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‘Cabin Fever’ May Nudge Us to Suck at Something New

The COVID-19 pandemic poses many challenges, such as staying away from our work environment and being quarantined at home. For each of us, finding safe approaches to procure the necessities at the grocery store or the pharmacy can prove to be an uphill battle. Remotely navigating through job-related commitments also requires mental gymnastics. Unfortunately, others have been furloughed or no longer have jobs due to the limitation of travel and social distancing required for retail interactions. With these challenges, we search for ways to stay healthy – physically, emotionally, and hopefully, intellectually.

Given this short-term reality, I would like to share the following experience that has allowed me to cope with this new upside-down life. It can be challenging to stay both active and positive, especially while being indoors and practicing responsible social distancing.

Biking Outside – Prior to COVID-19

Early in the morning during the Spring, Summer and early Fall, I cycle between 22 to 30 miles each outing. Depending on the time the sun rises, my desire is to beat the traffic on the streets and impressive bike paths found in central Iowa.

For me, cycling in the morning is a sacred experience. This non-interrupted time allows me to plan out the day and hopefully solve problems – usually ‘marinating’ the facts that I know (or should know). Nature, it seems, serves as my inexpensive ‘office.’ Yes, cycling is a form of exercise, but really, it is about lubricating my mental well-being! My preference is to be on my own schedule. Because of this, I ride alone, pedaling as hard as I wish (or can!). I also must admit that I hate crowds!

But as we know, during the winter months, Iowa can be a challenging place to ride a bike. When it’s time to put away the bike, I will spend more time on the elliptical or walk outside. Running is no longer an option due to back issues.

Indoor Bike Trainers

This winter, two friends mentioned to me separately that I should consider purchasing a bike trainer that replaces my bike’s back wheel allowing me to bike indoors during the winter months. I did so in mid-January. And because of the COVID-19 challenges, I am so happy I did!

The equipment setup is actually quite simple:

  • Remove the rear wheel of the bike, attach the ‘smart’ bike trainer to the bike and chain.
  • Connect your bike trainer (via Bluetooth) to an indoor cycling software app which is loaded onto your preferred laptop, iPad or a smart TV. The software will simulate an assortment of road events around the world that a rider can choose while riding with local and international cyclists.
  • Put an appropriate table in front of your bike for your laptop, water bottle(s), etc.
  • Place a mat under the bike to catch your perspiration – the rides can be intense!
  • Have a fan to stay cool – it’s really a must!

One can choose to enter a ‘virtual’ race with others, or simply take a leisurely ride in New York’s Central Park or some other designated location around the world (found on the software app). The app that I use, Zwift, does a great job providing me with vital workout statistics, such as miles ridden, ride time, level of pedaling, and a host of other data.

The ‘Community’ Experience

With other ‘virtual’ riders before the beginning of a race.

Even though I am riding alone in my basement, I pedal with hundreds (and thousands) of other cycling enthusiasts who happen to be biking at the same time – regardless of where they live around the world. Riders can communicate with each other by using their phone app that allow for encouraging comments or by using a ‘thumbs up’ button on the app.  This sense of connection with others can be as much as you want it to be. Given the COVID-19 pandemic, one can still ride with others and yet maintain their social distance!

I share this experience because it does provide a sense of ‘community’ with others who desire to stay active and yearn to have some form of ‘safe’ interaction with the outside world. Since Americans and others around the world have been quarantined the past few weeks, the number of people biking on Zwift (and other apps) has significantly increased.

For me, this new exercise experience has been an excellent opportunity to release the tension that comes from the uncertainty of the stress and anxiety-filled COVID-19 environment. Truth be known, I’ve learned that my biking skills are not as accomplished as I once thought. There are many wickedly-good athletic individuals who can, through great endurance, pedal circles around this bike rider – regardless of age and gender! Put another way, virtual biking can potentially humble one’s self-perception of his/her cycling abilities.

During this period of virtual cycling, I have quickly learned that it’s ok to suck at something new…and actually feel good about it!

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Finally, working from home can have unintentional negative side effects, as I indicated in a 2018 blog.  To help combat some drawbacks, the Healthiest State Initiative has a nice site for those who wish to stay healthy and active while working from home.

Here’s to your continued health and safety!

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Employers and the Coronavirus Crisis

Given the escalating local and worldwide coronavirus (COVID-19) outbreak, we are now inviting Iowa organizations to complete an unscientific ‘survey’ on this website. We hope to learn more about what precautions and business practices employers are taking to avert potential disruptions to the workplace. One example is mandating that a certain classification of employees work remotely. From this information, I will then periodically share personnel practices that have been implemented by Iowa organizations.

In just one day, I’ve been contacted by two friends and an Iowa business on what employers are currently doing to help alleviate the growing concern about this ‘epidemic.’ Because the COVID-19 is both fresh and fluid in our local communities as well as worldwide – so many decisions are being made on the fly as to how to handle and protect employees within the workplace.

Examples of National Employers

How are some key employers locally and around the U.S. responding to COVID-19? Employers have an obligation to notify their employees (and customers) who may have been in contact with a sick employee. Employers should encourage sick employees to stay home – using paid time off benefits or perhaps short-term disability coverage. If no leave is available, the employer may also choose to pay employees – even when they are not sick. This is one way to avoid exposure to COVID-19.

Walmart, effective March 10, began an emergency leave policy after an associate tested positive for the illness. Walmart will allow employees to stay home if they are unable to work or feel “uncomfortable” at work. According to a memo seen by Bloomberg News, employees will need to use regular paid time off options. If their workplace is placed under quarantine, Walmart will pay employees for up to two weeks, and this absence will not count against attendance.

If a Walmart employee is affected by this virus, in addition to receiving two weeks of pay, the retailer will pay “additional pay replacement” beyond the two weeks (if needed), up to 26 weeks for both full-time and part-time hourly associates.

Paid leave and workplace practices are front and center now for employers, and critical for retailers and restaurants. Paid sick leave is much less common for lower-wage employees who work in the leisure and hospitality sector. These employees typically interact with the public, such as in the restaurant industy.

Organizations like Twitter Inc., Microsoft Corp. and Amazon have instructed thousands of employees to work from home, if possible. Whereas Costco Wholesale said that corporate employees cannot work remotely unless there is concern about employees being at high risk. If this should happen, the employee could use vacation or sick time to stay at home.

Wells Fargo, the third largest bank in the U.S., indicated that 62,000 of its 259,000 employees worked from home on Monday, March 9. One employee in San Francisco tested positive for the virus and Wells Fargo learned of this diagnosis two days earlier. Other financial institutions are also taking precautions.

Google, in order to mitigate the potential spread of COVID-19, has sent out a memo to employees across North America to work remotely. Just hours later, Google is extending this recommendation to include all workers in the United Kingdom, Europe, the Middle East and Africa.

Nationwide Mutual Insurance Co. will have many of its 3,300 employees in Des Moines begin working from home, beginning on Monday, March 16. The goal is to have half of its employees working at home at any given time.

An insightful SHRM piece, written by Stephen Miller, regarding employer health, wellness and leave benefits and COVID-19 can be found here.

Centers for Disease Control and Prevention (CDC)

The CDC has a webpage that provides resources for businesses and employers when preparing for COVID-19. It provides a good beginning to address interim guidance for employers, in addition to cleaning and disinfection recommendations. Employers are advised by the CDC to “ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.”

The Centers for Medicare & Medicaid Services (CMS) just sent out a document that contains useful information on measures to keep workplaces, schools, homes and commercial establishments safe.

Summary

Within the span of writing this particular piece, new emails and updates about COVID-19 are coming in with a flurry. One might expect this will be the new normal for a while.

We live in a world that requires vigilance both at home and at work. Despite this evolving environment, remaining calm and gathering as much trustworthy information as possible is the best solution to navigate through this ‘season’ of the unknown.

Again, completing our informal online survey will allow us to share various organizations’ business practices and policies.  As a reminder, our official 2020 survey will be covering many components of paid time off and paid parental leave benefits.

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

Comparing Private Payer Prices to Medicare Rates

Private Payer Prices Relative to Medicare RatesTrust, but verify” is a memorable quote that President Ronald Reagan used while negotiating nuclear disarmament with the Soviet Union in the 1980s. According to Wikipedia, this quote was derived from a rhyming Russian proverb, Doveryai, no proveryai.

Trust, but verify” comes to mind in today’s healthcare environment, specifically as it relates to third-party price negotiations between commercial payers (insurance companies) and health providers. Since the prices we pay for non-government medical care are largely secretly negotiated in the backroom by insurers and providers, the TRUE payers (e.g. taxpayers, employers and consumers) often assume they are paying competitive prices for medical services. But they never really know just how much money is being left on the table – it’s anyone’s guess.

With a few exceptions, transparent medical pricing is virtually non-existent. For example, a family member of mine is scheduled to have a knee-replacement performed during this month, but despite our requests to learn the negotiated costs between our insurer and this provider, we were unable to obtain the true cost of the surgeon’s fee, in addition to many of the ancillary costs associated with this particular procedure. My mindset is quite simple: if we have to ask more than once about how much this will cost, then something is clearly not right with our supposedly ‘consumer-centric’ high-deductible health plan – supplemented by a health savings account. We have a $10,000 deductible, so we SHOULD know the true cost, right? But we don’t.

Additionally, we were offered the ‘choice’ between using the outpatient surgical center (owned by our surgeon’s group practice) versus having this procedure performed at a nearby West Des Moines hospital. When we asked the gracious office lady employed by the group practice about the price differential between the center and hospital, we received a blank stare that was followed with a promise that someone would be contacting us ‘soon’ with answers. Over two months later, we are still waiting for that promised phone call. But because we have insurance, our desire to become true ‘consumers’ is not that urgent. This will be fodder for future blogs!

To date, transparency-hype serves as a smokescreen to protect the status quo of pricing opaqueness. A great primer regarding opaqueness in healthcare pricing can be found at The Powers Report Podcast found here.

Linking Private Payment to Medicare Rates

In March of last year, I attended a conference in Indianapolis hosted by the Employers’ Forum of Indiana. The conference centered around a RAND Corp. research report that revealed a national employer-led initiative comparing private (commercial) reimbursements with known Medicare payments. In other words, how do privately-negotiated rates compare to the lower Medicare rates determined by our federal government? Claims data from almost 1,600 hospitals in 25 states were gathered and analyzed by RAND Corp. Iowa, by the way, was NOT represented in this study*.

Because there is little-to-no price transparency in the private/commercial payment sphere, RAND was forced to gather claims data from three types of data sources:

  1. Self-insured employers who chose to participate in the study.
  2. State-based, all-payer claims databases from Colorado and New Hampshire.
  3. Health plans (insurers) who chose to participate.

The key finding from the RAND study (comparing prices from 2015 to 2017) was that relative prices (which represent the allowed amount paid as a percentage of what Medicare would have paid for the same services) rose from 236 percent of Medicare rates in 2015 to 241 percent of Medicare rates in 2017. Put another way, assume that Medicare prices are at 100 percent, private reimbursements were well over double what Medicare pays hospitals for the same services.

Medicare payments are tied to average hospital costs. Some hospitals, due largely to efficient internal practices that result in lower costs, break even or make money on Medicare patients, while many less-efficient hospitals lose money.

The private reimbursement rates range widely from state-to-state, even when states are next to one another. For example, the RAND study found the average Michigan commercial payer price was 156 percent of Medicare rates, yet, their neighbor to the south, Indiana, was highest of all states with 311 percent of Medicare rates. Suffice it to say, Indiana employers in attendance at this conference where both shocked and upset about overpaying for care when compared to other employers outside Indiana.

Employers, specifically self-insured employers, have a fiduciary responsibility to spend prudently and are justifiably frustrated with ever-escalating healthcare costs that do not add value to their bottom line. Because of this, the RAND report is causing a snowballing effect with employers who wish to take a much more active role in directly negotiating and contracting with medical providers for better, more reliable and effective care. Employers are hoping to narrow the large gap between commercial and Medicare payment rates.

According to RAND, the implications of knowing this information allows employers new “opportunities to redesign their health benefits to better align hospital prices with the value of care provided. Employers can exert pressure on their health plans and hospitals to shift from discounted charge contracts to contracts based on a multiple of Medicare or other prospective case rates.”

What About Iowa Commercial Rates?

Because there were no self-insured employers from Iowa participating with RAND during the 2015 and 2017 studies, there is no information on how commercial payments in Iowa compare to Medicare rates and to other states. This, however, can certainly change if a few large, self-insured Iowa employers would voluntarily share their claims data with RAND* for future analysis. Sharing such data would provide proof that the commercial rates being paid in Iowa are competitive (or not) with other states when using Medicare rates as the measuring stick. Very large national organizations participating with RAND evidently trust that their claims data are highly guarded by RAND and will not be compromised due to HIPAA privacy concerns, etc.

In a perfect world, having completely transparent negotiated rates between commercial payers and providers would eventually become a game-changer on knowing just how competitive the prices are in Iowa and elsewhere. It is telling that research is necessary in order to learn whether or not the prices we pay to our healthcare providers are trusted to be appropriate. As President Reagan indicated a few decades ago, verification is a sound strategy.

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*Self-insured Iowa employers, if interested, can become part of the RAND Hospital Price Transparency Project for 2020-2021.