Susan Haise, Owner of Neroli Salon & Spa
and the Institute of Beauty and Wellness, leads with her heart and mind in symphony. While many business leaders find dangerous conflict of interest by mixing the two, Susan’s natural talents define a magnificent culture of trust, supported by a relentless commitment to education. Her passion and pursuit of excellence are compelling.
The keys to success for any employer are to create an aligned brand that delivers upon expectations and supports both mission and operations. Neroli and IBW are each positioned on quality, experience and education. Susan delivers to her team members exactly what she wants delivered to her clients and students. She “pays it forward” with astute understanding that environment, culture and experience are equally important to quality service and top level education.
Neroli’s mission… “To renew the spirits and awaken the minds of all whom we have the opportunity to touch.” Neroli’s culture… “We believe personal and organizational balance is the key to sustainable success. We believe in treating ourselves, each other, and the planet with care and respect.”
When the Affordable Care Act began peaking with questions, twists and heated controversy, Haise quickly called to action an open invite educational campaign for Neroli team members and IBW students. While most employers avoided dialog (except that mandated by the ACA itself), Haise deployed HRS to deliver an uncensored and unbiased third party expert forum, fielding team member questions on any ACA topic and promoting complete transparency into all sides of legislative and individual consumer impact. Both supporters and naysayers of the act attended. Grace in education and open minded inquiry were accomplished. Now two years since educational campaign commenced, Susan reports that every day navigation of the ACA has been easier for all.
Susan embodies the educational commitment of HRS, and we submit Neroli/IBW’s case study as a prolific example of education done right. True education depends upon discovery of opposing viewpoints with open minds. While we typically advocate against shining a light on a problem, in this case confusion and fear were the problem, and the employer shined a light on the solution: education and transparency. The program delivered exactly what team members needed to know and addressed questions they likely otherwise would not have known to ask…all while strategically supporting the organizational mission with custom curriculum. Ongoing resources were then available for updated information throughout the ACA’s journey to date. HRS further certified the educational campaign and ongoing commitment as employer “reasonable care” in compliance, facilitating additional written communications to the team. Haise comments…”We have successfully navigated the waters, and our team is comfortable today understanding their ACA rights and responsibilities specifically because of our educational campaign with HRS. They are aware and informed. They know information is accessible.” Where employers shut down information and behave "cloak and dagger," they lose employee trust. Once again, Haise optimized trust among team members. Trust is motivating, leading to top shelf employee engagement.
Employment law influences and often dictates workplace practice. As a precursor to the educational campaign, HRS facilitated the custom crafting of Neroli/IBW's employee handbook by consulting directly with Haise and her executive team to recommend policies which not only align with but also accentuate the brand. Follow up implementation training and on call consultancy were next steps.
While case and statutory law shape our recommendations, we typically recommend the handbook language educates employees as to how policies are deployed to uphold law and to protect workplace fairness and consistency. Inasmuch as we see some competitor legalese actually planting seed for complaint and disgruntlement, we advocate language which yields positive outcome instead. An opportunity exists to leverage compliance as a workplace benefit. Susan Haise adopted recommendations which are both comprehensively lawful but also precisely supportive of education and culture.
A leading businessperson who has not only mastered culture and brand but who keeps a keen eye, hour by hour, on the numbers which drive fiscal success, Susan is no stranger to the reality that financial acumen is the empowerment and sustainability of the ongoing mission. An award winning entrepreneur, Haise has created and sustained award winning businesses since 1993. Named among the “Best Places to Work” by the Milwaukee Business Journal for five consecutive years, Neroli Salon & Spa operates five popular locations, while the Institute of Beauty and Wellness remains the pre-eminent “go to” for top industry education. Both firms under Haise’s leadership have earned multiple industry innovation and business success awards and are said to have “changed the beauty industry.” And of course, as great leaders do, Haise shares the credit with her executive team.
As a trusted resource for employer case study and information, HRS reports and recommends the Neroli/IBW story as an example of “mission accomplished.” Certain this organization will not rest on its laurels, we look forward to the next chapter. HRS emphatically advocates a commitment to strategic education, adaptive to the learning styles of individuals and team demographics with custom curriculum to best support operational success and mission objectives. Handbook policies are equally important for expert custom crafting, while templates fall critically short of the goal. Haise’s mission for Neroli/IBW capitalizes on unique competitive edge and visionary innovation. Adopting status quo practice along any criteria would derail the mission and impede the noteworthy success.
HRS serves holistic management information and operations solutions to business leaders and HR/OD professionals. Areas of focus include HR, Employment Law and Organizational Development. Headquartered in Brookfield, WI, HRS delivers international reach with a local commitment to an audience of approximately 5000 employers. The highly decorated firm celebrates a fourth decade of success.
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Jessica Ollenburg - Thursday, July 23, 2015
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Make no mistake. HRS has been a substantial supporter of worthy nonprofits since our inception, and our Angel Wings
and HRS Gives Back
programs are fabulous examples. In the face of that, certain nonprofit associations, not specifically tied to greater good, are abusing tax-exempt status, betraying taxpayers and delivering dangerous advice. We warn to be wary.
A disreputable few nonprofits are beginning to cross the line and betray their status. In the world of HR, employer membership associations done well can be great places to swap case studies, find research, attain broad-based information and acquire non-custom tools. Those that promise to give advice, however, are in direct conflict with IRS tax code and their rights to the tax breaks they demand. Specifically, IRS tax exempt status prohibits a nonprofit from serving, addressing or advocating specific interests of individuals or individual members. This IRS covenant stands to prove that any nonprofit addressing the unique interest or custom need of an individual member is likely practicing tax fraud and is specifically ill-equipped to provide meaningful adaptive solutions of quality caliber. Some are delivering dangerously poor advice, resulting in six or seven-figure disaster for constituents. One such criminal was recently found distributing an employment application template unlawfully bearing a social security number field.
HRS continues to support, contribute to and partner with a wealth of professional associations relevant to our fields of study. You will find our logos and sponsorships proudly displayed. The best of them provide complimentary benefit to tax paying consulting firms and internal employer expertise. Similarly, IRS code also requests nonprofits to refrain from providing service available in the private sector market from tax paying employers. Any nonprofit that dramatically changes its service line in recent decades does not find itself exempt from responsibility to tax exemption covenants. Criminal behavior remains the outcome.
We at HRS embrace additional opinions on any topic of consequence. Our own boardroom approach to client problem solving demonstrates our ideology. Our multi-rater approach to assessment scoring further validates. With HRS, you already find holistic approach and several experts represented in any single proposed solution. As far as competition, we welcome competition. Today, seven critical disciplines fall under the HR umbrella, and the generalist needs specialist partners to get it done right. Having opened our doors before widespread HR demand at executive level, we welcome those who help us promote the critically expanded role of HR and those who keep us on our toes.
However, in a world where worthy nonprofits that save lives, advocate human rights and protect our kids are starving for government support and are suffering government cutbacks, we demand the non-legit nonprofits back away from the table. When nonprofits compete with tax paying firms, by definition and tax code, the nonprofit is not a legitimate nonprofit… in the wrong and abusing greater good. Tax breaks, grants and donations are sadly misguided when nonprofits dishonor their status. Buyers and taxpayers are called to use their voice and their buying power to encourage reform for greater good.
Jessica Ollenburg - Tuesday, April 07, 2015
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Update: Shortly after this article's publication, the US Federal Government announced a one-year delay of certain ACA mandates including the "pay or play" component. Visit our January 2014 update. As of February 2014, the component has been pushed back again. Stay tuned for more info.
As employers sift through immediate and forward moving impact of the Patient Protection and Affordable Care Act (ACA, PPACA or “ObamaCare”), we consulted with nationwide ACA experts to provide a quick blueprint of action items, FAQs and debunked myths. In respect to our expert unbiased objectivity, HRS employer clients have been asking us for credible and clear answers on this topic.
Preparation & Timeline
While some employers still believe they have until 2014 to make decisions, a more practical deadline is October 1, 2013, when health exchange notices need distribution to employees. Once these notices hit, employee questions will abound, and the risk of providing inaccurate or unsavory answers will impact employee retention, engagement, productivity and legal compliance. With employee access to health exchange, employer programs will find heightened scrutiny and explanations must be ready. In addition to impact upon talent resources, employer failure to meet ACA guidelines will result in substantial fine. While employers initially pledged to “pay” are shifting to “play,” due diligence is essential to “play.”
With minimum coverage covenants higher than ever before, minimum premiums are expected to increase as well. Employers are encouraged to anticipate this perception gap and to strategically educate employees as to the comparison between employer-sponsored and health exchange coverage. Summaries of benefits and coverage (SBCs) will not be enough to address this topic.
Matthew Weimer, Director of Employee Benefits Operations for Diversified Insurance Solutions, advises employers to prepare for employee surprise once the exchange opens. Weimer advises that many individuals are expecting exchange premiums to be lower than they actually will be, and an opportunity for an employer “win” is present.
Karen McLeese, JD, Vice President of Employee Benefit Regulatory Affairs for CBIZ Employee Services, Inc., advises employers of all sizes to “work with insurers, TPAs, benefit consultants, brokers and other advisors to ensure compliance with all ACA market reforms.” McLeese further advises to be prepared to deliver notices to all employees, not just those covered by the health plan, by October 1, 2013; to be familiar with single source market place applications; to ensure summaries of benefits and coverage (SBCs) are properly distributed; and to properly classify and count workers. HRS, Diversified and CBIZ are addressing these mandates by providing guidance as to crafting exchange notices, counting employees, educating team members and selecting plans to meet affordability standards.
Criticism, Fact Versus Fiction & Recent Developments
The relentless politicizing and profit taking on this topic have created mistrust and frustration among employers, so HRS has stepped in. We have no vested interest in insurance program sales. Our interest and reputation are tied only to accurate top shelf information and legal compliance standards. We have additionally invited adjacent field experts who have responded with transparency and integrity to our news campaign.
While arguments abound, opponents of the Act assert that the “Patient Protection” provisions can be mutually exclusive to the “Affordable” provisions, and employers need to address this concern. Some employees will undoubtedly be forced to buy more coverage than perceived necessary. Whereas the counter-argument is that these forced coverage levels will ultimately decrease overall health care costs, we cannot ignore and must address the initial sticker shock. Along that same line of thinking, Weimer addresses that many of his insured clients are already electively providing coverage levels that exceed ACA standards, and therefore, when employee premiums exceed health exchange premiums, the gap must be addressed to safeguard employee trust and engagement. Under affordability standards the employer must absorb the majority of premium costs, and therefore, while employees may pay higher premiums through the employer, it is imperative that they fully understand the value received and that the employer is absorbing the majority of excess benefits costs.
Employers were justifiably concerned by the initial ACA language which required employer review of “household income” in determining affordability. Not only did this pose an infeasible burden of costly administration but also a grave concern over privacy rights and employee discomfort. Affordability measurements have been thankfully addressed by updated calculation methods to include the W-2, rate of pay and federal poverty line (FPL) methods. These investigations are simpler, less invasive and consider only employee income rather than household income. As the federal ACA regulations shift substantial administrative burden to individual states, HRS urges employers to research state regulations and not just the federal. As the federal regulations do not protect spousal coverage, look to states for spouse and domestic partner rights.
Strategies & Caveats
Employers will choose plans based upon overall compensation scheme, labor intensity and workforce demographics. Benefits should be tailored to unique team attributes and perceived needs. Several HRS clients are employing primarily young, entry level, and therefore typically healthier teams who prioritize basic health but would rather receive other forms of compensation over benefits plan upgrades. For these employers we suggest consideration of a Minimum Value (MV) plan offering optional buy-ups. By deploying this strategy, the employees see premiums competitive to the exchange but also see their employers willing to absorb costs toward employee-elected upgrades. Employers who determine to trade plans down without proper employee education will likely find disaster rather than reward by this practice. “Design your health plan in such a way as to facilitate attracting and retaining your employees. Design the program to maximize personal engagement.” advises McLeese.
Some of the most common pitfalls will likely be linked to employer size, affordability and minimum value coverage. Small businesses (less than 25 FTEs) are offered conditional tax credits but not for business owners. Large businesses (50+ FTEs) will be fined for offering inadequate coverage. Minimum Value (MV) and Actuarial Value (AV) are impractical to calculate for most employers, and therefore working with insurance brokers and carriers you trust becomes more important than ever before. Safe harbor rules allow employers a small margin of error. Weimer advises employers to look to carriers for proper disclosure of MV and AV data. He tells us Diversified is overseeing these calculations for insured clients. McLeese adds that employers should properly classify employees as a new hire routine and to “work closely with a payroll provider who can assist in these recordkeeping requirements.”
Matt Weimer, Karen McLeese and HRS are all addressing proper FTE calculation methods. Weimer and Diversified have released a webinar rich with affordability calculators and employee counting rules. McLeese adds to these metrics a few cautions, including proper classification of employees versus independent contractors. HRS advises that improper 1099 classification is suffering more scrutiny and penalty than ever before, and not just with regard to ACA guidelines but also overall taxation and FLSA compliance impact. McLeese summarizes “Determine which employees are full-time, part-time, variable or seasonal. Decide whether to take advantage of a look-back (measurement) and stability period, and if you're not using a measurement/stability period, analyze status each month.” “Know your shared responsibility risk. How many full-time employees are offered minimum essential coverage? Is it affordable? To avoid a penalty risk, offer adequate coverage at an affordable rate. It is the offer, not the take-up rate, that matters,” continues McLeese.
McLeese recommends to “Establish a wellness program that promotes health and well-being; and ensure it is compliant with new ACA rules. If a wellness program currently exists, review it to ensure compliance with new ACA rules.” The ACA addresses wellness programs, and Weimer adds that wellness, HRA and HSA programs are under current review for their rightful position in coverage ratio calculations.
ACA guidelines will continue to address access and will require annual open enrollment for employer-sponsored plans. Employees will need to be offered health exchange notice within 14 days of new hire following group notification by October 1, 2013. Many employees will not be eligible to purchase insurance on the exchange but must be advised by employers as to availability for application.
HRS is addressing the Affordable Care Act with three new dedicated initiatives: 1) PPACA News Campaign, 2) Individualized Employer Workshops, and 3) Employee Education Tools. We remind that much of law is based upon case precedents rather than statutory language. Look for PPACA to be taking shape for years to come. Please consider us a resource, and stay tuned for more information.
Article by Jessica Ollenburg, HRS Senior Executive Consultant & CEO. Summary bio.
Matthew Weimer is Director of Employee Benefits Operations for Diversified Insurance Solutions. Matt’s extensive insurance industry knowledge and leadership helps to keep the entire benefits department abreast of legislation. He is Diversified’s Health Care Reform onsite expert and sits on the Board of Directors for the Independent Insurance Agents of Wisconsin (IIAW) along with several other industry and legislative committees. Matt has served on a number of advisory councils for the Wisconsin Office of the Commissioner of Insurance and still meets regularly to discuss state and federal insurance regulations. Matt holds a Bachelor of Arts degree in Business Administration and Marketing from Carthage College.
Karen R. McLeese, J.D., is Vice President of Employee Benefit Regulatory Affairs for CBIZ Employee Services, Inc., a division of CBIZ, Inc. McLeese serves as in-house counsel with particular emphasis on monitoring and interpreting state and federal employee benefits law. She follows and analyzes trends and provides information and technical support in response to technical questions regarding employee benefits. McLeese is a member of the Employee Benefits Committee for both the Kansas City Metropolitan Bar Association and the Missouri Bar Association. She is also a member of the Health Law Forum and the Labor and Employment Law Section of the American Bar Association. She has spoken professionally on wide variety of topics related to employee benefits, including HIPAA, COBRA, Welfare, Medicare, FMLA benefits. McLeese serves as an editorial board member for the publication Benefits Law Journal and is a graduate of Notre Dame and Duke Universities.
Jessica Ollenburg - Wednesday, June 26, 2013
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The Department of Labor tells us they are overwhelmed, understaffed and shifting additional burden to employers for employment law compliance. This can be a great deal for the average employer to undertake. HRS has taken some time to prepare a quick “how to” blueprint for employers.
P3, also called “Plan/Prevent/Protect” or “P Cubed,” will require every entity covered by the FLSA, OSHA, OFCCP, and MSHA to make written plans ("Plan"), create processes ("Prevent"), and test the processes with designated compliance employees ("Protect").
The following guidelines create a simplified and sustainable P3 protocol:
1. Stay On Top of Changing Laws.
Review not only government postings, but also secure a 3rd party compliance expert as needed and for annual overview. Our “overwhelmed” government states outright there is no government responsibility to educate employers. Enforcement is their responsibility, however, and fundraising is high. Case precedent law is just as impactful here as statutory law. While it is necessary to be a member of the Bar to litigate or serve as “officer of the court,” it is not necessary to be a member of the Bar to be a legal compliance expert. Full-time research commitment is essential for such expertise.
2. Avoid Copycat or Adaptation of Other Employers’ Handbooks.
Beyond the immediate intellectual property law threats, other employers are not recognized as experts. “Because Company X Did It” is not a reasonable defense. There are some terribly non-compliant practices circulating out there like “old wives’ tales.” Even policies that actually work for one company may not work for yours.
3. Build Legal Arguments from Day One.
Maintain records to prove either experts consulted on or approved your policies… or if self-constructed… save expert resources and statutory evidence as future “reasonable care” affirmative defense. Use scenario planning to create and document activities which defend the company against complaint. “Willful violations” pose the greatest threat. Negligence and lack of attention can be considered “willful” acts.
4. Protect Chain of Information.
Knowing what to keep and for how long as well as what not to keep are essential. Knowing who can have access and how to use this information without breaching privacy laws or risking discriminatory complaint are equally essential.
5. Follow Policy Outcomes.
With the overuse of “cookie cutter” policies, many companies are unaware that better policy options exist. Regardless of genesis for your policy, track outcomes to ensure it is working for you and not creating adverse impact or unlawful side effects. Designate specific individuals with reasonable ongoing access, and empower them with job description authority to monitor policy success.
HRS offers extraordinary legal compliance expertise, P3 design services and further information on any topic herein. Consider an HR certification audit as proactive P3 compliance. ROI is exponential.
Jessica Ollenburg - Monday, January 23, 2012
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1.Stay Informed via Reputable Experts
There is no acceptable plea of ignorance. Laws are constantly changing and it is the employer’s responsibility to stay on top of it. Government sites are improving, but state and federal governments often do not accept responsibility for creating clear communications via websites. The courts look to reasonable care and actual workplace outcomes; however, complaints can be costly. Secure a source of compliance updates reasonably considered compliance “experts.”
2. Choose the Right Expert Source
Subrogate liability: find an expert willing to “take the fall” and back you. Compliance experts need not be legal counsel as long as they remain committed to advanced legal studies and ongoing compliance research. HRS has proven it possible to attain 100% success in avoiding legal argument when compliance is deployed at the proactive stage. Reasonable care and due diligence are key. If you determine to use legal counsel as your “experts” and they have pulled you into the fire only to bill you going in and coming out, find new legal counsel or find an alternative remedy. Insurance brokerages, payroll partners, TPAs and other HR related vendors offer valuable templates and perks for their customers. Most, however, do not profess themselves as “experts” and non-compliant information potentially coming from them is on your plate, not theirs. Several of these firms are proven to circulate bad information because it’s just not their problem. If you grab a tax advice flyer at the grocery store, you shall be challenged in holding the store accountable for bad information. Several HR industry vendors hire HRS and other accredited experts to provide deeper quality risk management for clients.
3. Reject Cookie Cutter Advice
Compliance is more about judgment than templates. Non-profits can be a great source of templates and education; however, by the nature of being non-profits, they are ineligible to advocate for any individual client and can only serve the “membership as a whole.” Although we’ve caught one or two professing themselves in the “management consulting” field, please know this is categorically impossible. Take their information as one component of your research and adapt it to your company’s unique variables. Call upon experts who can bring widespread case studies where you prefer assistance. There are some valuable non-profits, they can be highly beneficial; however, they cannot be a “one stop shop” for your compliance needs.
4. Document Policies and Incidents
Do not let deniability work against you. The courts look for evidence and reasonable care in forms of currently compliant employee handbooks, related documentation and proof of receipt. For top risk management, an employer needs to prove the employee knew what was expected, received no confusing/contradictory messages, was capable of meeting expectations, knew the consequences of failure and chose to fail. Consistency of enforcement without discrimination is critical. Incident reports, valid job descriptions and clear compliant performance appraisals are each contributory toolsets. Legal postings must be up to date and accessible to employees. (Flat annual fee poster services can be a great partner here.) Maintenance and access to employee files must be controlled on a “need to know” basis according to HIPAA, EEOC, DOL, GINA and countless other emerging and ever-changing standards. Consider a voluntary compliance review for risk management and to build “affirmative defense” through reasonable care. Non-profits are ineligible by status to protect individual members/customers, so please do not deploy a non-profit organization in this capacity.
5. Train, Train, Train
Enforce a culture of lifelong learning and properly train employees not only in operations procedures but also in legal compliance to include anti-harassment, risk management, liability aversion, documentation and diversity. While the employer is not ultimately expected to control each and every workplace action, the employer is held accountable to “reasonable care.” Proper training averts risks, and the act of training builds “affirmative defense.” Training by 3rd party experts brings additional reasonable care and promotes exceptional questions and learning. Remember most people are not classroom learners and bear learning threshold of 2.5 hours typicalmaximum. Consider kinesthetic learning bullets. (Hint and shameless plug: contact HRS!)
6. Stay Current and Prepare for Change
The employer who has been non-compliant and has “never had a problem” is probably due. Granted those employers are probably not taking the time to read this, invulnerability is a myth. Everyone is vulnerable. Don’t waive it off. The government is fundraising. Many people would rather fundraise than work. Some lawyers are fundraising. Insurance companies, like any businesses, will protect their interests. It is your responsibility to protect your own interests as an employer. Stay up to date with regular compliance reviews for practices and policies. The right 3rd party expert partnership is excellent “reasonable care.” Secure updates and review for compliance regularly.
Please contact HRS for more information regarding answer desk, compliance review, handbook services, kinesthetic learning bullets to include anti-harassment, referrals to HR partners who rely upon actual experts and other risk management reasonable care programs.
Jessica Ollenburg - Thursday, December 16, 2010
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Emerging from a recession, grabbing opportunity and surviving intense global competition, we cannot be fooled by the dangerous and misleading propaganda... "Work Smarter, Not Harder!" Statements along these lines when misinterpreted can only lead to disaster. The blueprint for success requires balance.
Agreed it can be more effective to work smart than to work hard, in most cases both are necessary. In addition, “smart” can be a matter of misinterpretation in itself. “Smart” can only truly be judged by one who is “smart” in the capacity and criteria to be evaluated. “Smart” can be ill defined. Nonetheless, "Work Smarter" should remain our dedicated target, we just need to lose the "Not Harder" component.
Through study of human work ethic, it is undeniable that many top performers equate “working hard” with “doing your best.” Anything short of doing one’s best is less than adequate. Therefore, working “hard” is always one of the goals. Where and how we channel our energies and how we balance and care for ourselves is a matter of personal choice and commitment.
Nations rich in socialism and suppressed middle class existence present global competition of both working hard and working smart in tandem. Those who wish to compete must rise to the occasion or lose the opportunity to fight another day. While the U.S. is not easily adaptable by history and infrastructure to the socialist principles which have been embraced by other nations, Americans must not think they can exist in a vacuum, especially after centuries of global involvement.
Those proven to offer judgment, accomplishment and commitment to excellence effectively draw upon the “Work Smarter, Not Harder” mantra with astute understanding that successful results require efficiency and sound judgment. These toolsets can lead to quicker, easier and more accurate positive outcomes, freeing our resources to accomplish more in the end. The mantra works best for those already working hard. Those, however, lacking necessary work commitment are adversely impacted and misled by this mantra, using it as an excuse to retract effort.
This is an essential organizational development topic to be safeguarded by employee education, policies, practices and daily performance management. The ambiguity of related remarks is polluting team members’ understanding of workplace expectations and the blueprint to security and advancement. Consider this both a “call to action” and an opportunity of betterment for organizational leaders at all levels.
Jessica Ollenburg - Saturday, January 09, 2010
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If you want to understand why anything happens in health care simply follow the dollars.
After having spent 35 years in the health care cost management field I am convinced that this is a true statement. The dollars influence and in some cases dictate hospital expansion, physician carrier choices, additional technology, administrative systems, insurance company plan designs, employer benefits and any other aspect of the health care field. This being the case, influencing the dollars will drive solutions to the industries problems.
As evidence of this, look at the expansion of PPO type plans over the past 20 years. Offering employees a benefit incentive to use one doctor or hospital over another has resulted in the largest change in buying habits ever recorded, with over 90% of today’s health care being provided through PPO type plans. Even HMO’s have re-packaged their services into PPO type plans.
There are three changes that can be made to the existing system that will reduce costs, significantly limit cost increases, improve quality, improve access, streamline administration and expand insurance coverage. All three changes are made in the private sector and require no government intervention or additional taxes.
1. Price Transparency:
Today we do not know the true cost of even the most routine procedure (normal deliveries). As a result of multiple PPO, HMO and government contracts the price has been distorted. In Milwaukee 38 procedures represent 65% of the dollars spent at the hospital. The price range of each procedure among Milwaukee hospitals is at least 100%, with 300% and 400% variances common. Each hospital should be required to disclose the average private sector revenue for the top 20 procedures. Because this is an average confidential contract pricing is not disclosed.
2. Change the PPO and HMO contracts:
In the mid 1990’s most hospitals were reimbursed a set dollar amount per day of hospital stay. As a result the cost increases for benefit plans in 1995 and 1996 was virtually “0” according to the Mercer study on health care costs. In the latter 1990’s competitive pressures and improved hospital negotiating skills resulted in a move to a percentage off billed charges. The control of the cost of health care was turned over to the providers. From the late 1990’s to about 2006 cost increases were in the low to mid teens each year. A return to fixed pricing is essential to controlling costs. Both hospitals and physicians should be reimbursed according to a fee schedule.
3. Change Benefit Plan Designs:
Price transparency and a change to schedules under contracts allow the designers of benefit plans to create plans that embrace the schedules. The cost of this service ranges from $1000 to $4,000. The benefit plan will pay $2,500. These are the providers who will accept this price or less.
4. Create Global Services:
Fixed pricing allows the formation of Global Services. Under these services all of the parts of a procedure are contained in a single contracted price. For example a Global surgery would include the surgeon’s fee, assistant surgeon (if necessary), anesthesia, radiologist, facility, drugs, tests and any other items required to provide that service. This is the way that health care is provided when benefits are not involved. Most cosmetic surgeries are presented to the patient set fees are patient (who is going to pay the bill) as a single fee with all the necessary parts included.
These four changes would result in an immediate cost reduction (fixed prices are used and providers have an incentive to control costs since it will increase their profits), improve quality (the main differentiation factor is now quality of care and patient satisfaction), improve access (if providers know they will be reimbursed they are more likely to offer services in areas they might otherwise ignore), streamline administration (more efficient administration increases profits) and expand insurance coverage (better priced insurance products can be afforded by more companies and individuals).
These changes can be implemented by the end of this year with no government intervention or expense. If consumers demand better benefit plans they will be delivered.
On the flip side the current proposal of a government sponsored “public plan” will increase Medicare taxes by 20% to 30% within two years.
The “public plan” is based on fees that Medicare has negotiated with hospitals, physicians and other health care providers. These rates are often 60% below billed charges and according to a recent study 20% to 30% below provider costs. The only reason that the provider community has been able to tolerate these low reimbursements is because they can increase their costs to the private sector. A study by the Lewin organization estimates that if the “public option” were offered 85% of the private sector would move to this option within two years because of the lower cost to companies and individuals. This would effectively kill private sector helath benefit plans.
If there is no private sector there is no one to whom costs can be shifted. Medicare would have to increase reimbursement to at least cost or hospitals and doctors would go out of business. This would require a 20% to 30% increase in Medicare reimbursements and a similar increase in Medicare taxes. It would also result in limitations on services available and probably result in hospitals and doctors opting out of the “public” plan with their services being available to only those who could afford to bay the bill.
We have the ability to control health care costs in a fashion that benefits patients, providers and payers. The question is do we have the resolve to implement the changes.
This article was contributed by Richard L. Blomquist, Esteemed Member of the HRS Advisory Board
Mr. Blomquist's Bio and Contact Info
Jessica Ollenburg - Monday, September 07, 2009
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Sending wholehearted gratitude to those and their families who paid the ultimate price defending their country against socialism, the false propaganda in this country threatening blind allegiance and subserviance to socialist principles needs also to be defended against. Some proponents of the universal health care movement are now using socialism labels… and this is an unnecessary extreme to create the much needed change. Nations choose their political systems carefully and defend them tenaciously. The US has fought tenaciously as well and shouldn’t easily abandon longstanding beliefs.
Those who think they understand socialism need to visit a socialist nation and spend time truly analyzing its affects. Socialist principles can be altruistic and often attractive in theory. Like many political systems, the rollout of socialism yields outcomes completely contradictory to its perceived intention. In the US we are entitled choice, and in that, let’s please remember that for which our founding fathers and millions of US military have shed blood. Hitler and Mussolini also are also connected with socialism. Think carefully.
In the US please consider rejecting all programs cloaked with the word “socialism” and “socialized” unless you really believe pure socialism is the answer... and you believe the US needs to reject its longstanding principles and overturn that for which many have given their lives. There are many things to attempt here in the US short of socialism before overturning our guiding principles in such an extreme. Many believe through research that true socialism simply eliminates the middle class… making the rich richer and the poor poorer.
Whether you are for or against more government intervention in our BIG health care problem, socialism is not the next step in progression… and please don’t let much needed hope for betterment allow such a tricky movement to sneak past the great people of this country.
Jessica Ollenburg - Monday, September 07, 2009
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With a small percentage of “hired gun” CEOs being called out for ridiculous greed… and flaunting it, our legislative and media communities are creating a dangerous misperception which threatens not only the immediate workplace but also the US’s global position. Simply stated, so many CEOs are not greedy, and these are the people who can really impact the economy. So, why do we rake them over the coals? Having devoted my career to advocating sharing wealth among team members… proportionate to results contribution… I see how wrongful mistrust of the right CEOs negatively impacts workplace results.
This ivory tower perception of “me against you” in the employee-employer relationship tears down employee confidence and teamwork necessary for corporate bottom-line success. While we all know, “if it bleeds, it leads” in the press, this concept sells publications only because people buy in to this concept. Blame the media all you want (and I can be heard griping often), the media sells only what the public buys.
Successful corporations are those that have endured hardship, challenge and downturn. Discussing the resilience of corporate leadership can lead to positive outcomes. Without discussing concepts the employee isn’t qualified to process, keep it audience adaptive. Frame these discussions to build confidence, and don’t present them in a manner which presents weakness or creates fear. We know overcoming adversity depicts strength while dwelling upon and empowering the obstacles depicts weakness. The target is not to whine.
The problem is that most people are not the risk takers of entrepreneurism, so if we divulge hardship to those while we’re in it, they may become fearful to buy in and contribute when needed to do so. There’s nothing wrong with being more conservative here, so we don’t wish to lose the engagement of this audience. Risk takers “suck it up” and keep their sacrifices private. When they don’t take a paycheck, when they mortgage their home to pay employees, and when they make lifestyle choices which sacrificed personal or social time, it’s typically not visible. Later on, the Mercedes-Benz is visible and some people complain of greed. Those who complain are those who didn’t make the same sacrifices and don’t get it.
Many CEOs are not "silver spooners." The plain truth is that most Americans have opportunity to be CEOs themselves and they choose not to. They choose against the start-up risk, they choose the bar over the office or maybe they have family needs needs which become rightfully prioritized. To choose not to be a CEO is not wrong. Personally, I find the “pillow test” the ultimate test of success. If you’re comfortable with what you did that day when your head hits the pillow, you are successful. Yet, while emerging CEOs are choosing work over party time, the bars are filled with people complaining about their bosses. Backstories are emerging right now, illustrating the personal sacrifices made by some of the great US CEOs who have created jobs, shown philanthropy and endured hardship which benefits us all. Let’s not lump these good people in with the greedy few.
There are some amazingly great employees out there! It can be just as difficult to take direction as it is to give it, especially from some of the bad bosses out there. Amazing employees will probably never realize the benefits of the new COBRA subsidy, as they will probably never see “involuntary termination.” In most reasonable estimations, over time less than 1% of corporate downsize decisions are not directly attributed to employee poor performance. Most downsize decisions are selective. Employees do have a choice. Absent union protection of service length vs. merit or bad management, top performers typically keep their jobs. In many cases, better employee performance would have saved the company that need to downsize. That being said, we hold this to be true: it is the supervisor’s direct responsibility to ensure the right people are doing the right things. It’s not a blame-shifting game. Everyone has a role.
Right now we’re living in a country that penalizes those who create jobs and rewards those who are terminated for cause. Many believe we live with an administration that seeks to deny free choice under the disguise of the Employee Free Choice Act. Surely this is no way to compete. Keep this discussion on the table without creating destructive conflict. There are facts to be shared and teamwork to be built. Clearly, government and media are tearing down this important sense of capitalism. CEOs and organizational development leaders must counteract with the right amount of information needed to restore faith in organizational alignment. Chances are, the employees who don’t currently buy in are not reading this, so they need to hear it from you!
Jessica Ollenburg - Sunday, March 08, 2009
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