MCN | Medical Consultants Network

The Power of a Second Look

Home / MCNTalk / Tag: Workplace Situations

Viewing items tagged:

Workplace Situations

The Money Traps in U.S. Health Care

I am continuously baffled when I experience the disconnect between the data and facts presented in this article, and the hue and cry by those many who defend our current health care system. Case in point: the data cited in this New York Times article. Make sure you click on the graphics and absorb the data. And if there are salient points missing that would reveal flaws in the article or this comment, please add a comment.

As a consumer, provider and employer – it is obvious that the return on investment in our health care system pales relative to our friends in Canada, France, Germany and Britain. Only the latter of these four to my knowledge has a system of government-employed physicians. The others have systems of government pricing controls for the private sector providers.

The annual inflation that we experience in health care is unsustainable and puts the US at a competitive disadvantage internationally. It is a major drag on employment as many employers focus in part on rising benefits cost as a reason to not hire more positions. And it is obvious that money that might go in the pockets of employees in the form of raises, or consumers in the form of lower costs, are going into the rising costs of health care premiums for employers.

That many who defend the current system are one pink slip away from no employer coverage, and that few could afford to pay the cost of a private policy, seems to escape the minds or vision of many.

So merrily we march forward, with persistent demonization of those who would dare point out that this problem is not going away.

There are many fine examples of systems that fundamentally work in terms of care delivery, quality of care, health outcomes, and cost of care. Adopting any will entail trade-offs in terms of quantity and access, but on balance would be a marked improvement over our very sick system. Read more…

10 Arrested in $1 Billion Disability Scheme

I suppose it’s events like the fraud described in this New York Times article that keep us in business – the business of conducting medical evaluations on disability claims to ensure claimants are treated appropriately. But it’s hardly an event we’re celebrating at MCN: the cost of this type of fraud is staggering. From the complaint:

“And based [upon] my analysis of the data, including but not limited to the percentage of L.I.R.R. applicants handled by the three doctors discussed in this complaint and actual disability payouts to date, I further estimate that the fraudulent scheme could cause the R.R.B. to pay unwarranted occupational disability benefits exceeding $1 billion dollars if disbursed in full.”

The disability benefits are only part of the cost. The article also notes, “The doctors were paid — often in cash — between $800 to $1,200 for each fake assessment and narrative, in addition to the millions of dollars in health insurance payments they received for unnecessary medical treatments and fees for preparing false medical records to support the disability claims, the complaint said.”

Widespread fraud such as this are compounded by enormous opportunity costs in wasted physician time, increased insurance rates,  and other costs society absorbs one way or another. As the author notes, “The charges involving the railroad come at a time when public workers’ unions across the country have faced heavy criticism for negotiating pension obligations that have led many government agencies to slash services and lay off teachers, police officers and other workers.” Read more…

Companies Get Tougher with Employees Who Smoke

Smoking costs the U. S. more than $193 billion a year according to the Centers for Disease Control and Prevention, per this Bloomberg Businessweek article.  For employers, a smoker is 18 percent more expensive than a nonsmoker, says Cathy Tripp, a consultant at Aon Hewitt.

That cost gap likely will widen beginning in 2018 when, under a provision of health reform legislation passed last year, companies with health plans that spend way more than average will have to pay an additional federal tax. That may push some to reduce employee coverage. “Employers have two choices: cut benefits or cut the trend” of rising medical costs to avoid the levy, Tripp says. “It has made all of them a lot bossier when it comes to employee lifestyle choices.”

Health-care companies have been among the most active at tackling smoking. The Cleveland Clinic banned the use of tobacco in 2005 and stopped hiring smokers two years later. Job candidates, including doctors, must have their blood tested for nicotine. Says Toby Cosgrove, chief executive officer of the clinic network: “If we want to be a model of health care, then we as an organization need to show our patients what a healthy lifestyle means.” Read more…

Most violent job in Washington? Nurse’s aide

The most violent job in Washington state isn’t being a police officer or a security guard. It’s working as a nurse’s aide.

Seattle public radio station KUOW-FM made that finding as part of an investigative series on workplace safety airing this week, as noted in this Seattle Times article. The station found that violence strikes health care workers in Washington at six times the state average, and frontline caregivers in emergency rooms and psychiatric wards get assaulted even more than that.

The single most violent workplace in the state is at Western State Hospital, where criminal defendants are taken when they are found incompetent to stand trial. Workers at psychiatric hospitals are assaulted on the job more often than anybody else – 60 times more than the average worker in Washington state.

How many is that? James Robinson, president of the union for many workers at Western State Hospital, says there were 313 assaults there last year – a drop of nearly 30 percent in assaults per patient-care hour, though union officials also note that many incidents go unreported because of the time required to fill out paperwork about assaults.

Nan Yragui, a psychologist with the Department of Labor and Industries, studies workplace violence. She said budget cuts to the health-care safety net have made emergency rooms nationwide more violence-prone.

“When patients can’t get services they need, they end up going to the emergency department,” she said. “So more of the severely mentally ill are going to the emergency department and then that makes that group of nurses more at risk because they’re getting more exposure.” Read more…

As Health Costs Soar, G.O.P. and Insurers Differ on Cause

As Congress continues to debate the new health care law, health insurance costs are still rising, particularly for small businesses, as noted in this New York Times article. As Congress continues to debate the new health care law, health insurance costs are still rising, particularly for small businesses. Republicans are seizing on the trend as evidence that the new law includes expensive features that are driving up premiums. But the insurance industry says premiums are rising primarily because of the underlying cost of care and a growing demand for it.

As an example:

  • In New Hampshire, more than 90 percent of private employers have fewer than 50 employees.
  • This year, groups of more than 20 workers have been experiencing premium increases of around 20 percent.
  • Smaller groups are seeing increases of 40 percent to 60 percent or more.

Some insurance industry lobbyists say the new federal health care law is driving up premiums. But Vincent Capozzi, senior vice president for sales and customer service at Harvard Pilgrim, said that:

  • Only one percentage point of the increases here was attributable to the federal law, mainly its requirement for free coverage of preventive services.
  • Another percentage point results from new state laws requiring coverage of hearing aids and certain treatments for autism, Mr. Capozzi said.

Most of the remainder, he said, reflects increases in the use and cost of medical care by small-group customers, with adjustments for demographic characteristics like age. Read more…

The Rigors of Treating the Patient in Chief

No patient gets closer medical attention than the president of the United States. Wherever he goes, a doctor, nurse or paramedic trails a few footsteps behind, ready for any medical need. It is the ultimate in concierge medicine.

For the president’s doctor, it is a little different, as detailed in this New York Times article. The job of White House physician combines professional responsibility with the glamour and trappings of proximity to history. The White House medical office is only a few steps from the Oval Office, and the doctor has automatic access to the president’s living quarters.

A medical staff member stays overnight in the White House. When the president travels, the doctor rides in a limousine near the head of the motorcade. Jet lag and stress make the job one of near-constant fatigue, shadowed by dread of assassination attempts.

Now a recent holder of the job, Dr. Connie Mariano, has written an account of her nine-year tenure under three presidents, Bill Clinton and both George Bushes. The book, The White House Doctor: My Patients Were Presidents — a Memoir, is one of just a handful of autobiographical accounts by presidential physicians.

Dr. Mariano’s story is an inspiring one. The daughter of a Navy steward, she was the first Filipino-American of either sex to rise to rear admiral, and the first woman in the military to become the White House physician. Read more…

Sex, Lies and Videotape – and the Internet


We hesitated a bit before posting this. It is not often that we can see a combination in one event that includes the perils of the Internet, workers’ compensation, dishonesty, and perhaps human greed combined with ignorance.

We find these cases interesting on a social level. Typically the amount of money misappropriated in cases like this of probable malingering is in the tens or hundreds of thousands; an amount that would result in criminal charges if a person walked into their employer or someones else’s house and stole it. But in the case of clear and convincing evidence that an individual is faking injury or extent of injury, denial of subsequent benefits or as in this case, payback of prior payments seems more common. What is the difference between this situation and theft and why is prosecution not the norm?

While the majority of claims are valid and respond to appropriate treatment and rehabilitation, cases of fraud and malingering when they occur are costly and troublesome, and underscore at times larger social issues. This case also underscores the value of searching for information about claimants that are not under their direct control in the medical context. Historically this involved surveillance, but as this case demonstrates, the Internet – typically social networking sites, often provides a wealth of intentional or unintentional self-disclosure.

Repealing Health Care Reform Is the Real Job Killer

We have been watching the pundits and partisans discuss, argue and scream about health care reform. What continues to baffle us is the ability of a number of big lies to dominate discussion, and for the topic to have become a proxy on Obama. Here is a very interesting column in the New York Times on the subject.  

The topic is too complex to dissect here but let’s address just one argument raised against change and cited by the new speaker Boehner: That health care reform is a job killer. From a recent interview on NBC:

You have to understand that in my opinion Obamacare is the biggest job killer we have in America today. It’s a weight over every employer that we have. Thereby requiring them to hold back their willingness to hire people. Secondly, I believe that Obamacare will ruin the best health care delivery system in the world. And then thirdly, I think it’ll bankrupt our country. On September 24th, when we rolled out our Pledge to America, we made clear that we wanted to repeal Obamacare. We are going to do what we said we were going to do.  Read more…

Let’s deal with some real on-the-ground experience – our own at MCN. When the founder of MCN first bought his own insurance as an individual physician in 1982, he does not remember it. This suggests that the purchase was a non-event, like insuring a car or a home.

Fast forward to 2010 and the company is annually faced with double digit increases for the same level of coverage, not unlike other companies. And the company benefits from group rates, unlike individuals who routinely face much higher increases, largely because the pools they are part of are skewed towards the sicker and higher care consumers.

Employees who leave the company are faced with COBRA expenses that are considerable and burdensome, if they choose to be covered and do not have other options. We also find ourselves increasingly cautious about adding staff. Obviously hiring decisions are complex, but the tangible cost of insurance is one further barrier to adding staff.

From a common sense and policy standpoint, we have always wondered why it is the business of an employer to provide health care for employees. It is not the employer’s job to feed, house or educated the children of employees. That is what a pay check is for. All of the above are necessities, but only one seems to be an employer cost. If everyone was employed and covered, I suppose it would be a non-issue, but that is not the case. Those employers who provide health coverage need to compete against those who do not, and this is not a fair competition in many cases, especially when in the same sector such as hospitality.

We would prefer to see in increase in taxes applicable to ALL businesses and employees — including small businesses — contributing to a system that covers all. The ability to have and pay for health care is not an option. Those who by virtue of true poverty or stupidity do not have access to coverage do not get denied care. The cost is shifted to the rest of us. A system depending upon involuntary cost shifting is not charity, it is inefficient and unfair to all.

 
Those who truly maintain their views that the Government has no place in health care I assume will be willing to burn their VA Health and Medicare cards or disavow those systems when and if they become eligible. A significant portion of the US Health spend is already government based, so it is a bit late to keep government out of it. Government involvement is not radical or unproven, but rather is the mode or some variant thereof, in many of the most robust world economies, including Canada, Australia and Germany, among others.

A claim made by those who support job creation – who doesn’t? — is that entrepreneurship is good. How does this relate to health care reform, however? What is the likelihood that an individual will leave the comfort of a secure job with health coverage for the immediate financial uncertainty of their own business — and how is this impacted by the burden of providing individual health care for the entrepreneur’s family?

This very real uncertainty as much as any other reason is why the status quo (which is not really a status quo, but rather a relentlessly increasing and unsustainable burden) is why innovation and job creation are being killed.

And a core issue that no current proposals appear to meaningfully address is the continued increase of health as a portion of GDP (17.6% in 2009) and the absence of normal market forces that come into play with most purchases. By this I refer to the buyer and the consumer being de-linked.

Witness drug companies waiving copayments on expensive drugs that get charged to the carriers (from another article in the New York Times), and witness our own behaviors that rarely involves asking — when it comes to health — “how much is it?” and shopping for alternatives.

Imagine going shopping and filling your cart in a store with no prices, and you have US health-care today. The “free marketers” who make up the health care industry decry and condemn allowing the true buyers of care – insurance companies, employers and government — when these entities suggest that they may use their purchasing power to impact price and consumption.

Our current view of patients and doctors knowing what is ‘right” while staying blind, indifferent to, or directly benefiting from the cost paid by others is not working.

Rather than reflexively engage in partisan bickering on the topic, let’s look at the reality of what we are now seeing in our businesses and lives and those of our families and neighbors – as we review our options going forward. David M. Cutler, Otto Eckstein Professor of Applied Economics, Harvard University, and a Senior Fellow at the Center for American Progress, notes that: “The imminent effort in the House of Representatives to repeal health care reform is a major step in the wrong direction if promoting economic recovery is job one.”

Who bears the responsibility for health and the cost of health?


I am troubled on many levels by themes in this article from The New York Times: The concept that individuals need to be incentivized with cash for taking care of themselves is perverse. Those who care about their health should need no incentive to take care of themselves on an ongoing basis. And the notion that employers must bear the burden of flagrantly poor health choices of their employees appears to underlie employers taking on the creation of incentives to change.

In the US, it is illegal to discriminate in hiring on the basis of a number of attributes, most of which are out of the control of the individual, such as age, gender and national origin. But employers discriminate regularly on the basis of past experience, academic standing and accomplishment, interviews, references and many other factors, some of which—but not all— may be under the direct control of the applicant, or at least flow from choices made at the application process or over time. Employers make no apology for such discrimination and applicants expect to be measured on many qualities.

Is an employer well served who ignores or downplays choices of prospective employees that increase their health risks? Is there a correlation on work quality and employment costs that can be observed among employees who engage at the time of hiring in fewer risky health behaviors? And what is the actual success rate of employer incentives, “wellness” programs (the trendy word “wellness” itself is in dire need of its own rehab – “health” would suffice), in creating long term results and change?

What would be the impact of employers making hiring decisions in part based upon legal discriminators that are health related, such as smoking, physical fitness appropriate to age and other factors. We tell our children to get a good education to increase their chances of successful employment, and this is strong incentive for study. Were there similarly explicit conversations about the relative employability of individuals based upon their physical lifestyle choices, might it have a positive social impact on the health of society overall?

Our declining health status and dramatic increases in chronic diseases relating to lifestyle—such as Type 2 diabetes—is creating billions in expense and much human tragedy. Society’s conversation on who bears the responsibility for health and the cost of health is one that must continue.