Monday, October 31, 2022

Just 2 Minutes of Intense Exercise Every Day Could Extend Lifespan

From StudyFinds

The first study included 71,893 adults without cardiovascular disease or cancer. The median participant age was 62.5 years old, and just over half (56%) were female. Study authors measured weekly levels of vigorous activity and the frequency of exercise bouts lasting two minutes or less. This was a long-term study; subjects were tracked for an average of 6.9 years.

Then, associations between volume and frequency of vigorous activity with death (all-cause, heart disease, and cancer) and incidence of heart disease and cancer after excluding events occurring in the first year were analyzed by researchers. Sure enough, as both the volume and frequency of vigorous activity increased, risk of all five considered adverse outcomes declined. ... 

[S]ubjects who didn’t exercise vigorously at all had a four percent risk of dying within five years. That risk was cut in half (2%) with less than 10 minutes of weekly vigorous activity. Death risk fell to one percent with 60 minutes or more.

When compared to two minutes of intense exercise per week, 15 minutes of vigorous exercise was associated with an 18 percent lower death risk and a 15 percent lower risk of cardiovascular disease. Meanwhile, 12 minutes was linked to a 17 percent lower risk of cancer.

Generally, the more exercise the better. For example, roughly 53 minutes of physical activity on a weekly basis was associated with a 36% lower risk of death from any cause.

Sunday, October 30, 2022

Employers Expect Major Increases to Health Care Costs in 2023

In 2022, most employers’ healthcare costs increased. According to recent industry data, current signs are also pointing to significantly higher healthcare costs in the upcoming year. Employers now face the difficult task of reigning in rising healthcare costs and keeping employee coverage affordable while trying to remain attractive to current and prospective talent despite their shrinking budgets.
Many employers are worried about controlling rising healthcare costs and providing employees with affordable and quality care options. This article explores employer expectations regarding health care costs, reasons health care costs are rising and strategies employers are implementing to address increasing costs.
Employers Expect Health Care Costs to Increase
Reports from industry experts seem to agree that employers expect major increases in healthcare costs in 2023. Data from Willis Towers Watson’s 2022 Best Practices in Healthcare Survey found that U.S. employers’ healthcare costs are projected to increase 6% next year, compared with an average 5% increase experienced in 2022. Early Mercer survey results suggested that U.S. employers expect their healthcare costs per employee to rise 5.6% on average in 2023.
Those costs may increase even more if employers fail to take action to curb rising healthcare costs. If employers fail to make any changes—such as expanding telemedicine options and digital healthcare resources—employers believe the costs for their largest healthcare plans will grow by 7%. The International Foundation of Employee Benefit Plans reported that employers anticipate a 7.5% median increase in medical plan costs in 2023.
An analysis from global professional services firm Aon predicted employer health care costs will increase by 6.5% in 2023, with the average costs per employee reaching $13,800. Based on Aon’s analysis, this prediction is below the current inflation figure reported in the consumer price index, but it’s significantly higher than the increase in healthcare costs employers saw from 2021 to 2022. Additionally, HR and employee benefits consulting firm Buck found employer healthcare costs in 2023 are projected to increase between 5.8% to 6.9% in its 2022 National Healthcare Trend Survey.
Why Health Care Costs Are Increasing
There are a few reasons health care costs are increasing. While most employers had lower claim costs during the COVID-19 pandemic, medical plan costs are returning to pre-pandemic levels as healthcare utilization rebounds. Utilization has especially increased for employees dealing with severe chronic diseases and late-stage cancer due to missed or delayed care during the pandemic. Additionally, many employees are struggling with long COVID-19. Even those employees who have recovered from COVID are experiencing cardiovascular and neurological diseases, which is causing employer healthcare costs to increase.
Inflation is also causing healthcare costs to rise, and it will likely drive up costs moving forward; however, due to the long-term nature of provider contracts, some employers may not immediately feel the cost increases caused by inflation. In addition, the recent trend of consolidation among hospitals, physician practices, and commercial insurers is triggering higher healthcare prices for private insurance. Other factors contributing to increased healthcare costs include new technology, novel prescription drugs, specialty drugs, and catastrophic claims.
Employer Strategies for Managing Health Care Costs and Improving Affordability
Traditionally, employers have addressed rising healthcare costs by shifting increased costs onto employees through higher premiums. While some employers are continuing to implement this strategy, most employers do not want benefit choices to interfere with their recruiting efforts due to the state of the labor market. Therefore, employers are using multiple strategies to manage their healthcare costs while attempting to improve affordability for employees.
These strategies include the following:
  • Self-funding more of their cots with Health Reimbursement Arrangements
  • Structuring payroll contributions to reduce healthcare costs for employees
  • Employing programs to combat fraud, waste, and abuse
  • Increasing healthcare plan budgets
  • Contracting directly with high-quality, cost-competitive hospitals and physician networks
  • Requiring employees to use cost-effective medical centers or obtain preapproval for scheduled inpatient services
  • Offering employees health care navigation and concierge support services
  • Evaluating prescription drug costs, particularly for specialty drugs
  • Providing telemedicine or virtual care services
  • Implementing new benefit programs, such as wellness programs, or using vendors
  • Expanding voluntary benefit offerings, such as supplemental health insurance for catastrophic events
  • Supporting and effectively managing employees with chronic conditions, long-term illnesses, and complex diseases
  • Seeking help from insurance brokers to detail organizational healthcare spending and educate employees on shopping for healthcare services
Rising healthcare costs are causing employers to reevaluate healthcare plan designs and offerings. By gathering data and using it to predict where and when increased costs may occur, employers can determine the best strategies to address growing healthcare costs.
Employers of all sizes are looking to offer quality healthcare benefits in 2023 while focusing on employee affordability and accessibility. This will be difficult as prices increase and employer budgets shrink as a result of the current economic environment. Employers can act now to proactively prepare for anticipated healthcare price increases and find long-term solutions to mitigate rising costs.

Thursday, October 20, 2022

New CA Employment Laws, Trends in Rx Spending, Telemedicine Challenges and More

Benefits in Brief

Employees can put an extra $200 into their health care flexible spending accounts (health FSAs) next year, the IRS announced on Oct. 18, as the annual contribution limit rises to $3,050, up from $2,850 in 2022. The increase is double the $100 rise from 2021 to 2022 and reflects recent inflation. 

Compliance News

A Group Health Plan Without a Public Website may satisfy the new transparency and price disclosure requirements if the plan’s TPA posts the required information on its public website - (Q 11, pg. 12) Federal regulators have now made it clear that self-funded employers can rely on their administrator (TPA) to make the necessary price disclosure files publicly available so long as there is a written agreement in place. One original federal interpretation was that employers had to provide that on their websites, and if they did not have a public website, they had to create one for that purpose. Of course, that seemed ludicrous. And thankfully, regulators now agree it was.

California Expands Who an Employee Can Care for Under the CFRA and California Paid Sick Leave Law - "Beginning January 1, 2023, employees throughout California will be able to use sick leave or take leave under the California Family Rights Act (CFRA) to care for a 'designated person' ... defined as any individual related by blood or whose association with the employee is equivalent to a family relationship. An employee can designate this person at the time they request leave." 

California Unleashes Last-Minute Onslaught of New Employment Legislation - California Governor Newsom recently signed several pieces of employment-related legislation into law including: Supplemental Paid Sick Leave Extension, an expansion of the California Family Rights Act and California Paid Sick Leave, Unpaid Bereavement Leave, Emergency Working Conditions, Reproductive Health Decisionmaking, and Cal/WARN Act Enforcement for Call Centers.  

Benefit News

Trends in Prescription Drug Spending, 2016-2021 - This HHS Issue Brief presents the Agency’s findings on prescription drug spending trends between 2016-2021. 

  • In 2021, the U.S. health care system spent $603 billion on prescription drugs, before accounting for rebates, of which $421 billion was on retail drugs. 
  • Spending growth on drugs was largely due to growth in spending per prescription, and to a lesser extent by increased utilization (i.e., more prescriptions).
  • Expenditure growth was larger for non-retail drug expenditures (25%) than for retail expenditures (13%). 
  • Between 2016 and 2021, the location where people received their drugs changed. Americans increasingly received their drugs from mail order pharmacies (35% increase), clinics (45% increase), and home health care (95% increase). During the same time period, there were decreases in drugs received through independent pharmacies (5% decrease), long term care facilities (17% decrease), and federal facilities (9% decrease). 
  • Drug spending is heavily driven by a relatively small number of high-cost products. The cost of specialty drugs has continued to grow, totaling $301 billion in 2021, an increase of 43% since 2016. Specialty drugs represented 50% of total drug spending in 2021. While the majority (80%) of prescriptions that Americans fill are for generic drugs, brand name drugs accounted for 80% of prescription drug spending in both retail and non-retail settings, with little change over time. The top 10% of drugs by price make up fewer than 1% of all prescriptions but account for 15% of retail spending and 20%-25% of non-retail spending.
  • Prescription drug spending trends have been less affected by the COVID-19 pandemic than health care services. 
  • Several provisions in the Inflation Reduction Act address drug pricing, including allowing the Secretary of HHS to negotiate prices in Medicare Parts B and D for selected medications and introducing Medicare rebates for drug prices that rise faster than inflation. These provisions may impact future drug spending trends.
  • There were 1216 products whose price increases during the twelve-month period from July 2021 to July 2022 exceeded the inflation rate of 8.5 percent for that time period. The average price increase for these drugs was 31.6 percent.

Telemedicine was made easy during COVID-19. Not any more - "Over the past year, nearly 40 states and Washington, D.C., have ended emergency declarations that made it easier for doctors to use video visits to see patients in another state, according to the Alliance for Connected Care, which advocates for telemedicine use. Some, like Virginia, have created exceptions for people who have an existing relationship with a physician. A few, like Arizona and Florida, have made it easier for out-of-state doctors to practice telemedicine. Doctors say the resulting patchwork of regulations creates confusion and has led some practices to shut down out-of-state telemedicine entirely. That leaves follow-up visits, consultations or other care only to patients who have the means to travel for in-person meetings."

Health and Wellness

Sore Throat, Now the Most Common Sign of COVID - "where once a fever and loss of taste or smell were early warning signs of the bug, the symptom tracking app has revealed the most common symptoms have changed."

People who sleep 5 hours or less a night face a higher risk of multiple health problems as they age - "The study, published Tuesday in the journal PLOS Medicine, took a closer look at a group of nearly 8,000 civil servants in the United Kingdom who had no chronic disease at age 50. Scientists asked the participants to report on how much sleep they got during clinic examinations every four to five years for the next 25 years. For those whose sleep was tracked at age 50, people who slept five hours or less a night faced a 30% higher risk that they would develop multiple chronic diseases over time than those who slept at least seven hours a night. At 60, it was a 32% increased risk, and at 70, it was a 40% greater risk."

Monday, October 3, 2022

Compliance and Benefit News, October 3, 2022

Compliance Updates

CA Legislature Expands Pay Transparency and Data Reporting Requirements; Extends COVID Supplemental Paid Sick Leave - "If signed into law by Governor Newsom, the current amended version of SB 1162 would increase employers’ pay transparency obligations as follows: 1) upon request, all employers will be required to provide the pay scale (i.e., hourly rate or salary range) for the position in which the employee is currently employed; 2) employers will be required to maintain records of job title and wage rate history for all employees for the duration of employment plus three years; and 3) all employers with 15 or more employees will be required to disclose pay scales in all job postings.

SB 1162 also expands California employers’ current pay data reporting requirements, which were initially passed into law in 2020 as part of the nation’s first such state-imposed obligations. The current requirements mandate that private employers with 100 or more employees report annually the number of their employees by race, ethnicity, and sex in specified job categories to the Department of Fair Employment and Housing (recently renamed the Civil Rights Department (CRD))."

California Slated to Usher in New Era of Pay Transparency in 2023: What California Employers Need to Know - "The Act expands pay data reporting to all California employers with 100 or more employees regardless of whether or not they are exempted from the EEO-1 filing requirement. The Act also significantly expands the types of pay information employers must report each year. The first deadline to report is the second Wednesday of May 2023 (May 10, 2023). Covered employers must now also provide the “median and mean hourly rate” within each job category (discussed above), for each combination of race, ethnicity, and sex."

Benefit News

The Cost Of Long COVID To Employers Is Skyrocketing -"two types of claims were sorted out: those labeled long COVID, and those attributed to diabetes. When the numbers were crunched, here’s what came up: Per-member employer spend on long COVID was on average $2,654.67, more than 26% higher than the average diabetic spend....The study also finds that long COVID patients reported a 3.6 times greater likelihood of missing work for medical reasons than plan members without the symptoms. ... [T]he average predicted cost of long COVID to patients is nearly $9,500 within the first six months following a diagnosis."

Segal Trend Survey, 7.4% Plan Increases in 2023 - "The projected annual cost trend for outpatient prescription drugs is expected to be approaching double-digit levels, the highest rate observed since 2015. Double-digit specialty Rx cost trend, mostly driven by price increases and new-to-market specialty drugs, continues to be a major driver of Rx cost trends. Survey respondents project per-person cost trends for open-access PPO/POS plans to be 7.4 percent."

Yet Another Reason to Look at Reference-Based-Pricing (another hidden cost shift against employers) - Employer plans pay an average of 224% of what Medicare pays for the same hospitalizations. This cost shift away from Medicare and onto employers has led to growth in employers moving away from traditional insurance and reverence-base-pricing their plans. I spoke about it with Armstrong and Getty in September here. And I wrote about it becoming a growing trend in the 2020s hereA new study now shows that the same hidden tax/cost shift is happing with Obamacare Exchange plans.

‘Gaming’ Of U.S. Patent System Is Keeping Drug Prices Sky High, Report Says - Four pharmaceutical companies have filed hundreds of patents to keep their drugs out of the hands of generic competition and prolong their “unprecedented profits,” according to a report published Thursday. The excessive use of the patent system — by drugmakers Bristol-Myers Squibb, AbbVie, Regeneron and Bayer — keeps the prices of the medications at exorbitant levels, often at the expense of American consumers, according to the report from the Initiative for Medicines, Access & Knowledge, or I-MAK, a nonprofit organization that advocates drug patent reform. ... The U.S. patent system is meant to reward innovation by permitting drug companies to sell new medications on the market and barring other manufacturers from making generic versions for a set period of time — usually 20 years. Once the patent expires, generics are allowed on the market, often at a lower list price than the brand-name drug. But drugmakers often extend their patents by making small tweaks to the drugs, sustaining their monopolies for several years. Legal experts refer to this tactic as “evergreening...”

Health care spending for mental health disorders increases between 2013 and 2020 -

  • Overall spending on mental health services increased from 6.8% to 8.2% between 2013 and 2020, according to a new study published by the Employee Benefit Research Institute (EBRI).
  • The percentage of the population under the age of 65 with employment-based health coverage diagnosed with a mental health disorder increased from 14.2% in 2013 to 18.5% in 2020.
  • Among enrollees with a mental health diagnosis, average annual spending on mental health care services increased from $1,987 to $2,380 between 2013 and 2020 — an average of 3% per year.

Physician Burnout Has Reached Distressing Levels, New Research Finds - "Results released this month and published in Mayo Clinic Proceedings, a peer-reviewed journal, show that 63 percent of physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022, an increase from 44 percent in 2017 and 46 percent in 2011. Only 30 percent felt satisfied with their work-life balance, compared with 43 percent five years earlier."

The perks that work to retain employees now - "Among employed adults, 56% say that the work schedule attracts them most in their current role ­— a factor valued more by women (61%) than men (51%). Almost half of the workers surveyed say that colleagues (48%), fair pay (46%), and work-life balance (43%) are most appealing, with 34% also appreciating their health benefits. In fact, 58% of Gen Z are attracted to their job because of colleagues and work friends, while men (52%) are more likely than women (39%) to be drawn to their job because they are paid fairly."

Health and Wellness

Antidepressants Work Better Than Sugar Pills Only 15 Percent of the Time - "Five years ago Mark Horowitz seemed an unlikely skeptic of psycho-pharmaceuticals. He had been taking the popular antidepressant Lexapro virtually every day for 15 years. He was so fascinated by the drugs that he spent three years hunched over a dish of human brain cells in a laboratory at King's College London, measuring the effect of human stress hormones and drugs like Prozac and Zoloft. Then, when he tried to wean himself off the medication, he suffered panic attacks, sleep disruptions, and depression so debilitating that he had to move back to his parents' house in Australia—symptoms that he says were far worse than anything he experienced prior to going on the drugs. He went online and found thousands of others in a similar pickle. They had been unable to kick one of the psychiatric drugs known as Selective Serotonin Reuptake Inhibitors, or SSRIs, which include Lexapro, Zoloft, and Prozac, among others. Since withdrawal symptoms were thought to be mild and temporary, many of them, like him, had been told by doctors that they were experiencing a relapse of their depression. ..."

How to maintain peak brain health: Scientists say it comes down to these 3 factors - "The three identified keys to strong brain health are:

  1. Physical exercise
  2. Social activity
  3. Strong, passionate interests and hobbies

Simple, right? Let’s break down each factor a bit further. ..."

CDC no longer recommends universal masking in health facilities - "The Centers for Disease Control and Prevention no longer recommends universal masking in health care settings, unless the facilities are in areas of high COVID-19 transmission. The agency quietly issued the updates as part of an overhaul to its infection control guidance for health workers published late Friday afternoon [Sept. 23rd]. It marks a major departure from the agency’s previous recommendation for universal masking."

Being unhappy or lonely speeds up aging — even more than smoking - "Being unhappy or experiencing loneliness accelerates the aging process more than smoking, according to new research. An international team says unhappiness damages the body’s biological clock, increasing the risk for Alzheimer’s, diabetes, heart disease, and other illnesses. The team reports that they detected aging acceleration among people with a history of stroke, liver and lung diseases, smoking, and in people with a vulnerable mental state. Interestingly, feeling hopeless, unhappy, and lonely displayed a connection to increasing a patient’s biological age more than the harmful impact of smoking."

Wednesday, September 21, 2022

Reducing Employer Healthcare Costs via RBP with Armstrong and Getty

 I spent a couple of segments on the air with Joe Getty this morning discussing the very latest healthcare cost increases in and out of the exchanges, as well as how employers are fighting back by option out of the Government-Insurer-Complex madness with reference-based pricing.  

If you want to read more about reference-based pricing, I wrote about it over at Think Adviser, here.  

Tuesday, September 20, 2022

Compliance and Benefit News Updates, Sept. 20, 2022

Tools You Can Use

How Employers Should Handle MLR Rebates - The Affordable Care Act (ACA) established medical loss ratio (MLR) rules to help control health care coverage costs and ensure that enrollees receive value for their premium dollars. The MLR rules require health insurance issuers to spend 80-85% of premium dollars on medical care and health care quality improvement rather than administrative costs. Issuers that do not meet these requirements must provide rebates to consumers. Rebates must be provided by September 30 following the end of the MLR reporting year. For the 2021 reporting year, issuers are required to pay rebates by Sept. 30, 2022. Employers that expect to receive rebates should review the MLR rebate rules and decide how they will administer the rebates. For assistance with rebates, please contact your Fantastic McGriff representative.

The affordability percentage for “Pay or Play” purposes under the Affordable Care Act will be decreased for 2023 to 9.12% of household income (from 9.61% in 2022). As a result, some employers will have to contribute more heavily toward the cost of individual coverage in order to avoid penalties. 

Compliance Updates

California Set to Extend COVID-19 Supplemental Paid Sick Leave Until End of Year - California is expected to extend COVID-19 Supplemental Paid Sick Leave (SPSL) through the end of 2022, but the leave-extending bill does not require employers to provide a new bucket of leave and establishes a relief grant for small businesses and non-profits who incur costs for SPSL. 

Court Allows GINA Claims to Proceed Against Wellness Program Sponsor - A recent case should remind employer plan sponsors that the Genetic Information Nondiscrimination Act may limit the information they are allowed to request from employees as part of a wellness program.  

How A Facebook Messenger Chat Can Become a “Usual and Customary” FMLA Notice Procedure For a Company - A Fourth Circuit case highlights the importance of abiding by the company’s written absence policies and call-in procedures. "Because the terminated employee’s manager accepted previous messages regarding absences via Facebook Messenger, the Company’s position that using Facebook Messenger was not its “usual and customary” notice practice for reporting FMLA absences was called into question. The Court found that previous utilization of Facebook Messenger to communicate absences raised a question of material fact for a jury to determine if a Facebook Messenger Chat satisfied the FMLA’s notice requirements."

California Passes Bill Protecting Employees’ Off-Duty Marijuana Use - California’s legislature recently passed AB 2188, a bill that would “make it unlawful for . . . employer[s] to discriminate against a person in hiring, termination, or any term or condition of employment . . .” for cannabis use while off the job and away from the workplace. 

Benefit News

Employers Project 7.5% Rise in Health Care Costs for 2023 - "As industry experts predict that organizations should brace for increased health care costs in 2023, the International Foundation of Employee Benefit Plans launched a survey of U.S employers to identify the considerations they are contemplating for the coming year. Results show that corporate employers project a median increase of 7.5% for medical plan costs."

Healthcare Pricing Protected So Far From Inflation, BLS Data Shows - "In July 2022, overall prices grew by 8.5% from the previous year, while prices for medical care increased by only 4.8%. While that’s a reversal from the typical trend, the relatively high rate of inflation seen in the rest of the economy may eventually translate to higher prices for medical care, the analysis found. This may lead to steeper premium increases in the coming years.... Since 2000, the price of medical care, including that of services provided, insurance, drugs and medical equipment, has risen faster than prices in the overall economy. Medical prices have grown 110.3% since 2000, while prices for all consumer goods and services rose by 71% in the same period."

The FDA Is Helping Millions Of Americans Hear Better. Finally - "The FDA finalized a rule that would allow people with mild to moderate hearing loss to buy hearing aids over the counter — no prescription, no haggling with insurance, which usually does not cover the devices, and no audiologist visit. This move will also allow people to bypass complex and unnecessary state-level restrictions, which often limit who can sell hearing aids and when, inhibiting patients from shopping around for the best products and discouraging manufacturers from competing on cost and quality."

Thursday, July 14, 2022

Employer-sponsored Health Insurance Yields 47% ROI for U.S. Businesses

A new report from Avalere Health analyzing the return on investment (ROI) of employer-sponsored health insurance (ESI) estimated a 47% ROI for U.S. employers in 2022—increasing to a predicted 52% return in 2026. The report was commissioned by the U.S. Chamber of Commerce and focused on employers with 100 or more employees.  

Avalere Health analyzed various benefits of offering ESI, such as reduced direct medical costs, productivity, recruitment, retention, short- and long-term disability, and tax benefits. Consider the following analysis of key drivers and their ROI:
  • Productivity—$275.6 billion in 2022 ($346.6 billion in 2026)
  • Tax benefits—$119.2 billion in 2022 ($139.7 billion in 2026)
  • Recruitment—$141 billion in 2022 ($167 billion in 2026)
  • Reduction in direct medical costs—$101 billion in 2022 ($108 billion in 2026)
The ROI growth is attributed to various factors, including growing employment, anticipated wage increases, a projected rise in per-employee spending on wellness programs, and relatively flat employee turnover rates.
Share of Benefits by Component, as % of ROI

Employer Takeaway

Companies offering such insurance could anticipate receiving an average of $1.47 back in financial benefits for every dollar invested in ESI. The report also demonstrated that employers offering higher quality coverage and wages could likely expect a higher return on their ESI programs. Additionally, industries in which employers generally made more significant investments in ESI, such as wellness programs, tended to result in larger ROI. Since costs associated with turnover and recruitment are positively associated with wages, a higher ROI is expected in higher-wage industries.

Full report, here.  

Friday, June 24, 2022

Managers Saying Stupid Stuff in Response to an Employee’s Request for FMLA Leave

He said, what?  From Jeff Nowak at FMLA Insights

Over the course of 27 years working for the Sheriff, Sal developed a number of health conditions, including work-related post-traumatic stress disorder. Sal took quite a bit of FMLA leave over time, and as of September 2016, he already had used more than two-thirds of the 12 weeks he was allotted for FMLA. So, when he lined up to take FMLA leave yet again, the benefits manager overseeing FMLA benefits allegedly told Sal this time around:

'You’ve taken serious amounts of FMLA . . . don’t take any more FMLA. If you do so, you will be disciplined.' 


As the story goes, Sal retired days later, and he did what former employees are oft inclined to do — he sued his former employer.

Cost to Bring New Drugs to Market Inflating at 20% ANUALLY

From Bob Langreth at BenefitsPro

The median launch price of a new drug in the US soared from $2,115 in 2008 to $180,007 in 2021, a 20% annual inflation rate over the period, researchers at Harvard-affiliated Brigham and Women’s Hospital in Boston found. Even after adjusting for factors such as drugmakers’ focus on expensive disease categories like cancer and estimated discounts that manufacturers give some purchasers, the annual inflation rate in launch prices over the period was still almost 11%.  

How Doctor Offices Harvest Your Personal Health Information and Circumvent HIPAA Protection

Here is a great summary of a nefarious HIPAA circumvention from Geoffrey Fowler writing at the Washington Post

The doctor will sell you now.

Your intimate health information may not be as private as you think if you don’t look carefully at the forms you sign at the doctor’s office.

There’s a burgeoning business in harvesting our patient data to target us with ultra-personalized ads. Patients who think medical information should come from a doctor — rather than a pharmaceutical marketing department — might not like that.

But the good news is, you have the right to say no. I’ll show you what to be on the lookout for.

Several Washington Post readers recently wrote to Ask Help Desk about a consent form they were asked to sign while checking in for a doctor’s appointment. Most of us just hurriedly fill out whatever paperwork is put in front of us, but these eagle-eyed readers paused at this:

'I hereby authorize my health care provider to release to Phreesia’s check-in system my health information entered during the automated check-in process … to help determine the health-related materials I will receive as part of my use of Phreesia. The health-related materials may include information and advertisements related to treatments and therapies specific to my health status.'

But Phreesia doesn’t just make money by selling its software to doctor’s offices. It also has a business in selling ads to pharmaceutical companies that it displays after you fill in your forms. And it wants to use all that information you entered — what drugs you take, what illnesses you’ve had in the past — to tailor those ads to your specific medical needs.

I can understand why pharmaceutical companies might want this. The ads remind you to ask your doctor about whatever drug they’re pushing right before you go into the exam room. With access to your data, Phreesia can ensure that its advertising messages are shown to the most receptive audience at the moment they’re seeking care....


Monday, June 6, 2022

Compliance and Benefit Updates, June 6, 2022

Compliance Updates

The California Supreme Court unanimously ruled that an employee’s meal and rest period "premium pay is subject to the same wage statement and final pay requirements as other wages earned by employees. 

  • Employers must pay all wages, accrued vacation earned and other premium pay immediately upon termination.
  • Employers cannot withhold final paychecks to induce employees to return tools or equipment, pay back money owed or turn in forms or reports.
  • Final paychecks or deposits must be delivered at the time of termination. Employers should be conscious of possible delays caused by delivery or deposit."

FDA: Pharmacists and wholesalers can import drugs from Canada - "Pharmacists and drug wholesalers can import prescription medicines from Canada for up to two years as part of state programs aimed at bringing down drug costs, according to final FDA guidance released Thursday.

  • Why it matters: With President Biden's drug pricing agenda still stalled, the FDA is further clarifying how states could take advantage of lower drug costs abroad without the need to limit prices in the U.S.
  • Background: Both the Biden and Trump administrations embraced limited importation to bring down health costs, though experts view the policy as having limited impact."

Newsom Signs Compromise Law Raising The Limit On Medical Malpractice Damages - "California’s $250,000 limit on damages for pain and suffering caused by medical malpractice, a ceiling enacted by lawmakers in 1975 at the insistence of doctors and insurers, will be lifted next year. Gov Gavin Newsom signed compromise legislation Monday, sponsored by consumer advocates and supported by medical groups, that will not remove all limits on malpractice damages but will raise them to account for some of the inflation in the past 47 years. Under AB35 by Assembly Majority Leader Eloise G√≥mez Reyes, D-Colton (San Bernardino County), the new limits for noneconomic damages in 2023 will be $350,000 for nonfatal medical malpractice by a physician and $500,000 for malpractice causing death. The maximum will rise gradually over the next decade, to $750,000 for non-death cases and $1 million for fatal cases, and increase by 2% a year thereafter for inflation."

Pandemic Fatigue Dooms California’s Excessive Covid Vaccine Mandate Aspirations - "In January, progressive California Democrats vowed to adopt the toughest covid vaccine requirements in the country. Their proposals would have required most Californians to get the shots to go to school or work — without allowing exemptions to get out of them. Months later, the lawmakers pulled their bills before the first votes. One major vaccine proposal survives but faces an uphill battle. It would allow children ages 12 to 17 to get a covid-19 vaccine without parental permission. At least 10 other states permit some minors to do this. Democrats blamed the failure of their vaccine mandates on the changing nature and perception of the pandemic. They said the measures became unnecessary as case rates declined earlier this year and the public became less focused on the pandemic. Besides, they argued, the state isn’t vaccinating enough children, so requiring the shots for attendance would shut too many kids out of school."

Benefit News

HR managers are more burned out than ever. Who is supporting them? "Ninety-eight percent of HR professionals have felt burned out at work in the last six months, according to a recent survey conducted by workplace communication app Workvivo, and nearly 4 in 5 are open to leaving their jobs. ... HR teams and managers should work in tandem to share and clearly outline any mental health benefits their company offers"

Will the Pandemic’s Missing Workers Ever Return to the Labor Force? "Looking at those who have exited the labor force and are not retired:

  • 23 percent said that available jobs are not in their field of work interest.
  • 17 percent said they haven't been able to find a job that pays enough.
  • 9 percent said they have chosen to learn new work skills or want to pursue a different career path.
  • 27 percent said that if their savings ran out or ran low, it would motivate them to return."

Employers Pay 224% Of Medicare Prices For Hospital Services - Employer-sponsored health plans paid on average 224% of what Medicare paid to hospitals for the same services at the same facilities, according to a new study from RAND Corporation. The report covers billing for hospital inpatient and outpatient services in 2020. The study said that there were significant variances in prices across states or geographic areas and added that the difference in cost seemed to be linked to hospital market share rather than hospitals’ share of Medicare and Medicaid patients.

  • The researchers found that in Hawaii, Arkansas, and Washington, relative prices were under 175% of Medicare.
  • Other in states, such as Florida, West Virginia, and South Carolina, relative prices were at or above 310% of Medicare.
  • Prices for COVID-19 hospitalization were similar to prices for overall inpatient admissions and averaged 241% of what was paid for Medicare patients.

Note from Craig: This is why I wrote that "America Will Dramatically Change the Way It Provides Health Care by 2030." This trend cannot continue. The federal government controls prices by arbitrarily slashing what it will pay for services in Medicare and Medicaid. This forces hospitals to inflate what they charge for all services to private employer plans. Hence, the tax subsidy is really a cost shift to employers that far exceeds anything any of us pay in FICA. In short:

  1. Companies that are large enough (over 300 employees) will self-fund and reference base price their plans. Why pay 224% of Medicare when you can pay 140% and have 97% of your claims sail through without pushback. This saves an employer 20% to 30% on healthcare in the first year alone.
  2. Smaller companies will be forced into some sort of defined contribution scheme where the employee is punished for the year over year 6% to 9% increases. Perhaps, as I wrote in the above article this will be done mainly through individual HRAs.
  3. Lastly, I believe we'll end up with some sort of Medicaid (not Medicare, that is too expensive) safety net for all who are not fortunate enough to end up in numbers one or two above.

Ninth Circuit Rules That a Temporary Impairment Can Qualify as a “Disability” Under the ADA - "The U.S. Court of Appeals for the Ninth Circuit, the federal appellate court with jurisdiction over much of the western United States (including Washington, Oregon, California and Idaho), ruled last week that an employee’s temporary impairment can qualify as a disability under the Americans with Disabilities Act (“ADA”). The Ninth Circuit’s decision resolves an important question under federal disability law and could signal a significant change in how employers are required to address employees’ short-term medical limitations.

In Shields v. Credit One Bank N.A., plaintiff Shields was employed by Credit One Bank ('Bank') as a human resources generalist. Shields underwent biopsy surgery. The biopsy revealed that Shields did not have cancer, but she had a number of post-surgery limitations (e.g., unable to use her right arm to lift, pull, push, type, write, tie her own shoes or use a hair dryer), and these limitations indisputably precluded Shields from performing the essential functions of her position. The Bank put Shields on a short-term leave of absence, but when she was not ready to return to work after two months the Bank terminated her employment. Shields’ lawsuit alleges the Bank violated the ADA by terminating her rather than offering her a reasonable accommodation, specifically, extending her leave of absence to allow her additional recuperation time. The Bank defended on the grounds that Shields did not have a disability under the ADA because her post-surgery limitations, while significant, were not sufficiently 'permanent or long-term' to meet the law’s requirements. The District Court agreed and dismissed Shields’ claim. The Ninth Circuit reversed. Under the ADA, a disability is defined in relevant part as 'a physical or mental impairment that substantially limits one or more major life activities,' without any reference to how long the 'substantial[] limit[]' might last."

Health & Wellness

The caregiver crisis: How employers can support workers in this new reality - "America faces a caregiving crisis. Whether it’s caring for an aging parent, a sick spouse or a child, more than 50 million Americans are unpaid caregivers for family members and loved ones. Tens of millions of those caregivers are also balancing work with caregiving responsibilities. And while caregiving is a rewarding experience, recent data show that 71% of family caregivers with full-time jobs suffer from mental health challenges and more than half of caregivers say they are too burned out to do their job well. It’s no wonder so many family caregivers are thinking about leaving their jobs."

Half-cup of blueberries a day could keep dementia away, scientists say - "An apple a day may keep the doctor away, but a new study finds blueberries may be better for your brain. Researchers from the University of Cincinnati have found that a half-cup of blueberries can keep middle-aged adults from developing dementia as they get older. Moreover, the study finds adding the fruit to your diet lowers insulin levels and improves metabolic function — making it easier to burn fat for energy."

Friday, May 6, 2022

Compliance and Benefit News Updates, May 6, 2022

 Compliance Updates

IRS Information Letter Explains Requirements for Expenses to Qualify as Medical Care - “The IRS has released an information letter regarding the requirements for expenses to qualify as medical care under Code § 213. The letter responds to a request for guidance on when the cost of health and wellness coaching is medical care that can be reimbursed under health FSAs, HSAs, and other tax-favored accounts.”

Work From Home – SOS! Post-Pandemic Legal Hazards - “A Gallup poll last fall indicated that 61 percent of workers expect to work remotely at least part of the time in the future, and just 9 percent expect to work from home only minimally or not at all. With that in mind, employers and HR professionals must consider how to properly navigate the legal hazards stemming from our new normal. The following provides some key considerations in successfully managing a remote workforce.”

Cal/OSHA Approves Third Revised ETS and Clarifies Position on Some Lingering Questions - “California’s Division of Occupational Safety and Health (Cal/OSHA or “the Division”) Standards Board met on April 21, 2022, and formally approved the third readoption of its COVID-19 Emergency Temporary Standard (“3rd Revised ETS”)… Under Governor Newsom’s previous executive order that paved the way this readoption, the 3rd Revised ETS will become effective when the Office of Administrative Law completes its review and files it with the secretary of state, which is anticipated to occur before the end of the first week of May 2022, and will remain in effect through December 31, 2022.”

Which Federal Employment Laws Apply to My Company - There are a number of different federal employment laws that have their own rules for covered employers. Employers should be aware of the federal employment laws that may apply to their company. An employer’s size, or the number of employees, is a key factor in determining which federal employment laws the employer must comply with. Some federal laws, such as the Equal Pay Act (EPA), apply to all employers, regardless of size. However, other laws, such as the Family and Medical Leave Act (FMLA), only apply to employers that reach a certain employee count. Also, some federal laws, such as COBRA, include exclusions for certain types of employers (for example, churches). This Compliance Overview provides a high-level overview of key federal employment laws and explains which employers they apply to. Most states also have their own labor and employment laws. This summary does not address state labor laws, and it also does not address additional compliance requirements for companies that contract with the federal government or businesses in specific industries.

Benefit News

U.S. Hospitals Struggle to Absorb Pandemic-Era Rising Costs - "Labor costs per patient jumped by 19% in 2021 from 2019, and supplies rose by over 20% per patient during that period, according to the report. Nursing expenses shifted heavily toward travel nurses. The travelers’ share of nursing budgets rose to 39% in 2022 from 5% in 2019."

Spending on U.S. Medicines Rose 12% in 2021 Due to COVID-19 Vaccines and Therapies, Says IQVIA Institute for Human Data Science - Spending on medicines in the United States, at estimated net manufacturer prices, reached $407 billion in 2021, up 12% over 2020, as COVID-19 vaccines and therapeutics became widely available and added $29 billion in related spending. That’s according to a new U.S. Medicines Trends 2022 Report, released today by the IQVIA Institute for Human Data Science. In the same year, the non-COVID medicines market grew more slowly, at 5%, from the growing impact of biosimilars, which increased significantly, offsetting increased use of branded medicines.

HSA/HDHP limits for 2023 - HSA annual contribution limits for individual and family coverage will be $3,850 and $7,750, respectively. The HDHP minimum deductible for individual coverage will increase to $1,500, and $3,000 for family coverage. HDHP out-of-pocket maximum expense limits will be capped at $7,500 for individual coverage and $15,000 for family coverage.

Wednesday, April 13, 2022

Year Over Year Food Price Inflation

Here are the prices increases in various food categories that make up the Consumer Price Index report.

SOURCE U.S. Bureau of Labor Statistics as reported by the Detroit Free Press