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Be a "butt" about smoking in the workplace
The death of news anchor Peter Jennings reminds us all of the detrimental effects of cigarette use. Smoking-related diseases claim approximately 440,000 lives each year in the United States alone. Directly attributed to smoking are 90 percent of all lung cancer deaths and 80 to 90 percent of all emphysema and chronic bronchitis deaths. Smoking is also a major factor in the occurrence of coronary heart disease and stroke. More than 8.6 million people have at least one serious illness caused by smoking, meaning that for every person who dies of a smoking-related disease, there are twenty more people who suffer from at least one serious illness associated with smoking.
What does this mean for an employer?
Aside from individual health concerns for employees who smoke, smoking directly affects overall costs in the workplace. It is estimated that a smoking employee costs an employer at least $1,000 dollars per year in total excess direct and indirect health care costs. Other indirect costs that an employer bears include more employee absenteeism, decreased productivity on the job, and increased early retirement due to ill health. Additionally, indirect costs arise out of unemployment, disability, and workers' compensation benefits for illnesses due to exposure from smoking and secondhand smoke.
Employers have a legal right to restrict smoking in the workplace or establish a smoke-free workplace policy. As a result of those employers who have taken a stand on smoking in the workplace, nearly 70 percent of the United States' workforce
was employed under a smoke-free policy as of 1999. Nevertheless, there are still some employers that remain behind the current trend. For those still catching up, various strategies are available in addition to a smoke-free workplace policy. While a smoke-free policy will result in immediate benefits, these additional strategies can help to reduce smoking by employees and overall related employment costs.
- In-house program
An employer may offer informational and motivational presentations by health care personnel, provide individual or group counseling, and/or provide "how to quit" materials.
- Incentive program
An employer may seek to reinforce or enhance an employee's motivation to quit smoking by providing incentives such as an insurance premium reduction or payment of all or some of the costs associated with a smoking cessation program. An incentive may be as simple as providing a button to wear in the workplace with states, "I quit smoking." (See article below: "Caution! Rewarding nonsmoking employees may burn you," for further details.)
- Referral program
An employer may develop a health and wellness program with a medical facility for smoking cessation and counseling or provide referrals to community clinics such as the American Cancer Society or similar agencies or support groups. (Laborwatch; Berens & Tate, P.C., September 2005, Vol. 22, No. 9)
Caution! Rewarding nonsmoking employees may burn you
Insurance premiums continue to rise, and employers constantly search for ways to control the escalation. One alternative is to encourage employees to lead healthy lifestyles. The
reasoning behind this is that healthy employees file fewer insurance claims resulting in lower insurance premiums. With this in mind, some employers reward nonsmokers by offering, for example, a discount on insurance premiums. Simple enough, right? Not necessarily. Many employers do not realize that such rewards can violate HIPAA if not correctly structured.
Proposed HIPAA regulations prohibit discrimination on the basis of any "health factor." Because nicotine addition has been found to be a health factor, rewarding nonsmokers can be discriminatory. However, there is a loophole. Rewards provided through a bona fide wellness program are lawful. Here are some pointers for complying with the proposed rules:
- The reward can be in the form of a discount, rebate of a premium or contribution, waiver of all or part of a cost-sharing mechanism, or the absence of a surcharge.
- The total reward given to an individual for not smoking cannot exceed 20% of the total cost of employee-only coverage. The cost of employee-only coverage is based on the total amount of employer and employee contributions to the premium.
- The program must be designed to promote good health or prevent disease. A program is not reasonably designed to promote good health or prevent disease unless the program gives employees eligible for the program the opportunities to
qualify for the reward at least once per year.
- The reward must be available to all similarly situated individuals. Specifically, the program must allow any individual for whom
it is (1) unreasonably difficult due to a medical condition to quit smoking; or 2) medically advisable to attempt to quit smoking to satisfy a reasonable alternative standard in order to qualify for the reward. For example, a current smoker for whom it would be unreasonably difficult to quit smoking could be given the reasonable alternative of participation in smoking cessation classes. For the period the employee participated in smoking cessation classes, he or she would be eligible for the reward even if the employee did not quit smoking.
- All plan materials describing the program must disclose the availability of reasonable alternative standards. The plan materials are not required to describe the specific details of reasonable alternative standards.
Keep in mind that these are proposed regulations and may change. Also, these rules don't just apply to rewards for nonsmokers; some employees reward employees with low cholesterol or low body fat ratios. These are health factors as well, and you should also follow the pointers given above.
Finally, don't forget to check state law. Some states prohibit employers from discriminating against employees who smoke. In those states, even a bona fide wellness program that meets the HIPAA requirements may violate state law. (Laborwatch; Berens & Tate, P.C., December 2005, Vol. 22, No. 12)
Increasing diversity throughout Nebraska's health care workforce
In an effort to increase minority representation throughout Nebraska's health care workforce, the NHA convened a collaborative minority recruitment team in September 2005. The first project implemented by this team will be a recruitment poster promoting racial and ethnic diversity throughout the health care workforce. This poster will feature Nebraska health care professionals - all representing different professions in diverse health care settings - and all representing disparate racial and ethnic minority groups. We hope that you can help us identify health professionals to be featured on this poster. This project will not only highlight some of the minority health care professionals in Nebraska, but also salute the health care workforce in general by illustrating the many types of health care professions and opportunities in Nebraska.
We are looking for a representative sample of minority health care professionals in Nebraska to include on the poster - a number of different professions will be featured. We ask that you please encourage health care professionals in your organization to fill out an application and submit a snapshot photo by February 20, 2006. A selection committee will review the applications and all applicants will be notified of the results.
If you have any questions or would like additional information, please contact Carly Runestad at 402/458-4915, or
crunestad@nhanet.org. The application can be found at:
http://www.nhanet.org/news/pdfs/posterapplication.pdf. Thank you for your time and participation.
Diversity matters
There's a talented, loyal and hard-driving workforce out there that's just waiting to be tapped. And despite their proven added value to America's businesses, they collectively remain a large, unacknowledged trove of would-be employees.
According to a recent National Organization on Disability Survey, only 35 percent of people with disabilities reported being employed full- or part-time, compared to 78 percent of those who do not have disabilities.
Nancy Starnes, vice president and chief of staff, National Organization on Disability, says there are many benefits to hiring disabled workers. She points out that studies demonstrate that such employees have "above-average records in job performance, attendance and safety. They are no harder to manage than anyone else," she says, adding that once an employee has acquired a disability, "there is little to no difference in medical utilization from that of other workers."
Employers savvy to the ways disabled workers can improve their bottom line should seek out people with disabilities for all levels of their organization, says Starnes. She suggests that companies strive to provide opportunities for advancement through mentoring and training opportunities. Such initiatives, she says, effectively work to dispel the "fear of the unknown" when it comes to people with disabilities.
Starnes also recommends offering an internship for local students with disabilities, contending it can be a good learning experience for both young people with disabilities and a company's seasoned professionals.
There are also strategic ways employers can actively court workers with disabilities. Starnes says employers can make themselves particularly attractive to this group by having a mission statement that recognizes that "disability is part of diversity." Employers should also publicize their commitment to diversity via images of people with disabilities on their Web sites and in their commercial advertising.
Combating the misconceptions people have about workers with disabilities begins, says Starnes, with realizing that "each person with a disability is unique in their abilities and approach to work life. Some may aspire to leadership, others may be driven by a desire for security, and still others are entrepreneurial."
The negative misconceptions persist, says Starnes, because disabled workers have difficulty in getting a chance to prove their talents. "People with disabilities," she says, "value employment relationships in a way that many other workers
don't. They are loyal, hard-working individuals who want to contribute to a corporation's positive image and bottom line." (Diversity Matter: Diversity News and Views That Matter to You; Bernard Hodes Group, October 2005)
NHA health care supply forum
The Nebraska Hospital Association, in collaboration with Nebraska Community College Health Directors, is pleased to offer a new service on the NHA Web site to facilitate the exchange of health care supplies. Secondary
schools throughout Nebraska would like to receive supplies and medical equipment donations for their health education classrooms. The NHA Health Care Supply Forum allows hospitals to post supplies available for donation to Nebraska academic institutions. The forum also enables schools to post their needed health care supplies or equipment. Hospitals that have space for various classes, such as CNA classes, are also encouraged to identify this on the forum.
Secondary schools would appreciate all types of health care donations. Examples of donated items include hospital beds, medical equipment (outdated equipment is acceptable), lab equipment, and health care supplies - gloves, antiseptic, swabs, etc.
To use the NHA Health Care Supply Forum, go to www.nhanet.org/forum, simply register your name and password and follow the instructions for posting the items you have to donate or would like to receive. The forum is free for Nebraska
hospital staff and academic members.
If you have any questions about the supply exchange program, please contact Carly Runestad, health policy specialist, at 402/458-4915 or
crunestad@nhanet.org. If you need technical assistance, please contact Angela Barry, communications specialist, at 402/458-4903 or
abarry@nhanet.org.
Study aims to make business case for more RNs
Hospitals could reduce patient deaths and expensive complications by boosting the proportion of registered nurses on their staff without an increase in costs, according to a proposal aimed at making a "business case" for better nursing care.
The study in the journal Health Affairs posited several approaches to improve the quality of care in hospitals, under a spotlight since a series of government reports in the late 1990s underscored the role of human error in tens of thousands of unnecessary deaths. It finds that hospitals could avoid 5,000 annual patient deaths if they boosted the proportion of registered nurses, by replacing 37,000 licensed practical nurses with RNs. LPNs require less training and education compared with RNs.
Based on data from 800 acute care hospitals, researchers found that boosting the mix of RNs and LPNs, while keeping the number of total nursing hours constant, would cost hospitals $811 million, but save $1 billion in the short term. "It certainly pays for itself to simply increase the number of RNs without increasing the number of hours of care," said Jack Needleman, an associate professor in the school of public health at the University of California at Los Angeles and lead author. Over the longer term, the savings are estimated at $2.6 billion.
A complete version of the study can be found at: http://content.healthaffairs.org/cgi/reprint/25/1/204.
NHA salary survey
The semi-annual salary survey data entry process is underway. For your information:
- The salary survey can be found at: https://www.healthcaresalarysurvey.com/.
- February 15, 2006 is the deadline for all data entry (including executive data).
- If you have questions or comments about the salary survey program, or if you are unable to remember your username or password, please contact Carly Runestad at
crunestad@nhanet.org or call (402) 458-4915.
NHA turnover & vacancy report
Just a reminder to enter your organization's turnover and vacancy rate report information.
- Turnover and vacancy rates can now be entered for both the third and fourth quarters of 2005.
- The turnover and vacancy rate report can be found at: https://www.healthcaresalarysurvey.com/.
- If you have questions or comments about the turnover and vacancy rate program, or if you are unable to remember your username or password, please contact Carly Runestad at
crunestad@nhanet.org or call (402) 458-4915.
HC Workforce News is published by the Nebraska Hospital
Association, 1640 "L" St., Suite D, Lincoln, NE 68508-2581. Phone 402/458-4900, Fax 402/475-4091.
Carly Runestad, editor, at crunestad@nhanet.org.
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