For example, says Karsh, many millennials grew up with working parents, the privileges of after-school activities and clubs, and constant individual mentoring. In a work environment, this translates to a desire to be told what to do, to be monitored while doing it, and then to receive praise for doing everything successfully. While not every work environment is able to supply such a structure, for any number of good reasons, it’s important to remember that the desire for it is rooted in generational factors, not necessarily selfishness or weakness.
A solid compromise, offers Karsh, is to provide concrete explanations from the start, so that millennials always have a structure to return to when they desire it. At the same time, it is best practice to “ween them off structure,” for example, reminding them that a supervisor might not check in every day, and that this isn’t a bad sign. Often, he says, millennials respond well to direct communication. Of course, everyone is an individual no matter their generation, and over time, most new structures can be learned and put to effective use. Other best practices that have proved effective for millennials are future-focused credentials, real time conversations, and microlearning.
Employers that self-insured any group health plans in 2017, including health reimbursement arrangements (HRAs), are responsible for determining whether the annual PCORI fee applies to their plan. If so, use Form 720 to calculate, report, and pay the fee by July 31, 2018.
PCORI stands for the Patient-Centered Outcomes Research Institute. Federal law imposes a small annual fee on most health plans that include medical benefits in order to raise revenue to finance the Institute’s work. See our blog for details on which employer-sponsored plans are subject to the PCORI fee, how to calculate the 2017 amount, complete Form 720, and make payment.
Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.
There is no doubt that prescription drug prices are a major driver in the overall cost of care.
The question is what to do about it, and what repercussions would it have on other parts of the market and the manufacturers themselves? The President has made partial good on his campaign promise, proposing a number of solutions to the problem, but will they work? Some already say “no” because he is not using the purchasing power of Medicare to drive down prices, instead relying on legalistic prescriptions which will promote transparency and then…
Value based purchasing in federal programs
Using Medicare to pay different amounts for the same drug depending on the illness
Pressure other countries to raise their prices for prescription drugs (oh, sure)
Require drug ads to include the price (but if the carriers are paying, who cares?)
Ban gag clauses for pharmacists to they can recommend other, less expensive drugs
The patent system will change to reward innovation and not protect monopolies
Change the existing rebate system (but how, when no one understands how it works)
That’s what it comes to in the analysis. What was said in the long White Paper produced by the President and his team were the following goals:
Increasing competition – Accelerating FDA approval of generics, focus on FDA improving efficiency of generic development, clarify complex generics, closing loopholes allowing brand names to game the system, modernize Medicare Part D, put an inflation limit on Medicare Part B drugs, increasing the integrity of the Medicaid rebate program
Lowering list prices – transparency with Medicare, ACA rebate provisions, FDA evaluation on direct to consumer advertising
Reduce patient out of pocket spending – end gag clauses, require Part D providers to show lower cost alternatives on the Explanation of Benefits, evaluate options to alow high cost drugs to be priced differently based on indications
Anthem has changed their policy regarding imaging performed in hospitals on an outpatient basis and will expand this into fourteen states. Hospitals are not happy, nor amused and have filed suit. Anthem stakes its claim on the idea of medical necessity, and hospitals are saying that doctors have the right to show necessity, not carriers. And so the battle continues as carriers continue to try to dictate care but those who are responsible for care are not responsible for the payment. No winners here…
And as if that were not enough, Anthem has also begun pushing back on patients who visit the emergency room for ailments the carrier deems minor – called the “avoidable ER program” (as in avoiding payment). While Anthem has lightened up on their procedures somewhat, they are refusing to pay some ER visits as non emergency (after the fact) which is not making patients and doctors particularly happy. Stay tuned.
The California State Supreme Court, in the case of a suit against Dynamex Operations West, said simply that “when a worker has not independently decided to engage in an independently established business but instead is simply designated an independent contractor – there is a substantial risk that the hiring business is attempt to evade the demands of an applicable wage order through misclassification.” In short, to be independent they must be, you know, independent. Businesses must show that the worker is free from the control and direction of the employer, perform work that is outside the hirer’s core business and customarily engage in an independently established trade, occupation or business
On April 30, 2018 the California Supreme Court determined that California employers must always start with the presumption that a worker is a common law employee. They may classify them as independent ONLY IF ALL of these criteria are being met:
Worker is free from control and direction in connection with the performance of the work
The worker performs work that is outside the usual course of the hiring entity’s business
Worker customarily engaged in independently established trade, occupation or business
This gives common sense to what the Department of Labor has long used as their “twenty questions” to determine the independence of an independent contractor. The only question remaining now is that, if the DOL finds an employer responsible for an “employee” who may have previously been misclassified, if all rights and benefits that apply will be made retroactively
This should be apparent, but apparently it isn’t. Sometimes prescription drugs, so often dispensed as generics, have a lower price than the copayment stated on the benefit card. A new study, however, shows that consumers aren’t asking, thus not only paying a higher amount than necessary, but this amount is then “clawed back” by the Pharmacy Benefit Manager (no, the pharmacy does not keep the difference, nor does the insurance carrier) which acts as a middleman between the carrier and the consumer. During a study period comprising the first half of 2013, a USC study found that overpayments totaled $135 million. A good example – hydrocodone acetaminophen (that would normally be called “Vicodin”) was prescribed 120,000 times and there was an average overcharge of $6.94. It is not just generics, moreover. The brand name drugs of longer standing also often fall under the brand name co payment (Ambien was cited as the most egregious example) So next time, don’t just reach for the card…
Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.
Opioids are made from the opium poppy plant. Opium has been around since 3,400 BC and it was first referenced as being cultivated in Southwest Asia. The drug traveled the Silk Road from the Mediterranean to Asia to China. Since then, the drug has gained popularity for pain relief but it also has gained notoriety as an abused drug. Morphine, Codeine, and Heroin are all derived from the opium poppy and are all highly addictive drugs that are abused all around the world. As the demand for these drugs has increased, so has the production. From 2016 to 2017, the area under opium poppy cultivation in Afghanistan increased by 63 percent. In 2016, it killed some 64,000 Americans, more than double the number in 2005.
We can see that the danger from this drug is growing rapidly. What can we do to recognize potential abuse problems and to get help? Here are some facts about opioid addiction:
How do they work? Opioids attach to pain receptors in your brain, spinal cord, and other areas that recognize pain signals. As they attach to the receptors, it reduces the sending of pain messages to the brain and therefore reduces the feelings of pain in your body.
Short-acting opiates are typically prescribed for injuries and only for a few days. They take 15-30 minutes for pain relief to begin and this relief lasts for 3-4 hours. Long-acting opiates are prescribed for moderate to severe pain and are used over a long period of time. Relief typically lasts for 8-12 hours and can be used alongside a short-acting drug for breakthrough pain.
Dependence is common with long-term use of an opiate. This means that the patient needs to take more of and higher doses of the medicine to get the same pain relieving effect. This does not necessarily mean the patient is addicted. Addiction is the abuse of the drug by taking it in an unprescribed way—like crushing tablets or using intravenously.
Help is available through many channels from private recovery centers to insurance providers. The Substance Abuse and Mental Health Services Administration helpline is 1-800-662-HELP. This line is confidential, free, and available 24-hours a day and 7 days a week. Family and friends may also call this number for resources for help. Additional resources can be found at drugabuse.com.
Make sure you are educated about the dangers of opioid abuse. But, don’t be discouraged and think that the abuse is incurable! There are many resources that can be used to break the addiction cycle and can make real change in the lives of its victims. Ask for help and offer help.
The Supreme Court has once again found that retiree benefits are not vested. So the employer can promise but… Actually, the Court simply clarified the need for clarity. In the absence of specific language that vests retiree health benefits, the retirees may no longer assume that silence or ambiguity allows a lifetime contract. Instead, the contract itself must state the case. Seems simple, but this has been kicking around, even though the Supreme Court said the same thing in 2015. Now it will show the unions that what they want needs to be negotiated and then put in writing (we will call this the “common sense” doctrine)
Well, now the concerns are over. Jamie Dimon JP Morgan, Jeff Bezos from Amazon and Warren Buffet from Berkshire Hathaway have all teamed up to solve our nation’s health care problems. There are no details at this point, of course, but they say they plan to hold down costs by bringing “their scale and complementary expertise to this long term effort” They will create an independent company “free from profit making incentives and constraints” to focus on technology solutions” This is great, except for the fact that technology is only one part of the problem (but definitely worth fixing) and that the scale these companies bring will really only benefit a narrow slice of consumers – their companies. By the way, Steve Case of AOL tried this years ago and failed miserably, but who remembers Steve Case any more?
This year’s flu season is a rough one. Although the predominant strains of this year’s influenza viruses were represented in the vaccine, they mutated, which decreased the effectiveness of the immunization. The flu then spread widely and quickly, and in addition, the symptoms were severe and deadly. The U.S. Centers for Disease Control and Prevention (CDC) reported that the 2017 – 2018 flu season established new records for the percentage of outpatient visits related to flu symptoms and number of flu hospitalizations.
Younger, healthy adults were hit harder than is typical, which had impacts on the workplace. In fact, Challenger, Gray & Christmas, Inc. recently revised its estimates on the impact of this flu season on employers, raising the cost of lost productivity to over $21 billion, with roughly 25 million workers falling ill.
Fortunately, the CDC is reporting that it looks like this season is starting to peak, and while rates of infection are still high in most of the country, they are no longer rising and should start to drop. What can you do as an employer to keep your business running smoothly for the rest of this flu season and throughout the next one?
Help sick employees stay home. Consider that sick employees worried about their pay, unfinished projects and deadlines, or compliance with the company attendance policy may feel they need to come to work even if they are sick. Do what you can to be compassionate and encourage them to stay home so they can get better as well as protect their co-workers from infection. In addition, make sure your sick leave policies are compliant with all local and state laws, and communicate them to your employees. Be clear with the expectation that sick employees not to report to work. For employees who feel well enough to work but may still be contagious, encourage them to work remotely if their job duties will allow. Be consistent in your application of your attendance and remote work rules.
Know the law. Although the flu is generally not serious enough to require leaves of absence beyond what sick leave or PTO allow for, in a severe season, employees may need additional time off. Consider how the federal Family and Medical Leave Act (FMLA), state leave laws, and the Americans with Disabilities Act (ADA) may come into play for employees who have severe cases of the flu, complications, or family members who need care.
Be flexible. During acute flu outbreaks, schools or daycare facilities may close, leaving parents without childcare. Employees may also need to be away from the workplace to provide care to sick children, partners, or parents. Examine your policies to see where you can provide flexibility. Look for opportunities to cross-train employees on each other’s essential duties so their work can continue while they are out.
Keep it clean. Direct cleaning crews to thoroughly disinfect high-touch areas such as doorknobs, kitchen areas, and bathrooms nightly. Provide hand sanitizer in common areas and encourage frequent handwashing. Keep disinfecting wipes handy for staff to clean their personal work areas with.
Limit exposure. Avoid non-essential in-person meetings and travel that can expose employees to the flu virus. Rely on technology such as video conferencing, Slack, Skype, or other platforms to bring people together virtually. Consider staggering work shifts if possible to limit the number of people in the workplace at one time.
Focus on wellness. Offer free or low-cost flu shots in the workplace. If your company provides snacks or meals for employees, offer healthier options packed with nutrients.
For example, says Karsh, many millennials grew up with working parents, the privileges of after-school activities and clubs, and constant individual mentoring. In a work environment, this translates to a desire to be told what to do, to be monitored while doing it, and then to receive praise for doing everything successfully. While not every work environment is able to supply such a structure, for any number of good reasons, it’s important to remember that the desire for it is rooted in generational factors, not necessarily selfishness or weakness.
A solid compromise, offers Karsh, is to provide concrete explanations from the start, so that millennials always have a structure to return to when they desire it. At the same time, it is best practice to “ween them off structure,” for example, reminding them that a supervisor might not check in every day, and that this isn’t a bad sign. Often, he says, millennials respond well to direct communication. Of course, everyone is an individual no matter their generation, and over time, most new structures can be learned and put to effective use. Other best practices that have proved effective for millennials are future-focused credentials, real time conversations, and microlearning.
Employers that self-insured any group health plans in 2017, including health reimbursement arrangements (HRAs), are responsible for determining whether the annual PCORI fee applies to their plan. If so, use Form 720 to calculate, report, and pay the fee by July 31, 2018.
PCORI stands for the Patient-Centered Outcomes Research Institute. Federal law imposes a small annual fee on most health plans that include medical benefits in order to raise revenue to finance the Institute’s work. See our blog for details on which employer-sponsored plans are subject to the PCORI fee, how to calculate the 2017 amount, complete Form 720, and make payment.
Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.
There is no doubt that prescription drug prices are a major driver in the overall cost of care.
The question is what to do about it, and what repercussions would it have on other parts of the market and the manufacturers themselves? The President has made partial good on his campaign promise, proposing a number of solutions to the problem, but will they work? Some already say “no” because he is not using the purchasing power of Medicare to drive down prices, instead relying on legalistic prescriptions which will promote transparency and then…
Value based purchasing in federal programs
Using Medicare to pay different amounts for the same drug depending on the illness
Pressure other countries to raise their prices for prescription drugs (oh, sure)
Require drug ads to include the price (but if the carriers are paying, who cares?)
Ban gag clauses for pharmacists to they can recommend other, less expensive drugs
The patent system will change to reward innovation and not protect monopolies
Change the existing rebate system (but how, when no one understands how it works)
That’s what it comes to in the analysis. What was said in the long White Paper produced by the President and his team were the following goals:
Increasing competition – Accelerating FDA approval of generics, focus on FDA improving efficiency of generic development, clarify complex generics, closing loopholes allowing brand names to game the system, modernize Medicare Part D, put an inflation limit on Medicare Part B drugs, increasing the integrity of the Medicaid rebate program
Lowering list prices – transparency with Medicare, ACA rebate provisions, FDA evaluation on direct to consumer advertising
Reduce patient out of pocket spending – end gag clauses, require Part D providers to show lower cost alternatives on the Explanation of Benefits, evaluate options to alow high cost drugs to be priced differently based on indications
Anthem has changed their policy regarding imaging performed in hospitals on an outpatient basis and will expand this into fourteen states. Hospitals are not happy, nor amused and have filed suit. Anthem stakes its claim on the idea of medical necessity, and hospitals are saying that doctors have the right to show necessity, not carriers. And so the battle continues as carriers continue to try to dictate care but those who are responsible for care are not responsible for the payment. No winners here…
And as if that were not enough, Anthem has also begun pushing back on patients who visit the emergency room for ailments the carrier deems minor – called the “avoidable ER program” (as in avoiding payment). While Anthem has lightened up on their procedures somewhat, they are refusing to pay some ER visits as non emergency (after the fact) which is not making patients and doctors particularly happy. Stay tuned.
The California State Supreme Court, in the case of a suit against Dynamex Operations West, said simply that “when a worker has not independently decided to engage in an independently established business but instead is simply designated an independent contractor – there is a substantial risk that the hiring business is attempt to evade the demands of an applicable wage order through misclassification.” In short, to be independent they must be, you know, independent. Businesses must show that the worker is free from the control and direction of the employer, perform work that is outside the hirer’s core business and customarily engage in an independently established trade, occupation or business
On April 30, 2018 the California Supreme Court determined that California employers must always start with the presumption that a worker is a common law employee. They may classify them as independent ONLY IF ALL of these criteria are being met:
Worker is free from control and direction in connection with the performance of the work
The worker performs work that is outside the usual course of the hiring entity’s business
Worker customarily engaged in independently established trade, occupation or business
This gives common sense to what the Department of Labor has long used as their “twenty questions” to determine the independence of an independent contractor. The only question remaining now is that, if the DOL finds an employer responsible for an “employee” who may have previously been misclassified, if all rights and benefits that apply will be made retroactively
This should be apparent, but apparently it isn’t. Sometimes prescription drugs, so often dispensed as generics, have a lower price than the copayment stated on the benefit card. A new study, however, shows that consumers aren’t asking, thus not only paying a higher amount than necessary, but this amount is then “clawed back” by the Pharmacy Benefit Manager (no, the pharmacy does not keep the difference, nor does the insurance carrier) which acts as a middleman between the carrier and the consumer. During a study period comprising the first half of 2013, a USC study found that overpayments totaled $135 million. A good example – hydrocodone acetaminophen (that would normally be called “Vicodin”) was prescribed 120,000 times and there was an average overcharge of $6.94. It is not just generics, moreover. The brand name drugs of longer standing also often fall under the brand name co payment (Ambien was cited as the most egregious example) So next time, don’t just reach for the card…
Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.
Opioids are made from the opium poppy plant. Opium has been around since 3,400 BC and it was first referenced as being cultivated in Southwest Asia. The drug traveled the Silk Road from the Mediterranean to Asia to China. Since then, the drug has gained popularity for pain relief but it also has gained notoriety as an abused drug. Morphine, Codeine, and Heroin are all derived from the opium poppy and are all highly addictive drugs that are abused all around the world. As the demand for these drugs has increased, so has the production. From 2016 to 2017, the area under opium poppy cultivation in Afghanistan increased by 63 percent. In 2016, it killed some 64,000 Americans, more than double the number in 2005.
We can see that the danger from this drug is growing rapidly. What can we do to recognize potential abuse problems and to get help? Here are some facts about opioid addiction:
How do they work? Opioids attach to pain receptors in your brain, spinal cord, and other areas that recognize pain signals. As they attach to the receptors, it reduces the sending of pain messages to the brain and therefore reduces the feelings of pain in your body.
Short-acting opiates are typically prescribed for injuries and only for a few days. They take 15-30 minutes for pain relief to begin and this relief lasts for 3-4 hours. Long-acting opiates are prescribed for moderate to severe pain and are used over a long period of time. Relief typically lasts for 8-12 hours and can be used alongside a short-acting drug for breakthrough pain.
Dependence is common with long-term use of an opiate. This means that the patient needs to take more of and higher doses of the medicine to get the same pain relieving effect. This does not necessarily mean the patient is addicted. Addiction is the abuse of the drug by taking it in an unprescribed way—like crushing tablets or using intravenously.
Help is available through many channels from private recovery centers to insurance providers. The Substance Abuse and Mental Health Services Administration helpline is 1-800-662-HELP. This line is confidential, free, and available 24-hours a day and 7 days a week. Family and friends may also call this number for resources for help. Additional resources can be found at drugabuse.com.
Make sure you are educated about the dangers of opioid abuse. But, don’t be discouraged and think that the abuse is incurable! There are many resources that can be used to break the addiction cycle and can make real change in the lives of its victims. Ask for help and offer help.
The Supreme Court has once again found that retiree benefits are not vested. So the employer can promise but… Actually, the Court simply clarified the need for clarity. In the absence of specific language that vests retiree health benefits, the retirees may no longer assume that silence or ambiguity allows a lifetime contract. Instead, the contract itself must state the case. Seems simple, but this has been kicking around, even though the Supreme Court said the same thing in 2015. Now it will show the unions that what they want needs to be negotiated and then put in writing (we will call this the “common sense” doctrine)
Millennials, commonly but not exclusively defined as people born between 1981 and 1996, occupy a complicated space in today’s workplace—predominantly because they’re the youngest generation in it. While many consider this group “ambitious” and “tech-savvy,” others understand it to be “whiney,” “distracted,” or “entitled.” As with any stereotype, this is a flat, un-nuanced version of a partial truth. The most important thing to remember, says Brad Karsh, CEO and founder of JBTraining Solutions, is that each generation in the workforce—from Boomers to Millennials—has been shaped by their upbringing.
Employers that self-insured any group health plans in 2017, including health reimbursement arrangements (HRAs), are responsible for determining whether the annual PCORI fee applies to their plan. If so, use 
This year’s flu season is a rough one. Although the predominant strains of this year’s influenza viruses were represented in the vaccine, they mutated, which decreased the effectiveness of the immunization. The flu then spread widely and quickly, and in addition, the symptoms were severe and deadly. The U.S. Centers for Disease Control and Prevention (CDC) reported that the 2017 – 2018 flu season established new records for the percentage of outpatient visits related to flu symptoms and number of flu hospitalizations.
