behavior on the people who work with him/her?
- If this person acted according to our accepted standards, could it make a difference in morale and productivity?
Managers should identify the actions of negative people – and make it clear those actions will no longer be tolerated.
An example: A Midwestern company established a “no jerk” policy. It included the statement:
Each employee will demonstrate professional behavior that supports team efforts and enhances team behavior, performance and productivity.
Handling tough conversations with acidic employees
Establishing policy is a solid first step; it creates a good framework.
But managers need practical advice that gets results day to day on the front lines.
Managers need one-on-one coaching sessions to cover these points:
- Acknowledge the awkwardness. Managers can let employees know they’re providing feedback that’s difficult to discuss. It’s only human to feel that way.
- Keep it results-oriented. A phrase like “I’m bringing this up because it’s important you address this issue to be successful in your job” is helpful.
- Accentuate the positive. It’s a good idea to highlight the good things that are likely to happen when the person changes the disruptive behavior. On the other hand, if the person remains defiant, stressing the negative outcome if the person’s attitude doesn’t change can be effective, too.
It’s human nature to want to delay having a tough conversation with an employee with a bad attitude. But that only makes things worse.
And since it’s going to be a tough conversation, it’s recommended that supervisors prepare for the discussion.
Suggestions for handling the confrontation:
- Be specific about what you want. It’s a mistake to use general terms in a discussion about a specific behavior problem. For example, a manager says “I don’t like your attitude. I want you to change it.” That’s pretty safe, but it could mean anything.
Instead, the manager should say “It’s not helpful the way you talk about our customers behind their backs. It poisons the attitude of the others in customer service. From now on, if you can’t say something supportive of a customer, please don’t say anything at all.”
Managers should try to gather specific examples of negative things the employee has said in the past, and use those in the discussion for clarity. - Let people rant … a little. Once a manager has gotten through discussing the specific behaviors, it’s likely the other person is going to feel the need to blow off steam and maybe even mount a defense. To avoiding having people feel like they are on the witness stand, let them rant a bit.
It’ll help them feel like they are being heard – because they are. Then steer the conversation back to the results you want. - Try to use “we.” Work to get across the notion that the issue is a problem for everyone concerned. A manager can start by saying “We have a problem” or “We need to change.”
The helps the person realize the behavior is important, without finger-pointing. - Avoid overusing “you.” Putting all the responsibility on the employee is a conversational black hole that’s impossible to escape. The constant use of the word you, as in “You have a bad attitude and everyone knows it” is an invitation for a fight.
Instead, try “We need to talk about your attitude.”
The point here is, while it is OK to use the word “you,” using it continually in a negative way kills the conversation. - Avoid “however” and “but.” Some managers believe that if they lead with a compliment, it’s easier to wade into the problem. That conversation looks something like this: “You’ve done a pretty good job, but …” and then the manager lowers the boom.
That often angers people and leaves them thinking, “Why can’t he ever just say something positive and leave it at that?”
Consider substituting “and” for “but” and “however,” and the conversation is likely to go smoother, as in: “You’re doing a pretty good job and we need to talk about how to get you to show more respect for customers.” - Don’t feel as if you have to fill the silence. In a tense situation a manager may be tempted to fill every gap in the conversation. Don’t. Stay silent when there’s a lull. Obligate the other person to fill in the silence.
It’s surprising the amount of information a manager can get without ever asking a question … just by remaining silent.
You can read the original article here.
Source:
Gould T. (25 March 2015). "Dealing with acidic attitudes: Help for your managers" [Web blog post]. Retrieved from address https://www.hrmorning.com/managers-dealing-with-negative-attitudes/
Pagers, AI, And Google: 3 Tales Of Technology And Medicine
As a society, we owe technology applause for helping improve our medical abilities tenfold. Today, we thought it would be fun to take a look back on how technological advancements have succeeded in making our medicine better than ever, and how they continue to do so. Take a moment of your time to read this article from Forbes on Pagers, AI, and Google.
Medicine and technological advancement have been intimately intertwined, from the invention of the stethoscope to the latest innovations in MRI scanning. But the road isn’t always smooth. There can be interesting bumps and glitches along the way, as illustrated by these three recent stories.
1) Old tech can linger
The Guardian recently reported that the UK National Health Service uses more than 10% of the world’s pagers. The pagers cost £6.6 million ($8.9 million) per year. Furthermore, the UK will soon only have one provider of pagers nationwide after Vodafone exits the market.
One critic noted, “Taxpayers will wonder why the NHS is spending millions on outdated technology, especially at a time when savings need to be made.”
As a young doctor in the 1990s, I carried a pager. But nowadays, most physicians I know use cell phones to take emergency calls. However, The Guardian notes that there are still a few advantages to pagers, namely:
...[S]lightly more reliability. Where mobile phone networks can be patchy, or slow, or overloaded, the separate paging network offers a modest improvement in reception and reach, especially in rural areas. Compared with modern smartphones, pager batteries also last much longer.
I can see pagers lingering on for special niche applications. But for most people, their time has passed.
By Jakez (Own work), Creative Commons BY-SA 3.0, via Wikimedia Commons.An old pager/beeper.
2) New tech can be overhyped
I believe that artificial intelligence (AI) will some day have a major impact in the practice of medicine. But STAT News reporters Casey Ross and Ike Swetlitz have described how the IBM Watson AI system “isn’t living up to the lofty expectations IBM created for it.”
Specifically, the Watson for Oncology was intended to help improve cancer care by helping physician with treatment recommendations based on the best available worldwide data
Ross and Swetlitz reported:
While it has emphatically marketed Watson for cancer care, IBM hasn’t published any scientific papers demonstrating how the technology affects physicians and patients. As a result, its flaws are getting exposed on the front lines of care by doctors and researchers who say that the system, while promising in some respects, remains undeveloped...
Perhaps the most stunning overreach is in the company’s claim that Watson for Oncology, through artificial intelligence, can sift through reams of data to generate new insights and identify, as an IBM sales rep put it, “even new approaches” to cancer care. STAT found that the system doesn’t create new knowledge and is artificially intelligent only in the most rudimentary sense of the term.
Because of problems with Watson, the highly-regarded MD Anderson Cancer Center (part of the University of Texas) cancelled its partnership with Watson “amid internal allegations of overspending, delays, and mismanagement.”
I still believe that AI will revolutionize medical care, even if specific products might not (yet) be ready for prime time. I take heart in the fact that the Apple Newton was also a product not ready for prime time — but it did set the stage for the much more successful Apple iPhone and the current mobile technology revolution. Similarly, I think the long-term future of medical AI remains bright, even if specific products may struggle to meet expectations.
3) Current technology can alter the doctor-patient relationship in unexpected ways
Many patients routinely use search engines like Google to find good doctors or to learn more about their physician’s professional qualifications. But to what extent should doctors be searching for information on their patients?
Erene Stergiopoulos discusses this issue in a fascinating essay, “Getting Googled by Your Doctor”:
Searching for patients’ information online gives physicians a way to gather collateral data about a patient who either cannot or will not communicate important clinical information, says Paul Appelbaum, a psychiatrist, professor at Columbia University, and world expert in medical ethics and the law...
That online collateral information is especially useful [in the acute setting, Applebaum] says, where patients may be psychotic, intoxicated, or suicidal. In these acute settings, social media can provide clinicians with valuable context to make decisions — whether the patient uses drugs or alcohol, has self-harmed, or has family support...
However, Stergiopoulos notes that patients can feel betrayed if content from their social media posts ends up in their medical record without their consent.
Furthermore, this can create medico-legal problems:
As more and more providers Google to guide their decisions, they may be shifting the clinical standards to which all practitioners are held... If practitioners neglect that standard, and something preventable goes wrong, they risk accusations of malpractice. In other words, if patient-targeted online searches become the new standard of care, then clinicians could become liable for information patients post online. If a patient leaves a suicidal message on Facebook, and the clinician misses it, there’s a future — seemingly more plausible by the day — in which that clinician could be sued for malpractice if the patient then attempts suicide.
In informal discussions with other health professionals, some colleagues have said they never Google their patients. Others do so selectively. Yet others consider it a legitimate part of conscientious medical practice. And some physicians feel strongly that if patients can Google their doctors, they as physicians should similarly be able to Google their patients.
Clearly, this is an area where medical and legal standards are still evolving. In the meantime, if patients are uncomfortable with their physicians Googling them, they might wish to make their preferences clear ahead of time, before they and their doctor suffer a misunderstanding.
Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind
How are the rising costs of Medicare Part B affecting Seniors? Don't be left in the dark. Find out more in this article.
Millions of seniors will soon be notified that Medicare premiums for physicians’ services are rising and likely to consume most of the cost-of-living adjustment they’ll receive next year from Social Security.
Higher 2018 premiums for Medicare Part B will hit older adults who’ve been shielded from significant cost increases for several years, including large numbers of low-income individuals who struggle to make ends meet.
“In effect, this means that increases in Social Security benefits will be minimal, for a third year, for many people, putting them in a bind,” said Mary Johnson, Social Security and Medicare policy consultant at the Senior Citizens League. In a new study, her organization estimates that seniors have lost one-third of their buying power since 2000 as Social Security cost-of-living adjustments have flattened and health care and housing costs have soared.
Another, much smaller group of high-income older adults will also face higher Medicare Part B premiums next year because of changes enacted in 2015 federal legislation.
Here’s a look at what’s going on and who’s affected:
The Basics
Medicare Part B is insurance that covers physicians’ services, outpatient care in hospitals and other settings, durable medical equipment such as wheelchairs or oxygen machines, laboratory tests, and some home health care services, among other items. Coverage is optional, but 91 percent of Medicare enrollees — including millions of people with serious disabilities — sign up for the program. (Those who don’t sign up are responsible for charges for these services on their own.)
Premiums, which change annually, represent about 25 percent of Medicare Part B’s expected per-beneficiary program spending. The government pays the remainder.
In fiscal 2017, federal spending for Medicare Part B came to $193 billion. From 2017 to 2024, Part B premiums are projected to rise an average 5.4 percent each year, faster than other parts of Medicare.
‘Hold Harmless’ Provisions
To protect seniors living on fixed incomes, a “hold harmless” provision in federal law prohibits Medicare from raising Part B premiums if doing so would end up reducing an individual’s Social Security benefits.
This provision applies to about 70 percent of people enrolled in Part B. Included are seniors who’ve been enrolled in Medicare for most of the past year and whose Part B premiums are automatically deducted from their Social Security checks.
Excluded are seniors who are newly enrolled in Medicare or those dually enrolled in Medicaid or enrolled in Medicare Savings Programs. (Under this circumstance, Medicaid, a joint federal-state program, pays Part B premiums.) Also excluded are older adults with high incomes who pay more for Part B because of Income-Related Monthly Adjustments (see more on this below).
Recent Experience
Since there was no cost-of-living adjustment for Social Security in 2016, Part B monthly premiums didn’t go up that year for seniors covered by hold harmless provisions. Instead, premiums for this group remained flat at $104.90 — where they’ve been for the previous three years.
Last year, Social Security gave recipients a tiny 0.3 percent cost-of-living increase. As a result, average 2017 Part B month premiums rose slightly, to $109, for seniors in the hold harmless group. The 2017 monthly premium average, paid by those who weren’t in this group and who therefore pay full freight, was $134.
Current Situation
Social Security is due to announce cost-of-living adjustments for 2018 in mid-October. Based on the best information available, it appears to be considering an adjustment of about 2.2 percent, according to Juliette Cubanski, associate director of the program on Medicare policy at the Kaiser Family Foundation. (Kaiser Health News is another, independent program of the Kaiser Family Foundation.)
Apply a 2.2 percent adjustment to the average $1,360 monthly check received by Social Security recipients and they’d get an extra $29.92 in monthly payments.
For their part, the board of trustees of Medicare have indicated that Part B monthly premiums are likely to remain stable at about $134 a month next year. (Actual premium amounts should be disclosed by the Centers for Medicare & Medicaid Services within the next four to six weeks.)
Medicare has the right to impose that charge, so long as the amount that seniors receive from Social Security isn’t reduced in the process. So, the program is expected to ask older adults who paid $109 this year to pay $134 for Part B coverage next year — an increase of $25 a month.
Subtract that extra $25 charge for Part B premiums from seniors’ average $29.92 monthly Social Security increase and all that be left would be an extra $4.92 each month for expenses such as food, housing, medication and transportation.
“Many seniors are going to be disappointed,” said Lisa Swirsky, a policy adviser at the National Committee to Preserve Social Security and Medicare.
Higher Income Brackets
Under the principle that those who have more can afford to pay more, Part B premium surcharges for higher-income Medicare beneficiaries have been in place since 2007. These Income-Related Monthly Adjustment Amounts (IMRAA) surcharges vary, depending on the income bracket that individuals and married couples are in. Nearly 3 million Medicare members paid the surcharges in 2015.
For the past decade this is how surcharges have worked:
Bracket One: Individuals with incomes of $85,001 to $107,000 were charged 35 percent of Part B per-beneficiary costs, resulting in 2017 premiums of $187.50.
Bracket Two: Incomes of $107,001 to $160,000 were charged 50 percent, resulting in 2017 premiums of $267.90.
Bracket Three: Incomes of $160,001 to $214,000 were charged 65 percent, resulting in 2017 premiums of $348.30
Bracket Four: Incomes of more than $214,000 were charged 80 percent, resulting in 2017 premiums of $428.60.
(Information for married couples who file jointly can be found here.)
Now, under legislation passed in 2015, brackets two, three and four are adopting lower income thresholds, a move that could raise premiums for hundreds of thousands of seniors. Bracket two will now consist of individuals with incomes of $107,001 to $133,500; bracket three will consist of individuals making $133,501 to 160,000; and bracket four will include individuals making more than $160,000. (Thresholds for couples have been altered as well.)
As John Grobe, president of Federal Career Experts, a consulting firm, noted in a blog post, this change “will add another layer of complexity” to higher-income individuals’ decisions regarding “electing Part B.”
You can read the original article here.
Source:
Graham J. (5 October 2017). "Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind" [web blog post]. Retrieved from address https://khn.org/news/despite-boost-in-social-security-rising-medicare-part-b-costs-leave-seniors-in-bind/
New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women
You can read the original article here.
Source:
Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/
The Trump Administration has issued new regulations that significantly broaden employers’ ability to be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement. The regulation opens the door for any employer or college/ university with a student health plan with objections to contraceptive coverage based on religious beliefs to qualify for an exemption. Any nonprofit or closely-held for-profit employer with moral objections to contraceptive coverage also qualifies for an exemption. Their female employees, dependents and students will no longer be entitled to coverage for the full range of FDA approved contraceptives at no cost.
On October 6, 2017, the Trump Administration issued two new regulations greatly expanding the types of employers that may be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement. These regulations are a significant departure from the Obama-era regulations that only granted an exception to houses of worship. One of the regulations allows nonprofits or for-profit employer with an objection to contraceptive coverage based on religious beliefs to qualify for an exemption and drop contraceptive coverage from their plans. The other regulation also exempts all but publicly traded employers with moral objections to contraception from rule. These new policies, effective immediately, also apply to private institutions of higher education that issue student health plans. The immediate impact of these regulations on the number of women who are eligible for contraceptive coverage is unknown, but the new regulations open the door for many more employers to withhold contraceptive coverage from their plans.
Contraceptive coverage under the ACA has made access to the full range of contraceptive methods affordable to millions of women. This provision is part of a set of key preventive services that has been identified by the Health Resources and Services Administration (HRSA) for women that must be covered without cost-sharing. Since it was first issued in 2012, the contraceptive coverage provision has been controversial. While very popular with the public, with over 77% of women and 64% of men reporting support for no-cost contraceptive coverage, it has been the focus of litigation brought by religious employers, with two cases (Zubik v Burwell and Burwell v Hobby Lobby) reaching the Supreme Court. This brief explains the contraceptive coverage rule under the ACA, the impact it has had on coverage, and how the new regulations issued by the Trump Administration change the contraceptive coverage requirement for employers and affect women’s coverage.
How do the new regulations change contraceptive coverage requirements for employers?
Since they were announced in 2011, the contraceptive coverage rules have evolved through litigation and new regulations. Most employers were required to include the coverage in their plans. Houses of worship could choose to be exempt from the requirement if they had religious objections. This exception meant that women workers and female dependents of exempt employers did not have guaranteed coverage for either some or all FDA approved contraceptive methods if their employer had an objection. Religiously affiliated nonprofits and closely held for-profit corporations were not eligible for an exemption, but could choose an accommodation. This option was offered to religiously affiliated nonprofit employers and then extended to closely held for-profitsafter the Supreme Court ruling in Burwell v. Hobby Lobby. The accommodation allowed these employers to opt out of providing and paying for contraceptive coverage in their plans by either notifying their insurer, third party administrator, or the federal government of their objection. The insurers were then responsible for covering the costs of contraception, which assured that their workers and dependents had contraceptive coverage while relieving the employers of the requirement to pay for it.
As of 2015, 10% of nonprofits with 5,000 or more employees had elected for an accommodation without challenging the requirement. This approach, however, has not been acceptable to all nonprofits with religious objections.1 In May 2016, the Supreme Court remanded Zubik v. Burwell, sending seven cases brought by religious nonprofits objecting to the contraceptive coverage accommodation back to the respective district Courts of Appeal. The Supreme Court instructed the parties to work together to “arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage.”2
On October 6, 2017, the Trump Administration issued new regulations greatly expanding eligibility for the exemption to all nonprofit and closely-held for-profit employers with objections to contraceptive coverage based on religious beliefs or moral convictions, including private institutions of higher education that issue student health plans (Figure 1). In addition, publicly traded for-profit companies with objections based on religious beliefs also qualify for an exemption. There is no guaranteed right of contraceptive coverage for their female employees and dependents or students. Table 1 presents the changes to the contraceptive coverage rule from the Obama Administration in the new Interim Final regulations issued by the Trump Administration.
Figure 1: Employers Objecting to Contraceptive Coverage: Exemptions and Accommodations Under the Trump Administration Regulations
The accommodation will be available to employers that previously qualified for the accommodation. They now will also have the choice of an exemption. The federal departments issuing the regulations posit that these new rules will have limited impact on the number of women losing contraceptive coverage. However, it is not clear how many employers previously utilizing the accommodation will now opt for an exemption, resulting in the loss of contraceptive coverage for their employees and dependents. In addition, there are also an unknown number of organizations that were not previously eligible for either the accommodation or exemption that may now opt for an exemption. These new regulations create two new categories of employers who can now qualify for an exemption or can voluntarily chooses an accommodation: 1) publicly traded for-profit companies with a religious objection and 2) nonprofit and closely held for-profit employers who have a moral objection to contraceptives, a considerably larger pool of employers than when the exemption was available only to those who were employees of a house of worship or who were eligible for an accommodation in the past.
| Table 1: Summary of Changes in the Contraceptive Coverage Regulations for Objecting Entities | ||
| Obama Administration August 2012 to October 5, 2017 |
Trump Administration Effective October 6, 2017 |
|
| What types of contraceptives must plans cover without cost-sharing? | At least one of each of the 18 FDA approved contraceptive methods for women, as prescribed, along with counseling and related services must be covered without cost-sharing. | No change |
| Are any employers “exempt” from the contraceptive mandate? |
|
|
| Who pays for contraceptive coverage for employees of organizations receiving an exemption? |
|
No change |
What type of employers may seek an “accommodation” to avoid paying for contraceptives in their plans? |
|
|
| Who pays for contraceptive coverage for employees of organizations receiving an accommodation? |
|
No change |
| When can entities change from an accommodation to an exemption? | N/A |
|
How has the contraceptive coverage rule affected women?
Contraceptive use among women is widespread, with over 99% of sexually-active women using at least one method at some point during their lifetime.3 Contraceptives make up an estimated 30-44% of out-of-pocket health care spending for women.4 Since the implementation of the ACA, out-of-pocket spending on prescription drugs has decreased dramatically (Figure 2). The majority of this decline (63%) can be attributed to the drop in out-of-pocket expenses on the oral contraceptive pill for women.5 One study estimates that roughly $1.4 billion dollars per year in out-of-pocket savings on the pill resulted from the ACA’s contraceptive mandate.6 By 2013, most women had no out-of-pocket costs for their contraception, as median expenses for most contraceptive methods, including the IUD and the pill, dropped to zero.7
Figure 2: The Contraceptive Coverage Policy Has Had a Large Impact on Out-Of-Pocket Spending in a Short Amount of Time
This provision has also influenced the decisions women make in their choice of method. After implementation of the ACA contraceptive coverage requirement, women were more likely to choose any method of prescription contraceptive, with a shift towards more effective long-term methods.8 High upfront costs of long-acting methods, such as the IUD and implant, had been a barrier to women who might otherwise prefer these more effective methods. When faced with no cost-sharing, women choose these methods more often9, with significant implications for the rate of unintended pregnancy and associated costs of childbirth.10
Finally, decreases in cost-sharing were associated with better adherence and more consistent use of the pill. This was especially true among users of generic pills. One study showed that even copayments as low as $6 were associated with higher levels of discontinuation and non-adherence,11 increasing the risk of unintended pregnancy.
Do states with no-cost contraceptive coverage laws allow exemptions to objecting entities?
The federal standards under Affordable Care Act created a minimum set of preventive benefits that applied to most health plans regulated by the federal government (self-funded plans, federal employee plans) and states (individual, small and large group plans), including contraceptive coverage for women with no cost-sharing. States have also historically regulated insurance, and many have had mandated minimum benefits for decades. State laws, however, have more limited reach in that they only apply to state regulated fully insured plans, do not have jurisdiction over self-funded plans, where 61% of covered workers are insured.12 In self-funded plans, the employer assumes the risk of providing covered services and usually contracts with a third party administrator (TPA) to manage the claims payment process. These plans are overseen by the Federal Department of Labor under the Employer Retirement Income Security Act (ERISA) and are only subject to federally established regulations.13 The ACA sets a minimum standard of coverage for preventive services for all plans. However, state laws regulating insurance, including contraceptive coverage, can require fully insured plans to provide coverage beyond the federal standards.
Eight states have strengthened and expanded the federal contraceptive coverage requirement (CA, IL, MD, ME, NV, NY, OR, VT). Another 20 states have contraceptive equity laws that require plans to cover contraceptives if they also provide coverage for prescription drugs but they do not necessarily require coverage of all FDA-approved contraceptives or ban cost-sharing (Figure 3).
Figure 3: Many States Have Contraceptive Coverage Requirements
Many of the 28 states that have passed contraceptive coverage laws (both equity and no-cost coverage) have a provision for exemptions, but the laws vary from state to state and only apply to fully insured plans. This means that there may be a conflict between the state and federal requirements when it comes to religious exemptions. In some states with a contraceptive coverage requirement, some employers who are eligible for an exemption under federal law will not qualify for an exemption under state law (Table 2). Employers in those states will have to have to meet the standards established by their state even though they may qualify for an exemption based on the new federal regulations. This conflict may set the stage for future litigation.
| Table 2: State Requirements for No-Cost Contraceptive Coverage | |||||||
| StateDate Effective | Applies to | Coverage required without cost sharing | Exemptions allowed | ||||
| Private plans | Medicaid | With RX all FDA approved | OTC | Vasectomy | Religious | Moral | |
| CaliforniaJanuary 2015 | X | MCOs | X | Narrowly defined nonprofit religious employers | None | ||
| IllinoisJanuary 2017 | X | X | X except male condoms |
Any employer, or insurer with a religious objection | Any employer, or insurer with a moral objection | ||
| MarylandJanuary 2018 | X | X | X | X | X | Religious organizations if the coverage conflicts with the organization’s bona fide religious beliefs and practices | None |
| MaineJanuary 2019 | X | X | Narrowly defined nonprofit religious employers | None | |||
| NevadaJanuary 2018 | X | X | X | Insurers affiliated with a religious organization | None | ||
| New YorkAugust 2017 | X | X | Narrowly defined nonprofit religious employers* | None | |||
| OregonAugust 2017 | X | X | X | Narrowly defined nonprofit religious employers | None | ||
| VermontOctober 2016 | X | X – and all other public health assistance programs | X | X | None | None | |
| NOTES: *Requires the insurer to offer a rider to policyholders so that women will have contraceptive coverage. SOURCE: Kaiser Family Foundation analysis of state laws and regulations. |
|||||||
Conclusion
The Trump Administration’s new regulations substantially expand the exemption to nonprofit and for-profit employers, as well as to private colleges or universities with religious or moral objections to contraceptive coverage. It is unknown how many of these employers and colleges will maintain coverage through the accommodation as before and how many will now opt for the exemption leaving their students, employees and dependents without no-cost coverage for the full range of contraceptive methods. As a result of the new regulation, choices about coverage and cost-sharing will be made by employers and private colleges and universities that issue student plans. For many women, their employers will determine whether they have no-cost coverage to the full range of FDA approved methods. Their choice of contraceptive methods may again be limited by cost, placing some of the most effective yet costly methods out of financial reach.
You can read the original article here.
Source:
Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/