Federal Appeals Court Takes Up Case That Could Upend U.S. Health System
A federal appeals court in New Orleans has taken up a case against the Affordable Care Act. If the lower court's ruling in the case, Texas v. United States, is upheld, it has the potential to shake the nation's health care system. Read this article to learn more about this case.
The fate of the Affordable Care Act is again on the line Tuesday, as a federal appeals court in New Orleans takes up a case in which a lower court judge has already ruled the massive health law unconstitutional.
If the lower court ruling is ultimately upheld, the case, Texas v. United States, has the potential to shake the nation’s entire health care system to its core. Not only would such a decision immediately affect the estimated 20 million people who get their health coverage through programs created under the law, ending the ACA would also create chaos in other parts of the health care system that were directly or indirectly changed under the law’s multitude of provisions, such as calorie counts on menus, a pathway for approval of generic copies of expensive biologic drugs and, perhaps most important politically, protections for people with preexisting conditions.
“Billions of dollars of private and public investment — impacting every corner of the American health system — have been made based on the existence of the ACA,” said a friend-of-the-court brief filed by a bipartisan group of economists and other health policy experts to the 5th Circuit Court of Appeals. Upholding the lower court’s ruling, the scholars added, “would upend all of those settled expectations and throw healthcare markets, and 1/5 of the economy, into chaos.”
Here are five important things to know about the case:
It was prompted by the tax bill Republicans passed in 2017.
The big tax cut bill passed by the GOP Congress in December 2017 eliminated the penalty included in the ACA for failure to maintain health insurance coverage. The lawsuit was filed in February 2018 by a group of Republican attorneys general and two governors. They argued that since the Supreme Court had upheld the ACA in 2012 specifically because it was a valid exercise of Congress’ taxing power, taking the tax away makes the entire rest of the law unconstitutional.
Last December, Judge Reed C. O’Connor agreed with the Republicans. “In some ways the question before the court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote in his decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
State and federal Democrats are defending the law.
Arguing that the rest of the law remains valid is a group of Democratic attorneys general, led by California’s Xavier Becerra.
“Our argument is simple,” said Becerra in a statement last Friday. “The health and wellbeing of nearly every American is at risk. Healthcare can mean the difference between life and death, financial stability and bankruptcy. Our families’ wellbeing should not be treated as a political football.”
The Democratic-led House of Representatives has also been granted “intervenor” status in the case.
The Trump administration has taken several positions on the lawsuit.
The defendant in the case is technically the Trump administration. Traditionally, an administration, even one that did not work to pass the law in question, defends existing law in court.
Not this time. And it is still unclear exactly what the administration’s position is on the lawsuit. “They have changed their position several times,” Sen. Chris Murphy (D-Conn.) told reporters on a conference call Monday.
When the administration first weighed in on the case, in June 2018, it said it believed that without the tax penalty only the provisions most closely connected to that penalty — including requiring insurers to sell policies to people with preexisting conditions — should be struck down. The rest of the law should stay, the Justice Department argued.
After O’Connor’s ruling, however, the administration changed its mind. In March, a spokeswoman for the Justice Department said it had “determined that the district court’s comprehensive opinion came to the correct conclusion and will support it on appeal.”
Now it appears the administration is shifting its opinion again. In a filing with the court late last week, Justice Department attorneys argued that perhaps the health law should be invalidated only in the GOP states that are suing, rather than all states. It is unclear how that would work.
Legal scholars — including those who oppose the ACA — consider the case dubious.
In a brief filed with the appeals court, legal scholars from both sides of the fight over the ACA agreed that the lawsuit’s underlying claim makes no sense.
In passing the tax bill that eliminated the ACA’s tax penalty but nothing else, Congress “made the judgment that it wanted the insurance reforms and the rest of the ACA to remain even in the absence of an enforceable insurance mandate,” wrote law professors Jonathan Adler, Nicholas Bagley, Abbe Gluck and Ilya Somin. Bagley and Gluck are supporters of the ACA; Adler and Somin have argued against it in earlier suits. “Congress itself — not a court — eliminated enforcement of the provision in question and left the rest of the statute standing. So congressional intent is clear.”
It could end up in front of the Supreme Court right in the middle of the 2020 election.
Depending on what happens at the appeals court level, the health law could be back in front of the Supreme Court — which has upheld the health law on other grounds in 2012 and 2015 — and land there in the middle of next year’s presidential campaign.
Democrats are already sharpening their rhetoric for that possibility.
“President Trump and Republicans are playing a very dangerous game with people’s lives,” Senate Minority Leader Chuck Schumer told reporters on a conference call Monday.
Murphy said he is most concerned that if the lower court ruling is upheld and the health law struck down, Republicans “won’t be able to come up with a plan” to put the health care system back together.
“Republicans tried to come up with a replacement plan for 10 years, and they couldn’t do it,” he said.
SOURCE: Rovner, J. (9 July 2019) "Federal Appeals Court Takes Up Case That Could Upend U.S. Health System" (Web Blog Post). Retrieved from https://khn.org/news/federal-appeals-court-takes-up-case-that-could-upend-u-s-health-system/
Creating an ‘urgent care first’ mindset for employee benefits
With urgent cares continuing to pop up everywhere, it’s important to guide your employees in adopting an "urgent care first" mentality. Continue reading this blog post to learn more.
Urgent care centers are popping up everywhere, which means getting quick healthcare is easier and more convenient for patients. But these centers could also help employers minimize expensive emergency room claims. That’s why it’s important to guide employees to adopt an “urgent care first” mentality.
The concept of urgent care has been around since the 1970s, but rising healthcare costs, especially for ER care, have spurred an increase in centers across the U.S. over the last decade. In fact, from 2014 through June 2017, the number of urgent care centers rose by nearly 20%.
Urgent care centers provide care for health problems that aren’t life-threatening, but can’t wait for an appointment with a primary care provider. No one wants to suffer with a sore throat all weekend. Many urgent care centers are staffed with doctors and nurses, and provide more advanced capabilities than what’s typically available at a primary care doctor’s office. For example, some urgent care centers give stitches, provide X-rays and even MRIs.
Patients can also get treatment at urgent care for conditions they’d typically see a primary care doctor for, such as the flu or a fever, mild to moderate asthma, skin rashes, sprains and strains, and a severe sore throat or cough — illnesses that produce unnecessary high claims if treated in an ER.
Still, when a severe sore throat and high fever strike on a weekend and the doctor’s office is closed, employees may gravitate to the ER because they’re sick and need help right now. That’s where the urgent care first mindset becomes good medicine. It typically costs the employer (and often the employee) far less if that sore throat is treated in an urgent care facility.
The high cost of ER care is enough to make anyone run a high temp. From 2009 to 2016 (the most recent data available), the average amount that hospitals billed insurance carriers for an emergency room visit more than doubled, from $600 to $1,322. By contrast, urgent care typically costs about $150 per visit. Members often pay a lower copay for urgent care visits, too.
The urgent care first mindset is starting to take hold. New data analysis from Aetna shows that as urgent care centers began to proliferate, ER visits for minor health issues dropped 36%, while the use of urgent care and other non-emergency health settings increased 140%.
However, the same study shows that plans only saw a decrease in ER visits if there were several urgent care centers in the geographic region where their employees lived. Awareness is key.
Fostering an urgent care first mentality
Employers can’t just include urgent care in a benefits plan and expect employees to use it. They need to design the plan to encourage use and follow up with plenty of education.
Education about the benefits of primary care versus urgent care versus the ER should take place during open enrollment and throughout the plan year so members understand the medical necessity and financial implications of each option. Including the closest urgent care centers to employees, as well as a list of services they provide, can help encourage them to adopt an urgent care first mentality.
A word of caution: not every nearby urgent care center is actually in-network. It literally pays for employees to keep a list of nearby in-network centers handy when that inevitable weekend sore throat strikes.
Reminders about urgent care before spring allergies, summer vacations, fall school physicals and flu season can also help encourage their use.
The too-low ER copay
Plan design is another important piece of the puzzle to help steer employees to the right level of care for their needs. It’s not that unusual to see a $100 copay for an emergency department visit. While no one wants to discourage ER visits for true emergencies, it makes sense to adjust the plan design to encourage primary and urgent care visits instead. That may mean a $20 copay for primary care, a $40 copay for urgent care and a $200 to $250 copay for ER visits — which is waived if the plan participant is admitted to the hospital.
For high-deductible health plans paired with a health savings account, the savings can be even more drastic; patients may pay $200 for an urgent care visit versus $1,200 for an ER visit.
The combination of education and plan design can help curb unnecessary ER visits, which could help employers control healthcare increases from plan year to plan year. For health issues that crop up during off hours, the urgent care first mindset is good for both employers and employees, who will ultimately save time and money.
SOURCE: O'Conner, P. (5 July 2019) "Creating an ‘urgent care first’ mindset for employee benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/creating-an-urgent-care-first-mindset-for-employees
Here’s how to ensure employees know how to pick the right benefits
Open enrollment is an important time for employees, but it's often a stressful one as well. According to recent research, the average employee spends less than 30 minutes selecting their benefits. Read this blog post for more on communicating benefit options to employees.
Annual enrollment is an important time for employees — but it’s also a stressful one. The choices they make can affect their financial health, yet the average employee spends less than 30 minutes selecting their benefits, according to research from benefits provider Unum.
With annual enrollment planning underway, now is the time for employers to ask themselves, “How can we help employees make the right benefits decisions?” The answers may be more valuable than they think.
See Also: Ideas for Effectively Demonstrating Plan Choices
Today’s workforce is the most diverse in history, with four generations actively working, and a fifth connected through benefits and pensions. A robust benefits package is increasingly important for recruitment and retention, challenging employers to provide choices and options that support diverse needs.
About 80% of employees prefer a job with benefits over one with a higher salary but no benefits, according to the American Institute of CPAs. As such it’s vital that employers ensure their workforce is engaged with their benefits and taking full advantage of what is available. Here are five ways employers can make sure that happens.
See Also: Ideas to Help Employees Find their "Best Fit" Plan
1. Acknowledge that decision support addresses personalized needs. Tools that demystify the benefits selection process can help employees make choices that align with their risk tolerance, financial circumstances and unique needs. The best tools lead employees to a recommended suite of benefits options that fit their individual physical, emotional and financial health.
2. Know that year-round engagement improves benefits literacy. While employees appreciate benefits, they aren’t experts. Indeed, roughly one-third of employees are outright confused about their benefits, according to recent data from Businessolver. Keeping up a cadence of communication about benefits throughout the year can help address this challenge.
3. Recognize the power of a total rewards statement. It empowers employees to maximize the benefits available to them, and these tools can be accessed at any time, not just during enrollment. The most impactful solutions aggregate all employee benefits options in one integrated offering that demonstrates the full value of compensation and benefits investments made by them and their employer.
See Also: Communicating the Value of Employee Benefits
4. Think about different generations. Customizable benefits options are a crucial step in meeting the needs of today’s workforce. For example, our latest data shows that nearly two-thirds of millennials are concerned with managing their monthly budget, while over 50% of boomers are most worried about a large, unexpected cost. Having core medical plan offerings along with complementary voluntary options helps employees address varying financial needs. Likewise, paid parental leave and different health plan options assist families at any stage, and they make it likelier that your employees will engage with their benefits and remain with your organization.
5. Be sure employees know that savings vehicles contribute to financial well-being. Employees of all ages and income levels are facing financial stressors — but they may not be the same ones. Offering different financial benefits, such as student loan assistance and emergency savings accounts, in addition to retirement benefits, enables your employees to address both their immediate and long-term financial needs.
See Also: Avoiding Communication Overload During Open Enrollment
More than ever, employers have a responsibility to help employees make informed decisions when it comes to selecting the right benefits. Otherwise, they risk losing top talent to organizations that are better implementing benefits strategies and technologies.
By meeting the needs of a diverse workforce with an array of benefits options supported by appropriate decision support resources, employers can ensure they’re meeting their workforce’s needs and retaining valuable employees.
See Also: Incorporating Incentives to Create Educated Benefit Consumers
SOURCE: Shanahan, R. (26 June 2019) "Here’s how to ensure employees know how to pick the right benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/educating-employees-to-pick-the-right-benefits
It’s time to incorporate cancer screenings into your wellness program
The National Cancer Institute reported that newer FDA-approved novel immunotherapies have shown to be beneficial responses to colorectal cancer but can cost upwards of $400,000 per year. This post from Employee Benefit News discusses incorporating cancer screenings into corporate wellness programs.
Scott Wilson, an employee at brewing company Molson Coors in Denver, was diagnosed with stage four metastatic colorectal cancer in 2016 — a disease that would cost him upward of $1.3 million to date, with significant dollars paid out for non-covered medical expenses.
As a consequence of a later-stage diagnosis, colon and liver resections were necessary coupled with aggressive treatment using chemotherapy and Vectobix — a newer and costly immunotherapy that is priced at $8,000 per week. On average, more than 40,000 people undergo treatment for metastatic colorectal cancer each year and the cost of treatment varies depending on the stage at diagnosis, treatment response and plan.
The availability of newer FDA-approved novel immunotherapies have shown to be beneficial responses to this deadly cancer, but at staggering costs that can be upward of $400,000 per year at market introduction, according to the National Cancer Institute.
Today, about 60% of diagnosed colorectal cases are discovered in later stage disease due to under-screening — a third of the eligible population have never been screened or are not up-to-date with screening guidelines. As a result, about 140,000 Americans are diagnosed with any stage of colorectal cancer and about 51,000 people die of this cancer annually. A recent study examined 1,750 colorectal cancer deaths from 2006 to 2012 in the Kaiser Permanente Health System — 76% of those deaths occurred in patients who were never screened or were not up-to-date with screening.
Cancer screening in the workplace
Last year, the American Cancer Society lowered the colorectal cancer screening age to 45 based on the rising rates of cancer trending in younger age populations — other cancer organization’s recommendations remain at age 50. Employers are in a unique position to reinforce and support these national recommendations among their employees.
Employees between 50 and 65 years of age have the lowest screening rates for colorectal cancer screening, and are typically covered by employer-sponsored health plans. Employers find offering cancer screening programs that reward participation via health and wellness programs are reducing disease risk and financial burdens for themselves and their employees.
The costs for treatment of cancer are more than double the rate of other healthcare expenses. For an employer, the impact of a late versus an early stage diagnosis is significant. National expenditures for treatment and care of colorectal cancer are second only to breast cancer.
In people age 65 and younger, the U.S spends in excess of $7.4 billion for treatment of colorectal cancer. For those employees diagnosed with any stage of colorectal cancer, a large percentage of costs are paid out by company-sponsored health plans despite the implementation of high-deductible health plans.
It would seem prudent to institute a screening initiative to find cancer early in your employee populations, or prevent it altogether by supporting screening for preventable cancers. Employees who test positive are referred by their physician for diagnostic colonoscopy to determine if colorectal cancer is present or to remove precancerous polyps or lesions. The intangible costs associated with cancer is the time off of work for treatment and lost productivity.
Most companies administer a wellness program for employees and families, like Molson Coors, but only about 20% offer colorectal cancer screening. Incorporating a blood test as a preventive cancer screening strategy alongside workplace wellness programs can get employees up-to-date with screening recommendations. Employers who are interested in instituting a colorectal cancer screening program in the office should consider the following suggestions.
Incorporate CRC screening into wellness programs. Screenings provide the opportunity to identify risks early and can bridge the gap between doctor office visits for employees who do not see their providers on a regular or annual basis.
Partner with third-party administrators. Third party administration services can ensure HIPAA regulations are followed for privacy. TPAs also will arrange for the delivery of results.
Create communications campaigns. Target your messaging to those eligible for colorectal cancer screening and make sure to cite the correct statistics for benefits and risk.
Reward participation. Participation is shown to increase when incentives are provided to reward participation. Decide what incentives work for your employees – PTO, financial rewards, gym memberships, coupons or gift cards.
Follow up. Plan for next steps based on employee screenings. Results should be provided in a timely manner to enable employees.
Wilson, the Molson Coors employee, remains in remission for nearly 20 months. He’s since devoted his time to advocate for access to colorectal cancer screening, especially in the workplace. Wilson recently joined the Colorectal Cancer Alliance organization as a board member, a non-profit dedicated to reducing the incidence of colorectal cancer through their many efforts aimed at prevention and awareness. He also wrote a book, “Through the Window: A Photographic Tale of Cancer Recovery” for the alliance. Wilson has been an advocate for the vital need for employee access and employer support for CRC screening in the workplace.
SOURCE: Childers, P. (27 June 2019) "It’s time to incorporate cancer screenings into your wellness program" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/add-cancer-screenings-to-wellness-programs
Finding the Hidden Benefits within your Offered Health Insurance Plan
Benefits packages offered by employers are just one of the many elements an employee considers when joining, remaining at or leaving a company. Striking the right balance of what employees want and what your business has to offer will allow for a return on investment. In this installment of CenterStage, Kelley Bell, a Group Health Benefits Consultant at Saxon Financial, explains how to unlock and bring forth benefits often overlooked by employers and employees.
The Reason for Employee Benefits
Employers of all sizes within the United States aim to offer attractive health insurance benefits that will both attract prospective employees and retain those talented individuals who are currently employed. Aside from looking to earn money to put food on the table, pay bills and set aside for later, people seek employment for assistance in alleviating the burden of having to pay for insurance plans singlehandedly. Thus, they plan where they will work and for how long they will work based on what your company has to offer.
When looking at benefits plans, most people assume the usual: a comprehensive health plan that assists in providing medical insurance and reduces pharmacy costs. However, a benefits package you receive from an employer today is no longer your parents’ benefits package. Just as trends in fashion and pop culture come and go, so should the benefits within an employer’s plan.
It is unique offerings that attract potential employees and retain current ones. Additionally, it is in the hands of employers to offer methods to achieve and shift culture in a positive way by offering necessary methods to do so. Employee benefits packages today are shaped to fit the needs of the employees.
As the nation’s health has declined, an uptick in the popularity in offering benefits such as discounted or free gym memberships has become a major plus. How are employees to be aware of the perks of employment with your business? They need to be properly educated about their plans. Kelley explained, “Employers must take time to educate employees as they are their most valuable asset.”
Benefits That Get Overlooked
Every employer, no matter how big or small, has something to offer. With over 25 years of experience in the financial industry, Kelley has seen and heard it all from employers with whom she partners with in selecting benefits for their employees. “I’ve heard people say they have a horrible plan but in reality, it is not a horrible plan, they don’t understand it or how to use it.” When investing in an ‘add-on’ benefit, there is typically a large sum injected into a new initiative, but the results are often short-lived, a short spark of novelty. The benefits that carry stamina are usually those that hold tremendous value in both a sense of time and money. Kelley continued, “Some of the embedded benefits in their existing plans will help save them money, become a wise consumer and ultimately choose to live a healthier lifestyle.”
What are some examples of benefits that fly under the radar of employers and their employees?
- Telemedicine medical services. Telemedicine is a fantastic way to recover and receive treatment for an illness or injury from the comfort and convenience of their car, work or home rather than in a doctor’s office.
- Wellness initiatives are another fantastic offering which is simply implementing a wellness committee dedicated to the well-being of your employees.
- Saxon offers a free portal with wellness information available to clients. Becoming a member includes receiving newsletters, email blasts, wellness information and challenges your business can utilize.
- Consumers of healthcare have historically been conscious purchasers. Within your plan, check for the ability to leverage multiple doctors and pharmacies to find the most cost-effective option for each employee. Medical offices inside pharmacy’s, or retail outlets, as well as Urgent cares, have seen increased rates of attention simply for their competitive prices as opposed to a traditional hospital.
- Employers looking for additional ways to offer savings for employees on their prescription medications can turn to mobile apps such as GoodRx which offers money-saving coupons for medications.
- Online wellness tools allow you to view claims, ID cards, locate doctors, browse medications and estimate costs. Many of the plans have teams to help people who are pregnant, want to stop smoking, lose weight or have specific health conditions such as asthma, diabetes, heart disease, etc.”
How Saxon Helps
Kelley understands every business is unique and is dedicated to proactively serving the needs of each client. At Saxon, Kelley and our team of advisors begin by engaging experts that truly listen, building successful strategies that stay focused on your vision and goals.
Saxon exists to care, cultivate and empower through relationships, expertise and exceptional standards of service. Saxon’s WIN team is always available at your convenience to unlock the benefits you did not know you had in order to excel your organizational efforts upward.
To begin the conversation about putting your overlooked benefits into action, contact Kelley Bell today at (513) 774-5493 or (937) 672-1547 or via email at kbell@gosaxon.com.
Engaging employees in healthcare — even while traveling
In 2018, Americans took 463.6 million trips for business, leaving employees unsure of what to do when they get sick or injured while away. Read this blog post for how employers can engage employees who are traveling in healthcare.
Business travel is booming. Americans took 463.6 million trips for business last year. But what happens when a business traveler gets sick or injured while away from home and how can employers help their employees in this situation?
It starts with a simple solution: Make sure you’re providing employees with a health insurance plan that includes coverage outside the state or region where the business is located. While the majority of plans provide coverage for illnesses and injuries that meet the insurer’s definition of an emergency, some plans don’t cover care for common serious, but non-emergency health problems like strep throat, migraine headaches, a sprained ankle or back pain. Employers should ensure they offer at least one plan option that includes either an extended physician and hospital network or coverage for out-of-network care.
If employees need to travel out of the country for business, employers may want to consider offering travel medical insurance, which provides coverage during the period of time while the employee is outside the U.S. and medical evacuation if needed. To ensure employees have all the immunizations they need and are aware of any health risks at their destinations, employers can offer access to or reimbursement for pre-trip visits with a travel medicine specialist.
Even when employees have health insurance that gives them access to care while they’re away from home, connecting with experienced healthcare providers can still be difficult. Some insurers offer phone support for plan members seeking care providers, although often these providers are not heavily vetted for the experience or providing the highest quality care. Health advisory services can also help employees find and connect with healthcare providers in the U.S. and overseas.
When considering health advisory firms, employers should ask how the firm vets the healthcare providers it connects employees with and whether the firm uses a set network of providers or whether it connects employees with the most appropriate providers regardless of their health system affiliation.
Make sure employees know how to find the right type of care
When an employee falls ill or gets injured while traveling for business, her or his first instinct may be to seek care at a local emergency room, but that’s not always the best option. In addition to long wait times, the cost of care delivered in the emergency room is significantly higher than other care settings.
- Employers can help employees make better choices by providing information about the options available and how to choose the right care setting:
- The emergency room for serious, life-threatening illnesses and injuries such as chest pain, symptoms of a stroke, serious burns, head injury or loss of consciousness, eye injuries, severe allergic reactions, broken bones and heavy bleeding
- An urgent care center for conditions you’d usually make a doctor’s appointment for such as vomiting or diarrhea, fever, sprains, moderate flu symptoms, small cuts, wheezing and dehydration
- A walk-in or retail clinic for minor problems such as a rash with no fever, mild flu-like symptoms, sore throat, cough and congestion, ear pain and eye itchiness or redness
- Telemedicine or virtual physician visits for minor illnesses and injuries and advice on whether additional care is needed
The key to helping employees know which care setting is the most appropriate is ongoing communication and education, which can take the form of in-person meetings with the benefits team, newsletter articles and email blasts, and video content shared through the company’s intranet channels.
Employees who are living with chronic health conditions should take special steps when traveling for business, including ensuring they have enough of any prescription medication they take and bringing an extra prescription with them for essential medications in case they’re lost in transit.
Ensure employees can quickly share their medical records with providers
Another important part of the healthcare equation for business travelers is ensuring that when they need care while they’re on the road, the healthcare providers who treat them can get quick, secure access to their medical records. Access to these records is important for several reasons:
- It gives a provider who’s not familiar with the employee’s medical history a comprehensive look at past and current health problems and chronic conditions, medications, allergies or adverse reactions, and treatments and surgeries. Having this information can lower the risk of misdiagnosis, inappropriate care and duplicate care or testing, which not only adds unneeded costs but can also cause harm.
- This information can be especially important when employees are seriously ill or injured and can’t speak for themselves to share medical history and their wishes about issues like the use of a ventilator or feeding tube.
There are several online services and apps that allow users to upload medical records so they can share them with healthcare providers. Another option is to work with a health adviser who can make sure employees’ records are carefully reviewed to ensure accuracy and stored in a secure universal medical record that can be accessed in minutes by treating physicians anywhere in the world.
Giving employees who travel for business the right resources and guidance can not only increase their peace of mind, it can help make sure they have access to the care they need wherever work takes them.
SOURCE: Varn, M. (18 June 2019) "Engaging employees in healthcare — even while traveling" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/engage-employees-in-healthcare-when-traveling
Think your employee is faking sickness? Here’s what you can do
Have your employees misused their FMLA leave before? Navigating FMLA can be tricky, leading to costly lawsuits if a wrong move is taken. Continue reading this blog post to learn more about handling FMLA misuse.
Your employee’s gout flared up, so they took the day off using intermittent medical leave. Later on, a photo of the same employee sliding into home base surfaces on social media that day. How do you find out if the employee was misusing FMLA leave?
Bryon Bass, senior vice president of workforce absence at Sedgwick — a business solution tech company — says navigating FMLA can be tricky, and the wrong move can provoke costly lawsuits. But if an employer has reason to believe the absence isn’t valid, Bass says there’s a process they can follow to investigate.
“I think [a social media photo] casts doubt on the reason for their absence,” Bass said during a recent webinar hosted by the Disability Management Employer Coalition. “It merits a second look, along with some potential code of conduct talks with HR.”
When a questionable situation arises, employers can ask for the worker’s approved medical condition to be recertified, Bass said. This involves having the employee resubmit their original FMLA application. Afterward, employers can send a list of absences to the employee’s healthcare provider to authenticate the dates as valid medical absences. Typically, employers can only request recertification after a 30 day period, unless there’s reason to believe the employee is taking advantage of the system.
“If, for example, you notice two employees — who happen to be dating — are taking off the same days for their different medical conditions, that’s a valid reason for asking for recertification,” Bass said. “Patterns of absence are a common reason to look into it.”
Instead of requesting recertification, some employers make the mistake of contacting the employee’s physician directly — a process called clarification. Employers are only allowed to use clarification during the initial FMLA application, and only after obtaining the employee’s permission. Clarification is used to answer employer questions about the amount of rest an employee’s condition merits.
Employers might not trust the opinion of their employee’s doctor, but they can’t ask for a second opinion until it’s time for the employee to re-submit their annual certification, Bass says. When that time comes, employers can appoint a physician to reexamine the employee at the company’s expense. If the employee objects to the second doctor’s report, a third opinion can be sought.
“With third opinions, both the employer and the employee have to agree on the provider because their decision is final,” Bass said. “Employers are also required to cover this expense.”
Although employers are within their right to file recertification, Bass says it should be done sparingly and in situations where evidence suggests misuse. An employee using slightly more time for recovery isn’t automatically abusing the policy, he said.
“FMLA does not permit healthcare providers to provide an exact schedule of leave, just an estimate of absences necessary for the employee’s treatment and recovery,” Bass said. “Treatments are more predictable, but it’s still only an estimate. If someone takes a little more time than estimated, it doesn’t mean you need to ask for recertification; in fact, the Department of Labor discourages that.”
SOURCE: Webster, K. (24 April 2019) "Think your employee is faking sickness? Here’s what you can do" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/how-to-certify-medical-leave-and-handle-pto-requests?feed=00000152-a2fb-d118-ab57-b3ff6e310000
7 tips for keeping shift workers healthy
Most companies that are open for more than 10 hours a day have some sort of shift work or work pattern. Though shift work can have multiple positives for companies and their workers, it can also have numerous negative impacts on physical and mental health. Read this blog post for seven tips on keeping shift workers healthy.
For companies open for more than 10 hours a day, it’s likely that you have some sort of shift work, or a pattern of work involving rotation through different fixed periods across a working week or month. Employees who work in healthcare, call centers, manufacturing and in a warehouse all regularly work round-the-clock shifts, and these are some of the most common industries utilizing this type of model.
While shift work can have numerous positives for the company and even the workers, it also can have many negative impacts on health — both physical and mental. Beyond the most common health impact — sleep disruption — there are numerous other ways shift work can negatively impact a worker’s health including: mood disorders, gastrointestinal disorders, injuries and accidents, metabolic disorders, cancer, cardiovascular disorders, interference on family live and limited social life.
Shift workers also experience high levels of annual leave requests and short-term disability claims.
For employers in one of these industries, or any industry with non-regular shift hours, there are a few best practices that will help improve worker productivity and minimize leave.
Provide schedules that are as predictable at possible. Allowing an employee to settle into a regular schedule will allow them to establish a routine both at work and at home. Interference with home and social life can be a key trigger for a variety of negative health habits.
Limit the number of nights worked consecutively. Just like a traditional Monday-Friday, 9-5 worker, those working night hours need a weekend of their own, too. While this may not always be Saturday-Sunday, allowing them a couple of consecutive days off will give them time to disconnect and recharge.
Designate areas and times for employees to rest in the workplace. Whether a nurse in a busy ER department or a warehouse worker stocking shelves, everyone needs a break during their workday. Work with the shift manager to map out regular breaks and a calm and quiet place for employees to take a break.
Provide health and wellness programs that are accessible at night and on weekends. Since most HR professionals work office day jobs, they often forget about accessibility of services to employees working different hours. Assure your EAP provider is accessible 24/7 and if you have on-campus programs, be sure to offer them at different times for your shift workers. A factory employee working third shift should have the same level of access as a first-shift office worker.
Give employees more control over their schedules with shift-based hiring. This is an approach of hiring people for individual shifts rather than hiring employees, then scheduling them into shifts. Employees come to companies with a range of responsibilities outside of the workplace. Allowing them to match with the shift that best works with their personal lives will result in greater productivity and fewer health impacts.
For those returning to work following a leave, keep the schedule as close to their normal schedule as possible. While it’s not always possible to perfectly align with their previous schedule, you’ll want to get those returning from a leave back into the routine of their previous shift work. While on leave, many will have transitioned into a different sleep routine, so getting them back to the previous patterns will help with the transition back to work.
Provide resources on good sleep health. For shift workers, a healthy sleep routine can be challenging. However, there are simple and well-proven approaches to establishing sleep patterns regardless of the time of day. Be sure to regularly promote resources in the workplace and through regular communications. The American Academy of Sleep Medicine is a good place to start.
SOURCE: Willett, S. (26 April 2019) "7 tips for keeping shift workers healthy" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/tips-for-keeping-hourly-employees-healthy?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001
7 ways employers can support employee caregivers
Seventy-three percent of employees in the United States act as caregivers for a child, parent or friend, according to research from Harvard Business School. Continue reading for seven ways employers can support employee caregivers.
The number of caregiving adults in the U.S. has reached a tipping point.
As the baby boomer generation gets older, an increasing number of people in the workforce are taking on the role of unpaid caregiver for a family member or friend. Many also are in the midst of raising their own children, which means they’re pulled in many different directions, trying to keep up with work commitments and family responsibilities. In fact, according to researchers at Harvard Business School, 73% of employees in the U.S. are caring for a child, parent or friend.
What do all these statistics point to? They mean that employers have an opportunity to play a role in helping employees balance these often competing priorities.
The Harvard study highlights the impact of employee caregiving responsibilities on the workplace. While only 24% of employers surveyed believed employee caregiving influenced their employees’ performance at work, 80% of the employees who were surveyed admitted that caregiving had an effect on their productivity at work and interfered with their ability to do their best work.
The survey also found that caregiving can affect employee retention, with 32% of the employees surveyed saying they had left a job because of their caregiving responsibilities. In addition, employees who are caregivers are more likely to miss work, arrive late or leave early, which affects not only productivity, but also the employees’ ability to progress in their careers.
Employers can take a proactive role in supporting employees who are caregivers. That support, in turn, can have a positive effect on productivity, morale and employee retention. Here are seven strategies employers should consider.
Create an organization-wide understanding of the challenges caregivers face.
Employees who aren’t sure that their managers and leaders would understand the juggling they’re doing and the stresses they face are more likely to not only have problems at work, but — because they face high stress levels trying to get everything done at home and work — they also are at higher risk for a number of health problems such as depression and heart disease. By creating a culture that allows employees to openly express their challenges and ask for support, employers can not only keep employees healthy and productive, they also can reduce secondary costs associated with decreased productivity and chronic health problems.
Know what challenges employees face.
Regular employee surveys can help employers assess employees’ needs in terms of caregiving and tailor the benefits the organization offers to help meet those needs.
Communicate the benefits that are available.
In many cases, employers already offer programs and benefits that can help employees who are caregivers such as an employee assistance program and referral services for finding caregivers who can help when the employee isn’t able to. However, many employees aren’t aware these programs are available, so it’s important to continuously share information about them in company newsletters, emails and at meetings.
Consider flex time and remote work options.
Depending on the employees’ work responsibilities, employers can offer flexible work arrangements that allow employees to work different hours or to telecommute for a certain number of days per week.
Change the approach to paid time off.
Rather than dividing paid time off into vacation days, sick days and personal days, consider grouping all time off into one category. That allows employees to take time off for caregiving as needed. A growing number of companies, including Adobe, Deloitte, Bristol-Meyers Squibb and Coca-Cola, are also offering paid family leave benefits so that employees can take time off to provide care.
Connect employees with resources.
Beyond an EAP and referral services, employers can offer programs that connect caregivers with resources for both their caregiving role and for the self-care they need to remain healthy and able to handle both job and caregiving roles better. Those resources can include:
Beyond an EAP and referral services, employers can offer programs that connect caregivers with resources for both their caregiving role and for the self-care they need to remain healthy and able to handle both job and caregiving roles better. Those resources can include:
- Advisory services that help employees connect with healthcare providers for their parents, children and themselves
- Nurse managers, case managers and geriatric care managers who can help employees who are managing the care of a family member who’s living with a serious health condition or disability
- Advocates who can help employees who are dealing with complex insurance claims for the person they care for, planning for long-term care, or managing the legal and financial complexities that can arise when a parent or spouse dies
Internal caregiver resources groups that bring together employees who are dealing with the issues surrounding caregiving so that they can share ideas and experiences
Measure how well your support is working.
The first step to supporting caregivers in the workforce is to implement policies, programs and benefits that offer them the tools they need to balance work and caregiving. An equally important second step is to regularly review what is offered, how much the offerings are used, and by which employees. Ask employees for feedback on how effectively what the organization provides is in helping them with issues they face as working caregivers and solicit ideas for new approaches and tools they’d like to have.
SOURCE: Varn, M. (25 March 2019) "7 ways employers can support employee caregivers" (Web Blog Post). Retrieved from https://www.benefitnews.com/list/7-ways-employers-can-support-employee-caregivers
What HR pros should know about clinical guidelines
Sets of science-based recommendations, also known as clinical guidelines, are designed to optimize patient care in areas such as screening and testing, diagnosis and treatment. Read this blog post for what HR professionals should know about these guidelines.
Your employees and their family members frequently face tough questions about their healthcare: How do I know when it’s time to get a mammogram? When does my child need a vision screening? Should I get a thyroid screening? If I have high blood pressure or diabetes, what is the best treatment for me?
For the providers who care for them, the key question is: How do we implement appropriate, science-backed treatments for our patients, testing where needed, but avoiding potentially harmful or unnecessary (and expensive) care? The answer is to seek guidance from and use clinical guidelines —along with existing clinical skills — wisely.
Clinical guidelines are sets of science-based recommendations, designed to optimize care for patients in areas such as screening and testing, diagnosis and treatment. They are developed after a critical review by experts of current scientific data and additional evidence to help inform clinical decisions across a spectrum of specialties.
Based upon this process, guidelines are then released by a number of sources and collaborations, including academic and non-profit healthcare entities, government organizations and medical specialty organizations.
From preventive care to treatment protocols for chronic conditions, guidelines provide a framework healthcare providers use with patients to help guide care. However, it’s important to note that clinical guidelines are not rigid substitutes for professional judgment, and not all patient care can be encompassed within guidelines.
The impact on healthcare and benefits
Clinical guidelines are used in myriad ways across the healthcare spectrum, and providers are not the only ones who utilize them. Insurers also may use guidelines to develop coverage policies for specific procedures, services and treatment, which can affect the care your covered population receives.
To illustrate a key example of an intended impact of guidelines on health plan coverage, consider those issued by the U.S. Preventive Services Task Force, whose A and B level recommendations comprise the preventive services now covered at no cost under the mandate of the Affordable Care Act.
As another example, the National Committee for Quality Assurance, which accredits health plans and improves the quality of care through its evidence-based measures, uses the American Heart Association guidelines when creating its quality rules for treating high cholesterol with statin drugs.
Other examples exist among commercial coverage policies. For example, some cancer drug reimbursement policies use components from nationally recognized guidelines for cancer care.
Because science is rapidly changing, guidelines are often updated, leading insurers to revisit their policies to decide if they will change how services and medications are covered for their members. Providers and health systems may modify processes of patient care in response to major changes in guidelines and/or resultant changes in payer reimbursement.
Not all guidelines are updated on a set schedule, making it even more important for providers and organizations that rely on guidelines to stay on top of changing information, as it can have a direct impact on how they work. Attending conferences, visiting the recently established ECRI Guidelines Trust, and regularly reviewing relevant professional association websites and journals can help ensure needed guidelines are current. Lack of current information can affect care decisions and potential outcomes for patients. Those who have access to the most up-to-date, evidence-based information are able to work together to make well-informed healthcare decisions.
Why it matters for employers
As employers or benefits consultants, it’s critical to ensure that your health plan, advocacy or decision support providers, and other partners that depend on this information to guide their practices and decisions understand and follow current, relevant guidelines.
Further, by combining information from relevant guidelines and data from biometric screenings, health risk assessments, claims and other sources, it’s possible for clinical advocacy and other decision support providers to identify employees with gaps in care and generate targeted communications (through a member website and/or mobile app) to help them take action to improve their health.
Clinical guidelines are science distilled into practical recommendations meant to be applied to most patients for quality healthcare. By maintaining current, relevant guidelines, organizations and providers who work with your covered population can ensure that all parties have the key information they need to make the best decisions for their health.
SOURCE: Sivalingam, J. (18 March 2019) "What HR pros should know about clinical guidelines" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/what-hr-managers-should-know-about-clinical-guidelines?feed=00000152-a2fb-d118-ab57-b3ff6e310000