We have a Compliance Team that I’m part of here at Benefit Associates. We talk about regulations like ARRA, HIPAA, CHIPRA….. does that sound like alphabet soup to you? Sometimes, it feels like it’s not too far off!

Compliance issues often get relegated to the back burner. They’re not that exciting, they’re complicated, and it’s hard to stay on top of all the changes. If you work in HR and are familiar with the COBRA subsidy, you’re probably nodding your head!

But compliance issues are a big deal. HIPAA fines, for example, have been increased with the passage of ARRA. Prior to ARRA, violations capped out at $250,000 and up to 10 years in prison for certain wrongful disclosures. Now, fines will cap out at $1,500,000. It’s not a big deal if your company is compliant and take the appropriate steps to protect PHI, but the increased fines reflect the seriousness of the law.

Other changes added by ARRA:

• The Office of Civil Rights is authorized to conduct investigations and impose civil monetary penalties against any individual for criminal violations of HIPAA if the Department of Justice has not prosecuted the individual.
• Violations due to willful neglect require formal investigation and imposition of civil monetary penalties. The Secretary of HHS is to issue regulations within 18 months of ARRA’s enactment to implement this change.
• State attorneys general are authorized to bring civil actions in federal court seeking injunctions or damages against individuals who violate the HIPAA rules. Damages are limited to $100 for each violation of HIPAA and $25,000 for similar violations in a calendar year.
• The Government Accountability Office is to recommend to the Secretary of HHS a method by which individuals who are harmed by violations of HIPAA would receive a percentage of the civil monetary penalties or monetary settlements collected. The Secretary of HHS is required to establish by regulation the implementation of this methodology within three years of ARRA’s enactment.

Even with wellness programs, there are rules to follow. The Federal Register regulations surrounding wellness programs, for example, have standards in place in regards to incentive amounts with using health status factors.

The moral of the story is this - the fines and penalties for ignoring filings or laws regarding issues are steep. You can’t afford to ignore them!

Last week, I nervously mailed off our company’s WELCOA Well Workplace application to Omaha, Nebraska. I spent a good bit of time collecting information and putting it together, and a 1-inch binder with program details and explanation was the end product.

If you don’t work in the health promotion and wellness realm, WELCOA is the Wellness Council of America. Here’s a blurb from their website about what they do:

The Wellness Council of America (WELCOA) was established as a national not-for-profit organization in the mid 1980’s through the efforts of a number of forward-thinking business and health leaders. Drawing on the vision originally set forth by William Kizer, Sr., Chairman Emeritus of Central States Indemnity, and WELCOA founding Directors that included Dr. Louis Sullivan, former Secretary of Health and Human Services, and Warren Buffet, Chairman of Berkshire Hathaway, WELCOA has helped influence the face of workplace wellness in the U.S.

Today, WELCOA has become one of the most respected resources for workplace wellness in America. With a membership in excess of 3,200 organizations, WELCOA is dedicated to improving the health and well-being of all working Americans. Located in America’s heartland, WELCOA makes its national headquarters in one of America’s healthiest business communities Omaha, Nebraska.

Our Beliefs
Predicated on improving the health and well-being of working Americans throughout the United States, WELCOA adheres to a steadfast set of beliefs. Indeed, we believe:

• Healthcare costs are an issue of significant concern.
• A healthy workforce is essential to America’s continued growth and prosperity.
• Much of the illness in the U.S. is directly preventable.
• The workplace is an ideal setting to address health and well-being.
• That workplace wellness programs can transform corporate culture and change lives.

Our Mission
As one of the nation’s premier resources for workplace wellness, our mission is to serve business leaders, workplace wellness practitioners, public health professionals and consultants of all kinds by:

• Promoting corporate membership;
• Producing leading-edge worksite wellness publications and health information;
• Conducting trainings that help worksite wellness practitioners create and sustain results-oriented wellness programs;
• Creating resources that promote healthier lifestyles for all working Americans.

WELCOA is essentially the gold standard governing body of wellness. In addition to publishing resource materials, opinions, and selling health education pieces, they also certify wellness programs through their Well Workplace designation. We just applied for the Small Business Workplace Wellness designation, created just for businesses with less than 50 employees.

I get the question from employers rather frequently about these designations, awards, and such. Are they worth my time? Is this something I should be considering? What is going through this process going to bring to my program? The answers certainly aren’t black and white, but in short, yes, you should be considering a certification for your wellness program. Getting approval brings credibility to your program and will establish your place in the wellness world. But (and there is always a but!) going through the certification process isn’t a cake walk. You will most likely have to add activities, components, and measurement tools your program didn’t have before. They won’t always be things you think are useful, either.

Case in point? For our WELCOA application, we had to conduct a wellness interest survey. I created a questionnaire using our QuestionPro software and sent it to our employees. I got back the responses and included them in our application. Was it valuable? Maybe. It was nothing new for me. But we have a small group, we’re all in one location, and if people are interested in something, they generally let me know. Even though I thought the exercise was not exactly relevant to us, we had to do it anyway.

Now that we went through the steps and sent in our application, I’m waiting the standard 6-8 weeks for a response from the good folks at WELCOA. I am hopeful that we’ll get certified and our name will join the other great companies on the list. In the event that we don’t get certified, I’ll certainly be disappointed but it won’t mean that our program isn’t meaningful and hasn’t had an impact on our employees. But I am hoping I won’t have to worry about that!

Ten years ago, I had the pleasure of working with Sadee Van Ruler.  This was during my non-profit days.  I recall Sadee telling her story about the impact her mother had on her life even though Sadee spent only 8 years with her.

Sadee was born and raised in Galesburg, IL.   You may have stopped there for gas or a Subway sandwich on your way to Colorado.  Sadee’s parents were taught to save their money and protect their families interests. When Sadee was four, her mother was diagnosed with breast cancer, which had spread to her spine.  After a four year battle, her mom passed away.  Her mom was a wonderful, bubbly, out-going person.  Sadee takes after her.  It takes only five minutes with Sadee and you have gained a friend for life.

Because of her family’s diligence, Sadee’s dad was able to stay at home and take care of 8 year old Sadee AND his parents, who lived nearby.  Sadee was able to attend Northern Illinois University and graduate debt free.  This allowed her to enter the non-profit world free from the burden of debt.

Today, Sadee is married to husband Aaron. She is a Chapter Advisor for Alpha Phi sorority, teaches English for international students at Indiana University and is involved with her local church.  A success story indeed.

It was her father’s planning and the proceeds from a life insurance policy that allowed a legacy to continue.  I think of the many many people that Sadee works with today and I am grateful for Sadee’s family and their wise planning.

Sadee and Aaron

Do you feel like you need an interpreter to figure out your health insurance? Copays, deductibles, providers, out of pocket maxes…. these words quickly become confusing, even if you have a vague idea of what they mean. The Wall Street Journal (if you hadn’t noticed by now, I love the WSJ!) ran an article yesterday entitled The Importance of Deciphering Your Health Insurance. I think what it boils down to is that your health insurance can’t just be ignored. You can’t wait until you’re sick to figure it out.

A Harvard study back in 2007 examined bankruptcy filings and found that 62% of bankruptcies in the US are caused by medical issues - but more staggering, 78% of those people had health insurance. Does that scare you? It should!

So what can we learn from this? Here are my recommendations:

• When it’s Open Enrollment time at your company, take the time to review the plans and make an educated decision. If you have questions, talk to your HR department. If you have a private insurance policy, talk to your broker or the carrier. There are no stupid questions. Really.
• Confirm that your doctors and local hospitals are in-network. Out-of-network costs are probably covered differently on your plan, and they’ll cost a whole lot more. By confirming your local hospital’s in- or out-of-network status, if you ever do have an emergency, you’ll pay less going there.
• If your doctor recommends a procedure, or follow up test, don’t be afraid to ask about the cost and whether it’s necessary. For example, if your doctor suggests that an MRI could rule something out, ask “Do I really need it?” or “What would you do in this situation?”
• Ask if there is a generic available. Using a generic could save you ton of money.
• Don’t assume anything. If you understand how something is covered, great! But don’t assume that it’s covered a certain way because of what someone at your office told you or how insurance has paid something before.

And most importantly…

• If you’re having a procedure done, either in the hospital or just in an outpatient center, confirm with your HR department and the insurance company how your claim will be paid. You might need a pre-authorization for the procedure. You might need a letter from the doctor. If you read the WSJ article above, most of the people referenced had a procedure and then found out the the procedure was going to cost a whole lot more. You can avoid this by researching it before you have it done.

At the same time, I realize that it might not be possible to research a procedure. If you’re having a heart attack, that last thing you want to do is spend time on the phone asking how your claim will be paid. But if you’re having a scheduled procedure, like a knee replacement, won’t you feel better going into the surgery knowing how things are covered and that there will be no surprises? I know I would!

Have you read a newspaper lately that talks about the economic crisis? Turned on the TV to watch a news story about massive layoffs? Opened a magazine to read about the billion (or is it trillion now?) dollar defecit? If I didn’t know better, I would run for the hills and give up. The media paints a pretty grim picture of what’s going on right now.

I think it’s important to remember that there are positive economic signs out there. Today I was encouraged by a friend to remember that there is an abundance of positive events in the world. The media is created to display many negatives to help increase ratings and viewership. Uplifting stories about a man getting laid off and finding a new job just doesn’t garner the attention that it deserves.

The first quarter of consumer spending increased 2.2%. Additionally, we are seeing the overall savings by Americans increase as well. The demand for large item durable goods rise by around 9%. We do know that housing prices in many areas are down 20%. The S & P is up roughly 30% from its low point in early March.

Remember these are positives and that cash is loosening! There are better times ahead. You just have to look a little harder for it.

Along with my birthday  cake, I recently received my wonderful Social Security statement. It outlines my credits for my years working at O’Malia’s Food Market, McDonalds, Campus Crusade, and Benefit Associates.  It states that when I turn 65 I might receive $2,000 per month. Well, I’m a 35 year old male with about 30 years left to work. It would be naive of me to think that I will see any of that money. Although it would be nice, I certainly don’t feel like I can depend on it. CNN just released a few statements regarding Social Security and Medicare. Here are the facts- 

• The trust fund is to be exhausted by 2037.  (Too bad for me, who will retire around 2039…)
• The trust has taken a major hit with massive layoffs and unemployment
• Medicare is in the worst shape and is expected to be completely depleted by 2017

What’s your plan? Do you feel confident that there will be Social Security payouts in the future? Do you have any unconventional strategies to save up for retirement? Do share!

The New York Times ran a great story in today’s print edition about staying home when you’re sick. It got my mind thinking about how often we disregard our own health and well-being for what we think is important. Even working in the realm of health and wellness, I do it too! There have been times that I haven’t felt well (and haven’t looked that great!) and gone into work anyway. Maybe I had a big meeting or just needed to get some things taken care of at the office - I think we’ve all felt like that. I always seem to get sick at the most inconvenient times.

And it’s no wonder! Stress does a number on your immune system so that when you’re the busiest, you’re more susceptible to falling ill. So what can you do?

• Take a multivitamin and consider adding vitamin C when you feel like you might be getting sick. The research is inconclusive if the vitamin C actually helps or it’s a placebo effect, but it can’t hurt. At least that’s my non-MD thinking!
• Schedule time to yourself. It might sound crazy to add to your busy schedule, but by taking time away from the office for lunch or just to get away, you’ll calm down and relax, at least for a little while.
• Clean off your desk. Keyboards and phones are havens for bacteria.
• Wash your hands often and for enough time. A neat trick for kids is to have them sing the ‘Happy Birthday’ song twice. It works for adults, too.
• Stay home from work! If you’re ill, you’re not nearly as productive and you’re bringing everyone else down in your office by exposing them to your sickness. Stay home in bed, watch some daytime TV, and call me in the morning.

Do frozen dinners conjure up an image like this in your mind?

Frozen dinners have come a long way since then! For the most part, at least. I have seen Hungry Man dinners that look very similar to the one above, but in general, frozen dinners can be a healthy alternative to cooking yourself. Sometimes though, sodium and sugar can be sky high, just like with all prepared, processed meals.

WebMD has come up with a top 12 list of healthy options. Click here to view. I can vouch for the Lean Cuisine Chow Fun - it’s tasty!

These past few weeks our family has been able to celebrate with friends their new arrival, the sadness of saying goodbye to Grandma Dot and learning of a recent cancer diagnosis of a close friend of ours.  Life does happen and has its ups and downs.  There is actually a foundation whose mission is to offer support awareness for families and individuals for all types of insurance.  Their website is www.lifehappens.org. 

May is disability awareness month and the foundation is creating education around the topic of income protection.

Here are a very statistics, which I found interesting:

• In 2005, only 39% of all Social Security Disability claims were approved
• The average claim size was around $1,000 in monthly benefit (this is low)
• 90% of disabilities are caused by illness
• 90% of disability are off the job and therefore not covered by workers compensation

Are there any stories you would like to share?

Do you hate your doctor? Dislike their style, the tests they order, and how helpful they are? If you think about it, do you have problems with other doctors as well? Do you mistrust the medical community in general? Feel like they never have the answers?

Well, maybe it’s not them. Maybe it’s you! It’s hard to hear, but it just might be. You might be a difficult patient.

It’s no secret that I love the Wall Street Journal. I delight in receiving it every day and read it cover to cover if time allows. They ran an article earlier this week about difficult patients entitled The Importance of Trying to be a Good Patient that I found very interesting. The article talks about ways to deal with your doctor and when to consult professional help if you’re just not good at explaining your symptoms and issues.

This issue is pertinent given Zagat ratings for healthcare and Angie’s List rankings for providers. If a doctor sees a good number of disgruntled, difficult patients, is it their fault when they receive negative ratings? Zagat ratings are not available in the Indianapolis area but Angie’s List is. As an Angie’s List member, I did check out the names of doctors before selecting one. Mine actually is relatively young and doesn’t have any reviews (yet!), but I would rather see that than negative reviews. But what if I went to a doctor that I really liked and she (or he) had a few bad reviews? Should I stop seeing them? Probably not.

A doctor isn’t quite the same as a restaurant choice to me. You can’t really compare experiences when there are so many variables. But at the same time, knowledge is power, and a smart consumer will weigh all these factors when using the healthcare system.