President Bush signed the ADA Amendments Act into law last week without a whole lot of fanfare.  Did you miss it?

In recent years, the ADA -- the world's first human rights law for people with disabilities -- has been dramatically narrowed in the courts, leaving citizens with epilepsy, diabetes, mental illness, HIV-AIDS and other disabilities unprotected from discrimination. The ADA Amendments Act clarifies the intent of Congress and reverses the "judicial activism" that has resulted in more than 95% of employment-related ADA cases being dismissed on summary judgment.

More on the changes to the ADA from the Los Angeles Times:

Millions of Americans with diseases or impairments such as diabetes, epilepsy, heart disease, cancer and carpal tunnel syndrome will be protected from job discrimination under a new disability rights measure set to become law this week.

The measure overturns a series of Supreme Court rulings that sharply limited who was covered by the Americans With Disabilities Act. When it was first passed in 1990, Congress said the anti-discrimination law protected anyone with a "physical or mental impairment" that "substantially limits" them.

But the high court interpreted the law to apply only to people who were truly disabled, not to those with common impairments such as a hearing loss or a medical condition that can be treated.

In another widely cited case, the court ruled in 2002 that an auto worker with carpal tunnel syndrome did not have a disability, even though she could no longer perform the repetitive tasks on the assembly line.

Here's the crazy thing.  The U.S Chamber of Commerce, the arm of big and small business alike, backed the bill, which in turn led to quick passage of the bill:

"Michael J. Eastman, a lawyer for the Chamber of Commerce, agreed that the courts had excluded too many people. "This means many more people will be deemed to have a disability, and some employers are nervous about that."

Nancy M. Zirkin, a longtime civil rights advocate, said it was remarkable that Republicans and Democrats came together to expand the reach of the disability rights law and that the resulting bill won unanimous approval in both houses. "It's a stunning achievement in this partisan atmosphere," she said.

I'm proud of the business community for getting behind this bill.  After all, the measure will not mean people who can show they have a disability will always win a discrimination claim. They still must show they are qualified to do the job. If an employee is deemed to have a disability, an employer must seek a "reasonable accommodation" that would permit him to work.  Nothing's changed in that regard.  It's all stuff most of us would do for any employee, covered by the ADA or not.

Of course, broadening the act does open up your HR shop to a broader set of ADA-related claims, most of them occuring/filed after you've taken an employment action, most of the time for good reasons unrelated to a disabilty.

That's OK - just keep doing the right thing for the employees and the business alike, and everything else takes care of itself.

HELP WANTED - (4 Positions Available)

Progressive blogging organization is looking for witty and sometimes jaded professionals, in the Benefits/Wellness sector, to blog on a weekly basis, about their life as part of the machine.  New blog, as yet unnamed, to be launched to provide perspective of people conducting benefits management, wellness and associated activities in the field.

Requirements:

-A working position in benefits and wellness industries, focused on acquiring, aligning and maximizing benefits/wellness in your company, or on behalf of clients.

-Writing skills, plus the actual willingness to write and blog on a weekly basis.

-Personality and the ability to merge other resources and pop culture in writing, all in an effort to make it digestible for the commoners (that's me..)

-Ability to tell the world who you are while you are blogging - name, what you do, and where you do it.

-Skin thicker than that of a donkey, for the lashings you'll receive in the comments section.

Successful Applicants Will Come From the Following Areas:

-Inside companies who purchase benefits, inside vendors, inside brokers..
-Medical Plan Design and Utilization
-Consumer-Driven Healthcare
-Rx/Prescription Design and Utilization
-Legal Issues in Benefits Administration
-National Trending
-The World of being a Benefits Broker
-Wellness
-Retirement Plans
-Alternative Work Benefits (telecommuting, job-sharing, etc.)
-Voluntary Benefits

What You Get in Return:

-Membership in an exclusive, yet opinionated team that will undoubtedly make the dysfunction in your extended family look like an episode of "Little House on the Prairie".

-The ability to blog and share your thoughts without having to start your own site.

-Exposure of your ideas and brand in the online property of a cool blog that will have good initial traction.  If you're a current blogger, you'll also get enhanced exposure for your blog.

-A projected stipend per month that will fall somewhere between a night out at Denny's and paying your cable bill.

-The warm feeling of giving back to your profession with the professional distance that only digital media can provide.

Sound like you?  Interested in hearing more?  To apply, please confirm your interest in the comments section or email the Capitalist (that's me) at hrcapitalist@gmail.com.

Weight reduction surgery has long been controversial for employers, with healthcare insurers putting up multiple behavioral goals and other gates before providing access to extreme solutions like bariatric surgery to covered individuals.

Is that the right or wrong approach?  I've never had enough information to really have an opinion.

Here's the first research I've ever seen as a HR pro that talks about expected payback to the extreme weight loss procedures.  Follow me after the snippet from the article to talk about what it means for you and me as advocates of healthcare and retention.

From information provided in the Wall Street Journal:

"Health insurers can offset the cost of laparoscopic or traditional bariatric surgery as a weight-loss treatment for obese patients within two to four years as a result of savings on other medical costs, according to a study published this month in the American Journal of Managed Care, the Wall Street Journal reports.

For the study, Pierre-Yves Crémieux, a health economist and principal at Analysis Group, and colleagues analyzed health insurance claims data for 2003 through 2005 for 3,651 severely obese patients who underwent either laparoscopic or traditional bariatric surgery. The patients in large part were female, with an average age of 44; more than one-third of the patients had high blood pressure, and many of them had high cholesterol, diabetes and other health problems.

Researchers matched each patient based on age, gender, geography, health status and baseline costs with a patient who did not undergo either of the surgeries. Researchers tracked claims data for the patients who underwent either of the surgeries for six months of pre-surgical examination and care, the procedures themselves, and about 18 months of post-surgical care; tracked claims data for post-surgical care for some patients for as long as five years; and tracked claims data for the matched patients over the same period.

According to the study, health insurers that covered patients who underwent laparoscopic surgery, which has an average cost of $17,000, offset the cost in about 25 months. Health insurers that covered patients who underwent traditional bariatric surgery, which has an average cost of $26,000, offset the cost in about 49 months. Crémieux said, "The most cost-effective treatment for obesity is bariatric surgery," adding, "If you do that, within two to four years, you will get your money back." In addition, he said, "We have identified the break-even point for insurers."

The 2-4 year break even point is important to me, because it allows me to get my head around payback.  The thing that's confusing to me is that there's a lot of other research that talks about the failure rate of the surgery - meaning employees can have the surgery or procedure, then not do the things they need to do to keep the weight off.  I haven't read the study in full, so I also wonder if the cost of the medical complications so often written about is reflected here.

Still, the concept of payback is good to have.  We're talking about an investment in an employee to help them improve their life, much like tuition aid.  Many tuition aid programs mandate a payback agreement that an employee stay with the company for a year or two once the company has made the investment.

Now that we have payback numbers and companies have to bear the cost of this surgery, I wish companies could short circuit the red tape by allowing the employee to say, "I want to be at this company long term, and I'm willing to sign a payback agreement making that pledge as a part of this optional proceedure".

I know there are a million legal reasons why you can't do this, and I'm not looking to tie payback to other big ticket items. Medical necessity still rules the day on that end, but it seems like the big question with this one is medical necessity and payback.  That said, my take is that a lot of employees who want the optional surgery would be willing to fast track the process and would accept a payback agreement of 2 years for improved access.

If you're an HR executive at any level with budgeting responsibilities, you've dealt with the pleasure of the Benefit Squeeze. 

What's the Benefit Squeeze?  It's the magical number that's attributed to the budget model for all your benefit and payroll tax costs.  In the golden days, the number was pretty fat and you never saw a lot of pressure on the number.  Unfortunately, with healthcare costs up 200% in the last decade, the number takes on a lot more importance.

So, the game goes like this - if you're fully insured, you have a good idea of what your entire benefit load is.  However, if you're self insured, there's some variability in the model that you want to protect yourself against.  Unfortunately, no one else in the organization cares about your needs.  They just need the number you give them to be two things - skinny and predictable. 

The U.S. Bureau of Labor Statistics recently gave some quality stats across the public and private sectors that can help.  The average cost to employers for employee pay and benefits was $28.48 per employee hour worked in June, the U.S. Bureau of Labor Statistics said today.

"The cost of wages and salaries averaged $19.85 an hour, or nearly 70 percent of employers’ total compensation costs.  As usual, there was a pay and benefits gap between average compensation costs in the public and private sectors.

Total compensation costs to employers in the private sector averaged $26.78 per work hour, compared with $38.30 an hour for state and local government workers. The report did not include federal employee compensation costs.  The cost of wages and salaries averaged $18.92 per employee hour in the private sector, versus $25.19 for state and local employees. The cost of employee benefits averaged $7.86 an hour in the private sector, compared to $13.11 an hour on the public side.

Overall, the 30 percent of total payroll costs that went to employee benefits broke down this way:

•$2.39 per employee hour worked for health, life and disability insurance.

•$2.25 an hour for legally required benefits, including Social Security, Medicare, unemployment insurance, and workers’ compensation.

•$1.99 an hour for discretionary paid leave benefits, including vacations, holidays, sick leave, and personal leave.

•$1.25 an hour for employee retirement and savings plans.

•76 cents an hour for supplemental pay, such as shift differentials, premium pay for overtime and weekend or holiday work."

Helpful stats to be sure.  At first, the total cost for health insurance seems light, until you do the multiple and see that the numbers mean a budget of around $5,000 per employee - not a bad figure.

So, take a look and use this in your budgeting sessions to justify your benefit spend number.  Just don't be alarmed when you take a 10% haircut to your budget as an across the board treatment to get to the earnings target.  It's all part of the budgeting process...

If running a self-insured medical plan has taught me anything, it's that I am glad I have access to the network discounts for routine and non-routinue medical procedures provided to me by our medical provider (think Blue Cross, Aetna, Cigna, etc.).  Depending on your medical provider's market share, it's not uncommon for insurance providers to have agreements with doctors that provide up to a 50% discount from the sticker price provided by M.D.'s and surgeons.

God help those without insurance or access to government programs.  I'm guessing those folks are the ones who get stuck with the full retail sticker price for an operation, then spend the rest of their lives trying to dig out of the resulting debt since they held 100% responsibility for payment.

Here's another ugly angle to the current healthcare system.  A nasty process called Balance Billing.  A description from BusinessWeek:

"As health-care costs continue to soar, millions of confused consumers are paying medical bills they don't actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient. Uncertain and fearing the calls of a debt collector, the patient pays up.

Most consumers don't realize it, but this common practice, known as balance billing, often is illegal. When doctors or hospitals think an insurer has reimbursed too little, state and federal laws generally bar the medical providers from pressuring patients to pay the difference. Instead, doctors and hospitals should be wrangling directly with insurers. Economists and patient advocates estimate that consumers pay $1 billion or more a year for which they're not responsible.

Yolanda Fil, a 59-year-old McDonald's (MCD) cashier in Maple Shade, N.J., got tangled up with balance billing after gall bladder surgery in 2005. She and her husband, Leon, a retired state transportation worker, have coverage through Horizon Blue Cross Blue Shield of New Jersey. Horizon made payments on Fil's behalf to the hospital, surgeon, and anesthesiologist. Then, in 2006, Vanguard Anesthesia Associates billed Fil for an unpaid balance of $518. Soon, a collection agency hired by Vanguard started calling Fil once a week, she says. Although she thought her co-payment and insurance should have covered the surgery, Fil eventually paid the $518, plus a $20 transaction fee. "I didn't have any choice," she says. "They threatened me with bad credit."

Nice.  So the doctor's have signed the insurance provider's contract, which clearly states at what rates they'll be reimbursed for different procedures.  Then, in pure "let's go fishing" mode, they send out invoices that make it appear your employees are responsible for a greater amount that they paid at the time of the procedure via co-pay/deductible. 

Who gets blamed?  A combination of the insurance provider and the HR team, for obtaining a provider who couldn't give them cost certainty.  Especially troublesome is the fact that doctor's will often go after balance billing of less than $1,000 since they know the pay rate for these will be higher.  After all, if you're threatened with a $500 bill hurting your credit rating and don't have the time or knowledge to research it, many of us are apt to dig deep, pay the bill and move on.

That stinks.  Keep your eyes out for balance billing coming to an employee near you. (More below from CBS News, email subscribers click through for video).

Wellness in your company.  I'm trying to follow the topic in this space, but it's hard.  Here's a list of what I do and don't need in order to determine if wellness is something I can invest in as a HR Pro:

What I do need: Programs with demonstrated ROI, tools that can be implemented in a small company (under 500 employees) as well as a big one, a better understanding if I choose to invest, where I get the biggest bang for my buck, and probably most importantly, a legislative environment over the next ten years that allows me to wildly incent those who are doing the right things from a health/lifestyle standpoint.

What I don't need:  Wellness providers sending me another brochure to distribute, complete with a glossy picture of an apple on the front with the captions "Let's Eat Smart".   Please stop the madness.  Does anyone really believe that a company will help modify employee/family behavior by sending that out?  If fries are served with every meal at my house, can I really pull off the stir fry recipe?  Really?

Laurie over at Punk Rock HR commented on my article about investing in wellness in-house for companies with over 1,000 employees.  She's advocating markets and managing performance on a broad level, and I agree with most of the general thoughts (as well as Deb's at 8 hours and a lunch). I'm a skeptic of wellness (see my wellness category), but doing or investigating nothing is a bad idea.   

If you want a market-based approach and we retain the current system of companies being responsible for healthcare, you have to have broad ability to implement incentives/penalties (it's really semantics which you call it) for folks who respond to the call to live healthier lifestyles.  Of course, those penalties would have to dig into the family members who are covered to create the proper system of rewards.  See my past post on the CEO of Healthnation for a primer on what a market economy in healthcare would look like, complete with healthcare FICA score...

Is America ready for that?  I doubt it, and it's a shame, because the same factors that drive healthcare cost in a corporate environment are what would drive cost in a nationalized heathcare environment.

Those factors?  Behavior + Time.  Doesn't matter if it's Ford Motor or Uncle Sam administering the healthcare plan.  Treat everyone the same, and one things sure - no one's behavior will change as a result.

I'm increasingly becoming convinced that the best way to win the wellness game is to go "all-in" with on-site staff, etc.  That's bad news for small companies that can't afford those types of services. 

The situation with medical costs has now escalated to the point where it now makes sense to bring the doctor, or at least wellness folks who can do a variety of things, back on the campus of big companies.  Some previous studies have shown that especially when it comes to an on-site doctor to cut down on primary care costs, absenteeism, etc., you need at least 1,000 employees at a location to pull it off financially. 

A recent case study indicates the FTE count necessary for a big on-site wellness team might work for companies with far less than 1,000 employees - especially if they are primarily blue collar, manufacturing/production line environments with lots of worker's compensation risk. 

From CNN Heath:

"Lincoln Industries looks like a typical blue-collar plant: workers cutting, bending, plating and polishing steel for products such as motorcycle tailpipes and truck exhausts amid the din of machinery.

But the 565-employee Nebraska company is different.

Lincoln Industries has three full-time employees devoted to "wellness" and offers on-site massages and pre-shift stretching.Most unusual of all: The company requires all employees to undergo quarterly checkups measuring weight, body fat and flexibility. It also conducts annual blood, vision and hearing tests.

The company ranks workers on their fitness, from platinum, gold and silver down to "non-medal." To achieve platinum, they must reach fitness goals and be nonsmokers -- and the company offers smoking cessation classes.

For the company, the payoff is significantly lower health-care costs. The company pays less than $4,000 per employee, about half the regional average and a savings of more than $2 million. That makes the $400,000 Lincoln Industries spends each year on wellness a bargain.

The investment in "wellness" pays other dividends, according to Orme. He says fitter workers are more productive, have better morale and are safer. As evidence, he points to worker's compensation claims. Ongoing safety training and an increasingly fit work force have pushed worker's comp costs down from $500,000 five years ago to less than $10,000 so far this year."

In reading about this plant, I can't get an old Michael Keaton movie named "Gung Ho" out of my mind, where a Japanese company buys a plant and tries to get hard-core blue collar workers like George Wendt to pick up exercising before the start of their shift.

While the prospect of stretching Carl from the drill press team out before the start of his shift is a little daunting, I'd gladly get out of my comfort zone for a 50% reduction in medical costs.

I suspect you would as well. 

I've written a lot in the past about the continuing escalation of healthcare costs in the U.S. forcing companies into a corner, a corner which will force them to either penalize unheathly employees or reward healthy employees for their health metrics.

Whether you use the carrot or the stick will be up to you.  But employers are increasing their moves to link employee heathcare premiums to metrics like blood pressure, cholesterol, blood glucose, obesity, etc.

The state of Alabama recently annouced some changes that suggest you'll have your BMI memorized in 5 years.  From MSNBC....

"Alabama, pushed to second in national obesity rankings by deep-fried Southern favorites, is cracking down on state workers who are too fat. The state has given its 37,527 employees a year to start getting fit — or they’ll pay $25 a month for insurance that otherwise is free.

Alabama will be the first state to charge overweight state workers who don’t work on slimming down, while a handful of other states reward employees who adopt healthy behaviors. Alabama already charges workers who smoke — and has seen some success in getting them to quit — but now has turned its attention to a problem that plagues many in the Deep South: obesity.

The State Employees’ Insurance Board this week approved a plan to charge state workers starting in January 2010 if they don’t have free health screenings. If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enroll in a wellness program, or take steps on their own to improve their health. If they show progress in a follow-up screening, they won’t be charged. But if they don’t, they must pay starting in January 2011.

“It’s terrible,” said health department employee Chequla Motley. “Some people come into this world big.”  Computer technician Tim Colley already pays $24 a month for being a smoker and doesn’t like the idea of another charge.  “It’s too Big Brotherish,” he said.

The board will apply the obesity charge to anyone with a body mass index of 35 or higher who is not making progress. A person 5 feet 6 inches tall weighing 220 pounds, for example, would have a BMI of 35.5. A BMI of 30 is considered the threshold for obesity.  The board has not yet determined how much progress a person would have to show and is uncertain how many people might be affected because everyone could avoid the charge by working to lose weight."

Welcome to the brave new world.  I'm a proponent of rewarding employees who live healthy lifestyles that result in reduced risk.  Still, I wonder if $25 per month ($300 per year?) makes enough of a dent.  My take is that the psychological threshold for action is triple digits - $100 per month. 

Put the doughnut down.  Doughnuts are for closers people who exercise... Not for those who think the Wii Fit is a good exercise tool...

Before I get started on this post, let me do some self-disclosure.  I'm a relatively healthy (knock on wood) individual who is blessed with pretty good genetics when it comes to weight.  I come in at 6'2", 170 lbs., which rings me up a BMI of about 22.  All my health care metrics are in good shape (again, knock on wood)...

But, I work at it.  I run, on average, 4 times a week, and I don't eat much high fat or fried food.  Without  the exercise and diet habits, I probably track like some of my friends, which would probably put me in the neighborhood of 190 with a little pouch in the middle.  My family is like me, and physical activity is at the core of how we spend a lot of leisure time.  A healthy family diet is part of the deal too.

Personal situation aside, I'm sympathetic when I hear about people struggling with weight issues.  I'm never more sympathetic than when I read or hear about kids struggling with weight issues early in their lives.   That's why I had an interest in the recent New York Times article talking about the lack of insurance covering weight loss camp for kids. 

From the New York Times:

"There are nine million overweight or obese children in the United States. And although the prevalence of childhood obesity has tripled since 1980, there are few comprehensive or affordable programs to treat them. Summer weight loss camps are usually profit-making and can cost more than $1,000 a week. Most insurance does not cover that cost.

For Dr. Walter J. Pories, a well-known gastric bypass surgeon, the dearth of government and insurance financing for such comprehensive weight-loss programs is “the single most frustrating problem in dealing with childhood obesity.”

Several national groups are pressing for government financing or insurance reimbursement for more intensive weight loss treatment for children, including weight loss camps. In the meantime, many children mostly have to follow Tiffany King’s lead. She submitted a personal essay that was well written, sad and compelling. “If I could get on my knees and beg for this campership, I would, because I want to feel good about my life,” she wrote. “Sometimes, if I’m walking down the street, I can hear people talking about me and staring at me.”

I'm not the guy who's ordinarily going to run to the insurance industry's defense.  I get frustrated, just like my employees, when red tape holds up needed treatment.  But there's an obvious point the folks, who will shout out the need for weight loss camps, aren't sharing at the appropriate volume.

Here's the reality - A kid can go to weight loss camp, lose 10% of their body weight and pick up some great ideas how to live their lives with proper diet and exercise.  Unfortunately, if their parents are obese, sedentary or fond of fried foods, the kid generally won't keep the weight off.  The NYT was kind enough to balance the story out with the following:

"The big challenge comes later, when children resume their normal routines and confront the smorgasbord that is America — food in their own kitchens and at friends’ homes, fast-food restaurants and school cafeterias.

Dr. Pories, who also heads the Metabolic Institute at East Carolina University, found that children lost an average of about 8 percent of their body weight in a program he studied over three years; but two-thirds regained all or part of their weight.

Even Dr. Pories, who has been involved in promoting weight loss camp scholarships for underprivileged children in eastern North Carolina, says, “A two-thirds failure rate is not acceptable.”

It's all about the support system you are going back into.  If a kid has family and friends who don't exercise and eat healthy, there's no way the kid keeps the weight off.  To be fair, this is a story that transcends analysis from any single perspective.  There are cultural, socio-economic, educational and other issues at play.  The availability of weight loss camps is the least of the challenges. 

Weight loss camp for the kid isn't fixing the issue.  Perhaps weight loss camp for the family?

Some people imagine a world with no crime.  Others long to teach the world to sing in perfect harmony. 

Me? I'm wondering if we shouldn't be strapping Fred from logistics with the Sparkamatic 5000 across his head, to serve as an early warning system for mistakes.  Of course, to make sure everybody in the company doesn't expect one, we'll call it a trial.

From Scientific Amercian (it's on my coffee table, how about yours?):

"In recent years researchers have identified a region of the brain called the medial frontal cortex that plays a central role in detecting mistakes and responding to them. These frontal neurons become active whenever people or monkeys change their behavior after the kind of negative feedback or diminished reward that results from errors.

Much of our ability to learn from flubs, the latest studies show, stems from the actions of the neurotransmitter dopamine. In fact, genetic variations that affect dopamine signaling may help explain differences between people in the extent to which they learn from past goofs.

Meanwhile certain patterns of cerebral activity often foreshadow miscues, opening up the possibility of preventing blunders with portable devices that can detect error-prone brain states.

The brain contains neural machinery for recognizing errors, correcting them, and optimizing behavior."

Interesting stuff.  Of course, I've heard we need to be getting more kids interested in science, so maybe I should be sharing this with my kids, as well.  It's pretty cool to think that we might be wearing a device in a few years to help us prevent mistakes, based on what's going on with our brain chemistry.

I can hear the question now - "What are you?  A brain surgeon?"  "Well no, but I'm wearing a Blackberry on my hip that subscribes to the T-Mobile "Early Warning" service.  HR is doling out free subscriptions of the service, and they said I'd be perfect for the trial period."

What an honor.  Just don't think through the trial participant selection process too much.