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Caregiving Crisis – Employers Beware

Iowa is fortunate to have many jobs available for applicants, but unfortunately, there are not enough bodies to fill those positions. According to a 2017 Wall Street Journal article, Iowa, and 11 other Midwestern states have experienced a net outflow of 1.3 million people between 2010 and July 2017. In fact, if every unemployed person in 12 Midwestern states was placed into an open job, there would still be 180,000+ unfilled positions. The Iowa Workforce Development recently announced the number of unemployed Iowans in December (2018) is 40,600, an historic low of 2.4 percent. Iowa has THE lowest unemployment rate in the U.S.  (The U.S. unemployment rate in December moved up to 3.9 percent.)

To combat low unemployment, Iowa along with other states have developed plenty of free programs to train low-skilled workers for higher-skilled positions. For the second consecutive year, Iowa was named by Site Selection magazine as the Midwest’s top state for workforce training and development.  Another 2018 Wall Street Journal article indicated that Iowa’s extremely low unemployment rate has drawn “thousands of workers off the sidelines…with the share of Iowa adults working or seeking work at 67.9 percent in February (2018), nearly five percentage points more than the national average.” Rural Iowa employers have it more challenging, as the pool of local talent is just not there to fill positions.

Caregiver Responsibilities at Home

Now comes yet another challenge, but not just for Iowa employers. A new national survey by a pair of Harvard Business School researchers found that employers are likely to underestimate the struggle their employees have when balancing their professional and caregiving responsibilities. Caregiver responsibilities include providing for children and elderly parents. In fact, about three-quarters of U.S. employees face caregiving responsibilities, of which, 32 percent have left their job because they were unable to balance work and family duties. If employers fail to provide support for caregiving responsibilities, they will pay the hidden costs of presenteeism, absenteeism, turnover and rehiring.

This study was based on surveys of both employers and employees. A key finding was that despite more than 80 percent of employees saying their responsibilities at home kept them from doing their best at work, only 24 percent of employers believed that caregiving was affecting their employees’ performance. This enormous divide is troubling, yet it can also help nudge employers to understand what they can do to retain employees, especially during a very tight labor market.

Other study highlights include:

  • Younger employees, ages 26 to 35, were more likely to leave a job because of caregiving responsibilities.
  • Hard-to-replace higher-paid employees and those in managerial or executive positions were also most likely to quit.
  • More men than women said they left a job because of family needs.
  • As the nation ages, caregiving responsibilities are expected to grow. The Census Bureau projects that for every 100 working-age Americans, aged 18 to 64, there will be 72 people outside that range by 2030, an increase from 59 in 2010.
  • With an increasing share of jobs expected to require a college degree or beyond, the loss of many women could exacerbate labor shortages in the future.

This study caught my interest because, for the first time since we began in our employer benefits study in 1999, we will ask a series of work-life and convenience questions in our 20th Iowa Employer Benefits Study©. Among asking many work-life benefit questions, we will learn about the prevalence of the following caregiver benefits offered by Iowa employers, such as:

  • Personal days
  • Sabbatical leave
  • Adoption leave
  • Foster child leave
  • Leave to attend a child’s activities
  • Maternity leave
  • Paternity leave
  • Child-care subsidies
  • Elder-care subsidies
  • On-site or near-site child and/or elder care
  • And more…

As we learned from surveying both Iowa employers and their employees in our 2007 Iowa Employment Values Study©, there can be a great disconnect between what employees’ desire at the workplace versus what their employers think is important to employees. The aging of the Iowa workforce, in addition to the challenges faced by young families can cause caregiver ‘tension’ that adversely impacts both employees and the unsuspecting employer. To address these challenges, Iowa employers must search for new ways to further accommodate the changing workforce environment pressures that are vital to employee well-being and, consequently, their productivity.

Sometime this summer, our 2019 survey will reveal new results about the prevalence of caregiver programs offered by Iowa employers. Such benefits, I suspect, will vary greatly by industry and by employer-size categories.

To stay abreast of employee benefits and healthcare issues, we invite you to subscribe to our blog.

Hospital Pricing Mandate – A Sort of ‘Bird Box’ Reality

NOTE: This photo is not Sandra Bullock, but rather, a healthcare shopper seeking assistance online.

Over the holidays, my daughter and I watched a newly-released Netflix movie, ‘Bird Box.’ Other than having Sandra Bullock as the lead actress, I knew nothing about the film. The plot of this show, without issuing a spoiler alert, is that some unknown force mysteriously destroys the earth’s population, and the only certainty of survival is to not ‘see’ this evil. To remain alive, survivors must cover their eyes from the evil that chases them. One small peek can spell doom for those curious. In this riveting movie, having blindfold vigilance is the difference between life and death.

Recent findings in the January issue of the Health Affairs journal reveals that higher costs, not better patient care, serve as the primary explanation on why the U.S. spends much more on healthcare than other developed countries. Researchers found that U.S. healthcare spending was $9,892 per person in 2016, about 25 percent more than second-place Switzerland, which averaged $7,919 per person. Our neighbor to the north, Canada, is less than half of what we spend, $4,753.

The drivers for this enormous cost chasm, according to this article, is that the U.S. has higher drug prices, higher salaries for doctors and nurses, higher hospital administration costs and, yes, higher prices for many other medical services. Despite these costs, Americans have less access to many healthcare services than residents of other developed countries. A perfect storm, we might say. I have reported similar findings in a prior blog.

To make matters worse, the same study indicated that in 2015, there were 7.9 practicing nurses and 2.6 practicing physicians for every 1,000 Americans, compared to OECD medians of 9.9 nurses and 3.2 physicians. The long-term prospects of our numbers improving are not promising. Also in 2015, the U.S. had only 7.5 new medical school graduates per 100,000 people, considerably less than the median of 12.1 in developed countries.

Certainly, there must be some good news to share with you, right? Yes…and no.

Hospital Price Transparency Requirement

The prices we pay for hospital care, clinics, surgery centers, and prescribed medications, are usually unknown until sometime AFTER the interaction – typically following review and payment by our insurance vendor. The healthcare infrastructure gives much lip service to patient centricity, but follow through is underwhelming, to put it mildly. Transparency is extremely important these days because most Iowans and Americans are required by their health plans to pay higher deductibles and co-pays when seeking medical care.

Beginning January 1, the Centers for Medicare and Medicaid Service (CMS) is attempting to force price transparency by requiring all hospitals to post their list prices online. Under this arrangement, hospitals are required to publish a list of their standard charges online in a “machine-readable” format and to update this information at least annually. Hospitals are currently required to make this information publicly available or available upon request.

On the surface, this appears to be a hopeful beginning for all shoppers – and it is. However, when I look at hospital websites in Iowa and elsewhere, mandated compliance is far from patient centric. Using two of the largest hospital systems in Des Moines as proof – Mercy Medical Center and UnityPoint – we have a long way to go before price transparency nirvana can be reached.

Mercy Medical Center – Des Moines

The Mercy ‘Cost Estimator’ tab begins with a disclaimer that any costs published are nothing more than ‘estimates.’ The price-shopping patient must first click the “I Agree” button before being allowed to advance to the next page, which is sort of a magical mystery tour (special thanks to Lennon and McCartney). This page shows a similar disclaimer that all prices are mere ‘estimates,’ (special thanks this time to lawyers and marketing). In the left margin, we find links to a dozen ‘body systems’ that will allow price-shoppers to analyze procedures, median charges, various percentile charges, MS-DRG/CPT and Codes.

Not to be outdone, an exhausting ‘list of current standard charges’ is found subtly at the bottom of the ‘Body System’ list. Progress is now being made (tongue in cheek), as the price-shopper (hopefully not needing urgent care while searching for helpful prices) can find a treasure trove of data in an Excel spreadsheet:

  • CDM Numbers
  • Code Descriptions
  • CPT Codes
  • Revenue Codes
  • Charge

This spreadsheet shows 40,054 charge description masters (CDMs), which are incomprehensible medical procedures that are a hodgepodge of numbers and technical medical terms. One example is the 46040 4405 Abscess I&D Ischiorect, which has a charge (before discounts) of $10,936.  Huh?

In fairness to Mercy Medical Center, largely due to their repeated disclaimers, my expectations for finding value were set reasonably low. Put another way, I would not use this website as a shopper, as it is absolutely meaningless. Hospitals provide this data (and the gibberish language that comes with it) only because they are federally required to do so, not because they have a profound desire to empower patients.

Have you ever bought a non-medical product or service using ‘estimated’ prices? I didn’t think so…nor have I.

UnityPoint Health

UnityPoint’s ‘prices’ are found in the tab aptly labeled, ‘Patient Charges and Costs.’ On this page, the hospital does a reasonable job of explaining what the charges are…and are not. About halfway down this page the price-shopper can find two links that provide “Des Moines’s current charge information as of December 31, 2018,” in addition to “Des Moines’s standard Diagnosis-Related Group charge information as of December 31, 2018.” Each link will take the shopper to Excel spreadsheets that make little to no sense…even for someone like me, who makes a living using spreadsheets.

UnityPoint also provides a link to Iowa Hospital Charges Compare, a website provided by the Iowa Hospital Association. In addition to comparing ‘estimated’ hospital inpatient services by selected Iowa hospitals, it also provides ‘estimated’ prices for outpatient surgery procedures.

Trying to determine hospital prices in advance of a test, procedure or stay is daunting, frustrating and futile. This new hospital ‘transparency’ requirement is a very small step that needs a rocket boost into the 21st Century. What price-shoppers now see on hospital websites come from ‘chargemasters,’ which are massive compendiums of prices set by each hospital for every service or drug a patient receives. Historically, even hospital administrators can be flummoxed by how chargemasters are established.

But the real issue is that each published price is nothing more than a ‘list’ or ‘estimated’ cost. Currently, most procedures are still being charged separately, and are not bundled together. In most hospital encounters, it is extremely difficult to determine whether additional procedures will be required PRIOR to the patient entering the hospital. On top of this, the negotiated price of any claim is determined by the third-party payer (e.g. insurance companies, self-funded plans, Medicare, Medicaid, etc.) the shopper uses. Additionally, hospital location and the shopper’s specific health plan features (deductibles, coinsurance, etc.) will also determine the final cost.

Here’s a novel concept: Instead of pricing their services using the ‘horseshoes and hand grenades’ approach, hospitals could take the initiative and partner with ‘motivated’ insurance payers to develop a patient-friendly tool that provides legitimate ‘real-time’ prices along with patient-specific health plan out-of-pocket calculators. This sounds much too simple, doesn’t it?

Transparency WITHOUT the blindfold

To stay alive, Sandra Bullock needed to keep her blindfold close by before navigating outdoors. Healthcare shoppers, on the other hand, are trying remove their blindfolds to make appropriate decisions when seeking high-value healthcare. Unfortunately, to maintain the status quo, the current healthcare infrastructure works very hard to keep the blindfolds tight and opaque. But, to do the right thing in healthcare, we must tear down the existing silos of self-interest that dominate the care that Iowans and Americans deserve – and pay for.

Much work needs to be done to find this common good. By doing so, our blindfolds may finally be removed and clarity revealed.

To stay abreast of employee benefits and healthcare issues, we invite you to subscribe to our blog.

Working Remotely – It Comes at a Cost

I sometimes joke that my “international headquarters” is located in Clive, Iowa, with satellite offices peppered “throughout the globe.” Technically, there is a great deal of truth to this seemingly impressive boast. However, fact and fiction become more clear after revealing my true workplace arrangement.

My office is indeed based in Clive, but I don’t participate in daily or weekly employee meetings. I do not gossip at the water-cooler – heck, I have NO water cooler! My office consists of one person – ME. When I am not physically in the office, I can be anywhere and everywhere still transacting business – with the assistance of my laptop, iPhone and iPad (Wi-Fi is a critical ‘friend’ to me). Even though I have a physical office, I often feel that I work ‘remotely’. Much of what I do is by myself or orchestrated with a few trusted third-parties. I have come to like this ‘remote’ arrangement a great deal. But it does come at a cost.

According to a 2017 Gallup survey, 43 percent of 15,000 employed Americans said they spent at least some time working remotely – usually from their own home. This represents a four percent increase from 2012. In our 2016 Iowa Employer Benefits Study©, we found that over 34 percent of employers with more than 101 employees offer flextime, while just over 14 percent of employers with fewer than 101 employees did. Flextime allows for employees to customize their schedules within a certain range of hours and days. Unfortunately, these results do not specifically reveal how many Iowa employers allow employees to work remotely.

Flexible scheduling and working remotely are increasingly important factors for employees to take (or leave) a job. Employees argue, and many employers acknowledge, that these practices are beneficial for both – workers are more productive for their organizations (an obvious win for employers) while being able to more successfully navigate through their own personal work-life issues (a win for employees). Working remotely and having flexible hours also provide financial upsides to employees –  savings in lunches and transportation costs, along with having greater childcare flexibility.

A 2015 Employee Job Satisfaction and Engagement report by SHRM indicated that 55 percent of employees cited that flexibility to balance work and life issues was a very important aspect of their job satisfaction. This same report found that leading reasons employees would not leave their jobs within the next year was primarily due to compensation/pay (45 percent) and having the flexibility to balance work and life issues (42 percent).

But, as I have personally found, working ‘remotely’ does have some drawbacks. Here are two of the largest challenges that employers (and employees) should be cognizant of when working remotely.

Social Connectivity Can Suffer

Social connectivity drives the engine of our mental well-being. Connectedness within the workplace plays a vital role for employees to feel they are seen, heard and valued through organizational relationships. Working remotely can easily isolate one from social inter-activities that is crucial for employees who yearn to have the ‘sense of belonging.’

According to the 2018 State of Remote Work, surveyed employees who work remotely reported the two biggest advantages were having a flexible schedule (43 percent) and spending time with family (15 percent). But, if not careful, these advantages can be offset by loneliness (21 percent), reduced collaborating/communicating (21 percent), having distractions at home (16 percent), and staying motivated (14 percent).

To go one step further on social isolation and loneliness, as more people in the U.S. are living alone, some researchers are warning this could become a “greater public threat than the widely discussed problem of obesity.” That should grab our attention!

To combat the negative side-effects of loneliness, employers might encourage (or establish policies) requiring remote workers to come to the office once a week to learn and grow. Studies suggest this approach is more likely to generate happier employees compared to fully-remote employees who don’t physically reconnect with the office.

Some employees may be quite geographically remote, and perhaps it would be more realistic to have them come to the office monthly or quarterly. Speaking from experience, the most rewarding days at my office usually result from having face-to-face meetings with various individuals that I would otherwise correspond with via phone or email. Embracing the opportunities to physically meet with others should always be a priority – it is for me.

Stress or Burnout

This may sound somewhat counterintuitive to some of us, but working remotely can nudge employees to work longer hours to please their supervisors, just because they are grateful for having the opportunity to work remotely. For me, if I don’t stay on top of my self-imposed projects, they will not be completed. This responsibility causes added pressure to ALWAYS be engaged with my work, sometimes more than I really should be.

Unintentionally, employees may burnout from performing this additional work without the employer having the benefit of monitoring the employee’s well-being throughout a course of time. That is why it is so critical for organizational leaders to engage with remote employees about what is going on – not only in their work – but with their personal lives. Feeling isolated has large, emotional costs.

As workplaces continue to morph into new environments that require employees to work remotely, it is imperative for leaders to find ways to have regular ‘face-time’ to ensure the worker does not lose the social connectedness that will keep them both happy and productive. This same principle applies to entrepreneurs who are working on their own.

To stay abreast of employee benefits and healthcare issues, we invite you to subscribe to our blog.