DNA Discrimination Bill set to go into Law.... Good News and Bad News...

People learning, through genetic testing, that they might be susceptible to devastating diseases wouldn't also have to worry about losing their jobs or their health insurance, under anti-discrimination legislation the Senate passed Thursday.

The 95-0 Senate vote sends the Genetic Information Nondiscrimination Act back to the House, which could approve it early next week. President Bush supports the legislation.  The measure bars insurers from denying health coverage or charging higher premiums based on a person's genetic information. Also, it bars employers from using genetic information to make hiring, firing, and other job-related decisions. The measure applies only to people who have a genetic makeup that carries the risk of a disease. It does not cover people who already have the disease.

As with everything, there's good news and bad news

First, the good news.  The law provides protection, which should encourage more people to be tested Dennys for a variety of things earlier, which allows people to change behaviors and seek treatment earlier.  That's a good thing, as the prognosis for almost every condition improves if people have the information they need to make better choices.

Now the bad news.  The legislation offers no protection for those who already have a disease.  Seems a little unfair if you're already battling something.  Additionally, I think this will limit the potential effectiveness of wellness initiatives down the road.

Not following me on why this may hamper wellness initiatives?  When trying to motivate people to live healthier lifestyles, companies usually focus on the following measurements as a basis for how healthy a person is:

1.  Blood Pressure
2.  Body Mass Index (BMI)
3.  Blood Sugar/Glucose
4.  Cholesterol
5.  Resting Heart Rate

With that in mind, how many of these factors do you think might ultimately prove to have genetic predisposition based on your family history?  4 out of 5?

These are the measurements that any wellness incentive program would hold employees accountable by.  Whether you use the carrot (rebates on employee contributions for good scores) or the stick (charging employees with poor scores and no efforts to improve), the DNA bill will likely ultimately limit your ability to economically motivate your employees to live healthier lifestyles.

If I have high blood pressure and there's a test that shows I am genetically predisposed to that condition, you won't be able to use the carrot or the stick.  It would likely be discriminatory under the law.

Even if the employee is eating 4 Grand Slams at Denny's a day.   File it under the Law of Unintended Consequences...


HR Jobs From Hell - The LOA Administrator

By now, readers of the Capitalist know that I am a HR Generalist, meaning I do it all - recruit, employee relations, benefits, performance management, etc.   I'm also a firm believer that Generalist roles span the globe of HR titles - Generalists can be found at the Rep/individual contributor, manager, director and VP levels.

One of the things that is cool about being a HR Generalist is the variety - if you're sick of doing one Dirtyjobsthing, you just need to wait about 20 minutes, because you'll get a call shifting your priorities to another area as a routine course of business.

Some people call it chaos, I call it variety...

So, for me, a HR job from hell is one that includes no variety, and resides in an area of the HR practice where little joy is found.  Here's my first HR Job from Hell - the corporate Leave of Absence Administrator.

First up, let me say that me tagging the LOA Administrator as a job from hell has nothing to do with the people in the job, but instead has everything to do with what these folks have to put up with on a daily basis.  As luck would have it, HR Wench is currently in the job market, and recently phone screened for an LOA Administrator role:

"I had a phone screen yesterday that went ok. It was for the Leave of Absence Specialist. Get this: the organization has 15,000 employees. Guess how many NEW leave of absence cases were processed last year? 4,400. That is almost a 1/3 of their workforce, yo! Geez. Anyhow the in person interviews aren't until a few weeks from now due to vacations. So, we'll see".

UGH.  That pretty much sums up why I would consider the LOA Administer role as a HR role from Dante's 9th circle.  Here's what you have to deal with in that role:

-Primary focus is interacting with folks going through very rough times.  For the right person, this would be a plus, as they could use their empathy to make a difference.  But a steady diet of this over years surely leads to burnout.

-Being the tough gal/guy regarding compliance.  Folks are going through rough times, and you're the one that has to hassle them about the FMLA certification forms even though that's the last thing on their mind.

-Deciding when to play hardball on fraud.  You have 4,000 applications for LOA, you're going to have some folks gaming the system.  You have to decide when to play hardball and go after it.  You see the 5-10% that game the system - how can you not become jaded after a year or two of that?

Let me be clear - if you are in the LOA Administrator role in your company - thank you.   You are taking multiple hits daily for the HR function as a whole, and you're likely doing it very well.  If you get burned out, I hope your company has a rotational program in place, because you have skills that are a valuable resource.

That being said - HR Wench - Don't do it!!


Will You Eventually Have a Heath Care Score Similar to Your Credit Score?....

Imagine a Health Care system that functioned like the consumer credit industry.  Scott Kornhauser has.  The CEO of Healthation thinks the system will ultimately deliver a personal health care score (like a credit FICO score) that drives what consumers pay for healthcare, complete with the ability to improve rtheir rating over time with the right behaviors/performance. 

That tidbit was part of the vision Kornhauser delivered in "Processing the New Business of Health CareCredit_score in a Retail Marketplace" at the World Heath Care Congress.  Kornhauser's bigger vision is that the retail transformation of the U.S. health care delivery system is going to demand real time claims adjudication.  To make real time claims adjudication a reality, Kornhauser sees a combination of indexes and other data points coming together to make the real time claims process work.

What the heck does that mean to a HR Pro?

In Kornhauser's vision, consumers will have the ability to opt in or out of sharing their data with various types of providers.  However, to get the best health care credit score possible, they would have to share a great deal of data and then have their overall health judged - via a numerical score that looks a lot like the FICO score that drives your personal access to credit.

Ready to tell Danny in Accounts Payable he has a health care credit score of 500 and will have to pay double what others do for healthcare?

Great!

Have a bad health care FICO score like Danny?  In Kornhauser's world, you'd probably pay more for medical premiums.  But like the credit FICO score, you could improve your health care credit score by demonstrating desired behaviors - like paying your bills on time (easy for Danny, right?) or losing weight to get your BMI score within an acceptable range (harder for Danny...).


Obesity Surgery and Notre Dame Football - While Insurers Don't Automatically Approve...

Every time I think of obesity surgery, I think of the risks - see this article about Notre Dame football coach Charlie Weiss, who almost died on the table...

I took in a session at the World Health Care Congress led by James Roosevelt, the CEO of the Tufts Health Plan.  While the session focused on Tools for Consumer Engagement, Roosevelt focused on the Tufts strategy for Obesity/Bariatric Surgery.

Here's the definition of Obesity/Bariatric Surgery from Wikipedia:

"Although diet, exercise, behavior therapy and anti-obesity drugs are first-line treatment, these forms of medical therapyWeiss for severe obesity have limited short-term success and almost nonexistent long-term success.  Therefore, obesity surgery (or bariatric surgery for the professors reading this) has been a popular treatment in the war against obesity. Weight loss surgery generally results in greater weight loss than conventional treatment, and leads to improvements in quality of life and obesity related diseases such as hypertension and diabetes."

Several readers took exception to that definition, and I have to agree.  To say diet and exercise have non-existent long term success is clueless to say and the piece sound like it was written by a lobbying firm.

Roosevelt's rundown of the Tufts approach to Bariatric surgery was interesting in several ways.  First, Tufts gates access to the Bariatric program through BMI limits - including limits on the high side.  Have a BMI that goes over the acceptable threshold, and you can't get in the program due to the relative health of your body.  With the related stress that morbid obesity can cause, it's thought that those with super high BMI's were at the highest risk of not making it through the procedures.

Additionally, Tufts requires anyone entering the program to do a 6-month behavior modification program, where they get education and have to set and achieve two behavioral goals, such as to stop drinking soda.  So much for the Wikipedia definition from the Bariatric lobby... 

It's interesting stuff, as were the stats Roosevelt quoted regarding obesity surgery.  229 covered individuals have been accepted into the obesity surgery program, and at this point, 119 have graduated.

The education regarding alternatives to obesity surgery during the program must be working, as 17% of the graduates opt to forego or defer the obesity surgery they originally sought.

Estimated lifetime savings to the plan according to Roosevelt - 4 Million, or over 17K for each covered individual who's opted into the plan.


Smoke 'Em If You Got 'Em - German Company Fires Non-Smokers....

Has there ever been a harder transformation in societal expectations than the one that has occurred in the last 30 years regarding smoking?  I was raised in a family of smokers, and in the 70's and 80's, as a kid, it really never occurred to me that the whole habit was dangerous.  In a weird twist, it also never occurred to me that I should smoke. 

I hear I beat the odds...

Then, society got cracking and made all who smoke a little uncomfortable.  Don't smoke here, here orLeary here, and just so you got the message, here's a fishbowl to smoke in at the airport with your friends.

Of course, the whole thing has been good for our health care plans.  Fewer people smoking is good for what ails your PPO.  I'm channeling John Lennon when I say "imagine" if the U.S. made the same shift with Crisco.  Now that would really help the PPO trendline.

Of course, smoking is now seemingly uncool in the U.S.  Other countries however, like Germany, would like to thank you for smoking:

"The owner of a small company in Germany fired three workers because they were not smokers. It seems that their boss (evidently a smoker himself) felt that they were “disturbing the peace” in the workplace by being vocal about their smoking colleagues.

I can’t be bothered with trouble-makers,” said the boss. “We’re on the phone all the time and it’s just easier to work while smoking. Everyone picks on smokers these days. It’s time for revenge. I’m only going to hire smokers from now on.”

Of course, being anti-smoking doesn't fall in a protected class.   Here's my ridiculous list of other things that are easier while smoking:

1.  Filling out a health history at your local doctor's office.
2.  Helping your son bat during a father/son baseball game.
3.  Engaging a fire extinguisher.
4.  Typing a Blackberry message while driving, and smoking...

Hat Tip to Andrew Scott-Holman, keeper of the best blog in Kiwi-land....


Superbad Graph - "Total Odds of Dying, Any Cause: 1 in 1"...

Sometimes you run across a graphic that says it all - and this one (pictured below) from the WSJ journal does just that. 

We're all going to that "big records retention facility" in the sky at some point.

Want to make sure you have the longest period possible before your "records" go to deep storage?  Then take Bob Coffield's advice on the Health Care Law Blog and do the following:

"the graphic highlights advice from my dad, a retired physician in West Virginia, who always warns us of such risks. He says, "eat better, eat less, take small bites, drive defensively with two hands on the wheel, don't climb ladders and be careful with guns." Looking at the graph if we listened to this advice we would take care of most of the larger circles"

Good advice.  But what about death from hot weather? (odds of croaking from that - 1 in 13,000) 

I gotta get out of the South.  I don't see cold weather on the chart....

Death_chart_3   


Update - The Likelihood of You Being Forced to Provide Sick Time (in addition to PTO) in 2009 Just Increased...

Back in December, I riffed about the proposed Healthy Families Act (HFA), which would require employers with more than 15 employees to offer full-time employees seven days of paid sick leave.  The HFA would also mandate the sick time could be used for the employee's illness or to care for a child/parent/spouse/individual related by blood/domestic partner.   Here's some commentary on the merits of the bill....

UPDATE - The District of Columbia just passed something called the Accrued Safe and Sick Leave Act.  That can't be a good precursor to what might happen with the HFA.  Details from the Washington Post:

"The D.C. Council voted unanimously yesterday to make Washington the second city in theSick_baby country to require employers to grant their workers paid sick leave, but not before council members added several amendments that business leaders applauded and labor leaders said significantly weakened the legislation.

Under the Accrued Sick and Safe Leave Act, full-time employees at businesses with 100 or more workers will get seven days of paid leave, and employees at businesses with 24 or fewer workers will get three days.

Advocates say the legislation could affect 200,000 workers who don't have paid sick leave, but an amendment will require new workers to wait for the benefit. That measure will require an employee to be on the job for 12 months before becoming eligible for sick leave."

As far as the HFA, it's a broad bill that is likely to get a lot of traction in 2008/2009, if Congress continues to be controlled by the Democrats and the White House goes "blue state" as well. 

Here's the catch and why more government isn't always the best solution - the HFA as currently written, would also prohibit employers from eliminating existing leave coverage in order to comply with the Act.  That can get complicated.  Early readings suggest that if you are an employer trying to do the right thing, by offering a Paid Time Off (PTO) plan, you couldn't adjust the total number of PTO days, to reflect the legal requirement, for a stand-alone sick-time policy.   You would have to simply add the seven to what you currently offer to be in compliance.  For those of us offering a great benefit, that's crazy talk...

Here's hoping someone gets to the bill's sponsors and explains that if an employer is already offering 3 weeks of PTO to new employees, they're taking care of people.   Otherwise, expect companies to start breaking out their PTO policies into vacation/sick designations, if it looks like the bill will pass. 


42% of Tampa Bus Drivers Have Signed Up for Intermittent Leave..(!)

WOW.  It's been a few years since I supported a big consumer call center as part of my practice, so I had really forgotten about the pain that Intermittent Leave under FMLA can cause employers. 

The desire for maximum flexibility and at times, the avoidance of accountability, can cause Intermittent Leave to spread like a virus through an operating unit of a company.

For me, I thought bad news in this area would be about 3-4% of all employees in a division or company being approved for Intermittent Leave (10-12 employees in a call center of 300 would cause a big impact to scheduling, etc.).

But 42% of all employees?  You're kidding me, right?  Apparently not - from the Tampa Tribune:

"...Case in point is HARTline, the county's(Tampa metro) public transit service. Forty-twoRalphkramden percent of the bus drivers have signed up for a benefit the federal law calls "unscheduled intermittent leave." Many of them are using the law to extend weekends and go home "sick" to avoid unwanted assignments.

The law designed to cost nothing is costing HARTline and other employers many millions of dollars. The family leave act was intended to cost little or nothing while providing 12 weeks of job security to help workers through challenges (sic) times - such as bringing home a new baby, recovering from illness, or helping an incapacitated relative.

Some workers, including many HARTline drivers, have discovered that minor ailments also qualify, such as back pain and headaches. A one-time doctor's certification can give a worker a perpetual excuse for going home early, sleeping late, or not showing up at all.

Lawmakers were wrong in thinking that two features would minimize employee abuse and employer expense: One, the worker on leave under the act gets no pay and thus has no incentive to malinger, and two, the law applies only to organizations with 50 or more workers, which seems to be ample manpower to make up lost productivity."

But employers like the bus agency can't make up in the afternoon for a bus that doesn't run in the morning. In many businesses, schedules must be kept.

To keep its buses on time, HARTline is spending $2 million a year on overtime, an agency spokesman says, and 39 percent of that cost is attributed to FMLA absences."

42% of all employees.  Maybe it would be easier for that HR Team to certify the people who don't need intermittent leave....

Ralph Kramden would never approve...


HR Press Releases Gone Bad - Wal-Mart Takes Credit for Universal Heathcare and the Internet...

I'm not a Wal-Mart basher.  I shop there, and I'm not bothered by the big box store.   

But I'm glad I don't have to recruit for associates at the store level, because that would stink.  NotWalmart2 because they don't have good candidates coming through, but they have NO TOOLS to close them.  Comp is middling at best, customers are irritable about 90% of the time, and when you walk out the doors after your shift, you have to do that crosswalk dance where you try not to get run over as the Camry with the tunes turned up decides whether to gun it or be a nice guy 5 feet from the door...

But I digress...

The biggest issues impacting Wal-Mart's ability to recruit are Comp and Benefits.  Since I don't have data on the Comp side, let's look at Benefits.  Ever since that nasty memo came out, Wal-Mart's been on a PR mission to say things are improving.  That's a good thing.  But how good are things really?

Here's some data from a recent press release from Wal-Mart touting the fact that 92.7% of their associates have health care coverage:

"Associates surveyed cited the following sources for their health care coverage:

  • 50.2 percent – Wal-Mart plan;
  • 22.3 percent – Spouse;
  • 7.3 percent – Uninsured;
  • 4.3 percent – Medicare;
  • 4.2 percent – Parents, school or college;
  • 3.2 percent – Other/previous employer;
  • 2.4 percent – Individual policy;
  • 2.3 percent – VA or military;
  • 1.9 percent – Medicaid;
  • 1.2 percent – State program other than Medicaid; and
  • 0.7 percent – Another source than those listed above.

Total: 100 percent"

So they have health care coverage.  But about half don't get it from Wal-Mart.  Oh, NOW I get it...

Hat tip to John Hollon on this one.  I had the press release in my inbox, then he had something up two hours later.  That's fast coverage I can't match.  But I agree with his analysis - the title to the press release, which touts 92.7 coverage, is opportunistic at best. 

That kind of stuff gives spin a bad name.  I think Wal-Mart's better than this. 


Pharma Rep Playbook - 4 Minutes with Doctors = 52% Jump in Scripts Written...

I want all of our employees to have the medical care they need.  Let's start there before anyone brands me as a fiscal hawk looking at numbers rather than employee well-being...

If there's one area of Medical care that drives me crazy, it's got to be big Pharma vs. doctors, patientsLevitra, and yes, your local company medical plan. 

Big Pharma gets paid off of blockbuster drugs that they hold exclusive rights to.  That part of the system I get, since there are development costs tied to the R&D effort.  It's the repackaging of brand name drugs, once generics are available, that drives me crazy.  Hey, why take that generic every day?  We've just revamped the brand name equivalent with enough potency to last 5 days.   Uh, yeah... It'll cost your medical plan $1,000 more per year, but who cares?  Your employee contribution is the same regardless.

In case you needed more examples of the power of the Pharmaceutical Rep over most doctors, consider this article in a recent BusinessWeek entitled "Just Say No to Drug Reps":

"Dr. Adriane Ugh-Beman wishes more doctors would greet marketing pitches from drug companies with skepticism. So she is taking her message to medical schools. An associate professor of physiology and biophysics at Georgetown University, she has spent the past six months lecturing med students at Georgetown and neighboring schools on how to resist sales reps' overtures, such as doling out free drug samples to physicians and bringing lunches for office staff.

Often, the audience starts out belligerent, Ugh-Beman says, protesting that they're "too smart to be bought by a slice of pizza." But that changes when "we correct them with the numbers," she says. A doctor who spends just one minute with a sales rep typically ends up prescribing 16% more of that rep's product than he or she was prescribing before. And a four-minute encounter is likely to prompt a 52% jump in prescriptions, says Ugh-Beman."

I didn't dig around on the net for the white-paper behind Ugh-Berman's claims, but I am assuming if it made BW, it's legit research.

Let's assume programs like this can prepare doctors for the drug rep pushing product.  No sweat to Big Pharma, because they've got an even more powerful marketing tool.   It's called the demands of their patients after watching 20 Pharma ads every night during American Idol... What's a busy M.D supposed to do when someone brings him an ad for Paxil during a routine visit?  Prescribe (gasp) exercise? 

Every seen a Viagra ad?   All they have to do is create a market with a couple of Billion dollars worth of ads, and all of a sudden the pressure is on to pick up the full tab for each new class of drugs that's introduced... 

Man, am I tired of scrambling for the remote during a basketball game on the weekend or during prime time when the Viagra ads come on (hello? kids are watching when these things run!).  But those guys throwing the football sure are accurate throwing it through that tire in the back yard...