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Countdown to the Conference!

Dear ASHHRA Member:

If you've never attended the Annual ASHHRA Conference and Exposition, this is your year! I promise you an energizing and impactful experience, giving you plenty of new tools to bring back to your organization. You'll not only interact with some high powered presenters and experts, but you'll meet a number of fantastic healthcare HR people who will support you long into the future. And all this begins with your close-to-home colleagues at the Sunday morning Regional Breakfasts.

As a conference attendee, you will also receive a CD packed with helpful checklists, tools, and learning materials, and a second CD of all the companies and consultants advertising on the new ASHHRA Buyers Guide. If you haven't checked out the Buyers Guide, go to www.ashhra.org. You asked for it, and we heard you. Searching for healthcare HR experts has never been this easy!

See you in Anaheim!
Molly Seals
ASHHRA 2007 President


Headlines

ASHHRA News
ASHHRA Advocacy Update
ASHHRA Calls for Best Practices
Advocacy Committee Urges Members "Raise Your Voice"
ASHHRA Launches Buyers Guide

Legal
"Managing Harassment Complaints With an Eye Toward Litigation"
"Weather the Storm of 401(k) Lawsuits"
"What To Do When an HR Employee Sues"

Workforce
"Are Nursing Shortages Causing Deaths?"
"Shift Report Redesign"
"Are Nurses Allowed To Unionize?"

General HR
"Building Your Claim Management Dashboard"
"Helping Employees Step Up"
"The New Hiring Dilemma: Fit Versus Competencies"

Benefits
"Custom Tailors"
"Onboard Navigation: Successfully Steering a PBM Relationship"
"10 Ways to Avoid Mistakes When Selecting a Healthcare Plan"
"Employer Wellness Programs and the New HIPAA Regulations"

Physicians
"The Upside of Portals"
"On-Call? No Thanks"


ASHHRA News

ASHHRA Advocacy Update

Congress reconvened Sept. 4. The following is a summary of up-to-date items to watch during the fall session:

  • On the healthcare front, their first objective will be to try to conference the S-CHIP (State Children’s Health Insurance Program) reauthorization. The program expires on Sept 30, so this will be a priority for Congress. Both the House and Senate have passed different authorizing bills. The House bill, which boosts S-CHIP spending by $50 billion, includes a cut of 0.25 percent to Medicare hospital payment; the Senate version, which adds $35 billion to S-CHIP does not include cuts to hospitals. While the House version would reduce the in-patient update for hospitals, it contains a number of provisions that would benefit rural hospitals, and also staves off a ten percent cut to physician services that is scheduled to go into effect in January. The President has threatened to veto both the House and Senate bills as both expand S-CHIP beyond his recommended level of funding.
  • Both House and Senate will have to pass and conference their appropriations bills in September as the fiscal year ends on Sept. 30. The House has passed their Labor-HHS appropriations bill which funds many of the programs AHA and ASHHRA support, such as funds for workforce (nursing, etc). However, the Senate has not acted on their Labor-HHS bill. There are rumors that the Senate will not act on the Labor-HHS appropriations bill and instead go directly to conference with the House. There are also rumors that the Senate will withhold the bill so that it may be used at the end of the year as the basis for a larger omnibus bill. No decisions have been made as of presstime.
  • More importantly, we expect to see movement on the labor front. The “Re-Empowerment of Skilled and Professional Employees and Construction and Tradeworkers (RESPECT) Act (HR 1644) is expected to be marked up in Committee and then move quickly to the House floor. This bill changes the definition of “supervisor” in the National Labor Relations Act by deleting two supervisory functions: (1) assigning duties and (2) responsibly directing. If this bill passes, it will enable nurse supervisors to be part of the collective bargaining unit. Both ASHHRA and AHA strongly oppose this bill. The Senate version has been introduced by Sens. Durbin, Kennedy, and Dodd, but no action is expected in the Senate at this time.
  • We also expect to see action on mandatory overtime. – Sens. Kennedy and Kerry, on July 20, introduced S. 1842, barring health care providers from requiring nurses to work overtime except when a federal, state or local emergency is declared. The companion bill was introduced earlier in the year by Rep. Pete Stark (D-CA). While no hearings have yet been scheduled, there will be increasing pressure for Congress to act.
  • Senate Majority Leader Reid announced the fall Congressional schedule: Congress is expected to be out from Sept 12 – Sept 17 in honor of the Jewish High Holy days. Sen. Reid announced the anticipated adjournment date of November 16, but also indicated that Congress may have to be called back in December to finish up. This tells us that there is trouble on the horizon for getting the appropriations, S-CHIP and other bills conferenced.


For more advocacy resources, go to the new advocacy section of the ASHHRA Web site. Return to Headlines

ASHHRA Calls for Best Practices

ASHHRA is reaching out to members to help develop a "Best Practices" section on the ASHHRA Web site.

Please consider sharing your best practices samples* with your ASHHRA colleagues. The following categories are needed:

  • Position Descriptions

  • Policies

  • Sample Forms

  • Case Studies

  • Other resources you'd like to share

To view a sample of "Policy" best practices already posted on the ASHHRA Web site, click here.

To submit your own sample "Best Practices," please e-mail them to John Vicik, manager of education and product development: jvicik@aha.org.

*Before utilizing sample forms, tools, or processes, please consider consulting your legal counsel. Return to Headlines

Advocacy Committee Urges Members "Raise Your Voice"

ASHHRA Advocacy Committee alerted members Aug. 21, 2007 of an impending House Committee vote scheduled to occur immediately after the August recess: "The House Education and Labor Committee is likely to consider legislation that would include nurse supervisors as part of a hospital's collective bargaining unit." ASHHRA asked members to urge their U.S. Representatives to oppose H.R. 1644, the Re-empowerment of Skilled and Professional Employees and Construction and Tradeworkers Act. The bill removes from the National Labor Relations Act (NLRA) two functions that classify a charge nurse as a supervisor: "assigning" and "responsibly directing" other staff. Charge nurses are often the most visible staff "in charge" of a specific hospital unit, and their judgment and discretion are essential to the delivery of patient care. If the bill is enacted, charge nurses who are supervisors would no longer be exclusively the employer's voice in labor-management relations during union organizing campaigns, grievances and labor disputes. Even in carrying out day-to-day operations, nurse supervisors would be subject to union control, work rules, fines and other forms of union discipline for crossing a picket line or continuing to work during a work stoppage. Return to Headlines

ASHHRA Launches Buyers Guide

ASHHRA announced a new online buyers guide now available on the ASHHRA Web site, www.ashhra.org. The ASHHRA Healthcare HR Buyers Guide allows healthcare HR professionals and leaders to quickly and easily navigate through a comprehensive list of industry-wide products and services. Participants of the 43rd Annual ASHHRA Conference and Exposition, held in Anaheim, Calif., Sept. 30 through Oct. 2, will receive a free CD of the buyers guide. Return to Headlines


Legal

"Managing Harassment Complaints With an Eye Toward Litigation"
Metropolitan Corporate Counsel (08/07) Slobin, Stephanie Perin

Harassment claims can hurt a company’s reputation and finances, so to manage and mitigate these complaints a company’s legal arm must guide HR representatives through the process of responding to harassment allegations. Legal counsel should start educating HR personnel before any complaints occur and should establish a step-by-step procedure for attending to employee claims. Next, employees must be told of their rights and responsibilities, including how to properly file a complaint. When a harassment claim is filed, employers must tell the claimant that a prompt and timely investigation will be conducted, that the company does not stand for harassment, that no conclusion can be made until information is collected, and that the information will be kept as confidential as possible. Measures also should be taken to help the claimant feel comfortable at work. Next, all allegations must be investigated, all witnesses must be interviewed, and the alleged perpetrator should be asked for his or her account of the situation. Interviews should be conducted confidentially and objectively and should be documented as well. The company should take appropriate actions in a timely manner, with emphasis on precluding further improper conduct toward the claimant and other employees. Necessary action could range from a discussion with the alleged perpetrator and disciplinary action to termination, and legal counsel can help HR personnel settle on the best course of action. Once action is taken the company should notify the complainant that the matter has been addressed and appropriate actions taken.
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"Weather the Storm of 401(k) Lawsuits"
HR Magazine (09/07) Vol. 52, No. 9, P. 143; Ash, Gregory L.

Companies of all sizes are now dealing with a large batch of lawsuits, aimed at recovering what plaintiffs claim are unjust losses from 401(k) plans. Employers could be faced with not only large settlements, but also exorbitant court fees for cases that go to trial, though experts explain some recent motions should give employers a bit of relief. The lawsuits allege that losses stemming from their 401(k) providers' revenue-sharing arrangements and management fees were excessive and that full disclosures of account managing practices were not made clear to participants. Plaintiffs' cases assert 401(k)s as the primary source of savings for retirement, with minute reductions leading to major losses in returns. 401(k) caretakers are entrusted with looking out for participants' best interests, and these plan fiduciaries could be held responsible for lost returns under the Employee Retirement Income Security Act's (ERISA's) Section 404(c). Two cases in Illinois and Wisconsin already sided with defendants, but currently at least two similar cases are proceeding to trial to determine if a lack of information regarding plan expenses could place fiduciaries in violation of ERISA and make them liable for investment return losses. Employers should review contracts with 401(k) providers periodically to ensure fee arrangements are accounted for and executed correctly under the auspices of the agreements. Due diligence should be performed with regard to the services rendered and paid for, possible revenue sharing agreements with funds, and soft-dollar payments; once data is uncovered and checked against current administration agreements, employers should disclose management and other fees to participants.
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"What To Do When an HR Employee Sues"
Workforce Management (07/31/2007) Hamilton, Dexter

Handling a discrimination suit brought by an HR employee can be a tricky proposition for any company. HR staff members by nature have access to sensitive or confidential information. This knowledge, including the company's past suits, settlement strategy, internal investigations, and legal contacts, could all provide the plaintiff with leverage over their employer. Even though much of the information may not be related to the case, it could help firms draft a legal strategy. Fortunately there are also some aspects of HR employee suits that can actually make them easier to handle. First of all, an HR claimant is going to have far more realistic and informed goals when it comes to settling a claim, making them easier to negotiate. The staff member also may have just as much interest as the company in not going public with a case because it could prove seriously damaging to future career opportunities. Still, the best method is to avoid claims. This can be achieved by stressing confidentiality agreements and ensuring company policy is kept constantly abreast of all current legislative changes. Should a claim still occur, companies should make sure they meticulously investigate the claim while attempting to avoid further breaches of confidentiality.
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Workforce

"Are Nursing Shortages Causing Deaths?"
BusinessWeek (09/06/07) Herbst, Moira

One consequence of the U.S. nursing shortage is increased illness and death for American patients, according to a report by the nonprofit group the National Foundation for American Policy (NFAP). A dearth of nurses is anticipated by the U.S. Department of Health and Human Services to grow to a shortage of one million nurses by 2020. The NFAP report recently cited a study from the Journal of the American Medical Association that discovered when nurse caseloads double from four surgery patients to eight, patient mortality rates rise by 31 percent. NFAP recommends the private sector and public sector band together to provide funding for nationwide nurse training programs, especially since nursing schools turn away over 100,000 applicants annually due to capacity limits. The second challenge facing the healthcare sector is the loss of registered nurses to higher-paying healthcare or business careers, which limits the number of nursing educators available to teach students the skills they need to fill in workforce gaps. However, hospitals must strive to retain nurses by fixing chronic issues like “Stagnating wages, mandatory overtime, and short staffing problems,” says Cathy Glasson, president of the Nurse Alliance of the Service Employees International Union. A second recommendation from the NFAP report remains controversial; the report calls for looser immigration limits to introduce more foreign nurses into the U.S. healthcare sector. Critics contend pulling nurses from other nations could hamper foreign healthcare systems; they also indicate healthcare firms should increase nurses’ salaries. According to United American Nurses President and RN Cheryl Johnson, there are about 500,000 registered nurses not working in the field, and these nurses should be tapped to fill current and future vacancies with the help of wage increases or working condition improvements. However, hospitals may have trouble finding the money to increase nurses’ salaries, as wages are limited by reimbursements from Medicare and insurance companies, says Stuart Anderson of NFAP.
Return to Headlines

"Shift Report Redesign"
Health Management Technology (08/07) Brown, E. Victor

Provena St. Joseph Medical Center (PSJMC), located in Joliet, Illinois, implemented new phone technology in order to streamline the shift handoff reporting process. Before the 775-bed medical facility installed the OptiVox system, it took over an hour for the 10 night-shift nurses to report to the day shift nurses, a process that was loud and inefficient. The OptiVox system allows nurses to record their reports onto the main server, where it can be accessed by other hospital staff to create a database of patient reports. The system required just 10 minutes of training time for nurses and was refined to incorporate user suggestions in the first months following implementation. In the beginning, PSJMC did not use OptiVox in some hospital areas, including the ICU, because the system was not initially set up to allow groups to hear reports--a function that has since been added. In the two years since OptiVox was implemented, PSJMC has cut reporting time from over an hour to just 15 minutes. The facility also expanded the program into the emergency department to improve communication between the emergency nurses and staff in the patient care unit. PSJMC also uses it to teach nursing students without interrupting hospital staff.
Return to Headlines

"Are Nurses Allowed To Unionize?"
Provider (08/07) Vol. 33, No. 8, P. 41; Walsh, Thomas V.

A recent National Labor Relations Board (NLRB) ruling regarding the exemption of supervisors from unionizing stipulates workers can be deemed as supervisors if they meet one of 12 categories of authority. Healthcare employers use this definition to prevent nurses from unionizing, especially if they "assign" or "direct" other employees even if they do not hold hiring, promotion, or discharge responsibilities. While the NLRB has ruled in favor of nurses being unionized, many of those rulings have been overturned by the Supreme Court's Kentucky River Trilogy ruling that definitions were too restrictive; the ruling set the wheels in motion for clearer definitions of "assign," "direct," and "independent judgment." With the help of healthcare facilities and other experts, the NLRB issued definitions of those terms to ensure not all nurses would be considered supervisors merely because they assign shifts to workers or delegate certain duties. Experts report the new definitions only count nurses as supervisors if they assign, direct, and exercise independent judgment, which implies an accountability component should decisions result in adverse outcomes. Meanwhile, unions continue to strive for the passage of the Employee Free Choice Act, which would eliminate union's secret balloting processes, and the Skilled and Professional Employees and Construction Tradeworkers Act to exempt nurses from supervisory status under unionization regulations.
Return to Headlines


General HR

"Building Your Claim Management Dashboard"
Claims (08/07) Vol. 55, No. 8, P. 17; Quinley, Kevin M.

A trustworthy claim management dashboard is a valuable tool for evaluating the health and effectiveness of claim management and business forecasting. Claim managers should begin by selecting six to eight metrics to monitor on a regular basis to determine whether the claim management program is on track or heading off course. A dashboard becomes even more helpful if the metrics can be displayed graphically. Examples of key metrics include closings for the month, new losses per month, and re-opened files per month. A high number of the latter may be a warning sign regarding review processes. Following the average case life span is another way to gauge efficiency in handling files. Tracking average reserve per new case can be helpful, particularly when the results are compared to average payout per closed file. By monitoring loss payments for the month, claim managers can improve their judgments on proportionate legal and defense fees and their ability to pinpoint the most expensive claims. Because a sudden rise in new losses may signify a variety of problems, it can be helpful to track the open caseload from month to month. Regardless of which metrics are chosen, watching the data provides managers with new ways of measuring claim management performance. Spying issues early on enables claim managers to take crucial proactive steps to correct worrisome trends.
Return to Headlines

"Helping Employees Step Up"
HR Magazine (08/07) Vol. 52, No. 8, P. 49; Tyler, Kathryn

Internal promotions and employee retention are important to the success of many firms, and human resources personnel have to play an integral role throughout the process. HR needs to lay the groundwork for internal career development by conversationally engaging workers about their career goals and how they would like to expand their responsibilities within an organization. These conversations help workers articulate their goals and cue in management to possible succession candidates without promising workers they will be promoted. Managers also should have career discussions with workers to ensure they are aware of their current skills and the abilities they need to obtain in order to reach their career goals. Stamford Hospital in Connecticut fosters collaboration among managers, HR, and others when job postings are created, which must clearly define the position's duties. Once a detailed job description is created, HR and managers need to follow consistent posting procedures to avoid possible discrimination litigation. However, some general exceptions to the rules can apply, especially if one employee has the necessary skills for a position that no one else has or has proven himself in a certain role over time. HR can help navigate the process to ensure the right workers are selected, internal candidates are not discouraged, and the process is equitable.
Return to Headlines

"The New Hiring Dilemma: Fit Versus Competencies"
HR.BLR.com (08/07/07)

Many companies make their final decision to hire an employee based on how well the prospect "fits" with the workplace culture. This decision is often made on an unconscious level because of unspoken social and behavioral trends within the organization. Basing hiring selections on these informal structures, rather than solely on a candidate's abilities, can limit a group's potential. Although it is important for new-hires to mesh well with the team, this should not take precedence over the search for new talent and fresh ideas. By hiring a diverse selection of employees, companies will maximize the potential for creativity and innovation in the work environment. HR executives should do their best to identify practices that encourage favoritism and seek out the underlying reasons for that bias. They should then work with other leaders to weed out these practices and ensure hires and promotions are given based on performance and competency.
Return to Headlines


Benefits

"Custom Tailors"
Best's Review (08/07) Vol. 108, No. 4, P. 76; Wakefield, Christina

The employee-benefits market is changing, and new challenges are uniting carriers, employers, and advisers in the pursuit of alternative ways to control costs, protect benefit offerings, and possibly increase options for employees. Cost is a major pressure, as employer-sponsored health insurance premiums continue to rise at twice the pace of wage gains and inflation. Changing workplace demographics are another added strain, as the increasingly older and more diverse labor pool is expected to affect benefit programs, chiefly with regard to health and disability insurance. As a result, employers now acknowledge the importance of “employee-centric” benefits and are permitting workers to customize their own benefits and coverage amounts. Companies can contain costs and improve their benefit offerings by incorporating employer-provided group coverage with opportunities for individual buy-up. In addition, voluntary offerings (chosen and endorsed by the employer) and benefits with a foundation of employer funding will stimulate more participation and persistency than 100 percent worker-paid alternatives. Employers and employees are increasingly drawn to group funding alternatives, most of which comprise a “base/buy-up” benefit prototype and a “defined contribution” scheme. Moreover, voluntary benefits can help attract and retain talent, which is particularly significant in light of the anticipated labor shortage.
Return to Headlines

"Onboard Navigation: Successfully Steering a PBM Relationship"
Employee Benefit News (08/07) Vol. 21, No. 10, P. 18; Thomas, Tim

Before purchasing pharmacy benefit management (PBM) services, employers should hire someone who is knowledgeable about the PBM industry to conduct a PBM audit, a process that reviews PBM performance contractually and/or financially. There are two different types of PBM audits: pricing audits and comprehensive audits. The goal of a PBM pricing audit is to determine if the services contracted for equal what the employer has paid. During a PBM pricing audit, the auditor mines PBM data from a given time period and converts it into useable data, matching PBM claims data with pricing history data from a source such as FDB or Medispan in order to obtain the drug pricing information on the day the prescription was filled. One drawback to pricing audits is that they only show employers what they have paid and how that compares to what they contracted to pay. Comprehensive PBM audits, on the other hand, evaluate contract pricing as well as other information. In this type of audit, auditors study performance factors, such as whether performance guarantees are being met, whether the MAC for generics is working to an employer's advantage, and how an employer's prescription drug benefit compares to other organizations. After this audit is complete, employers can take several steps, including renegotiating with their PBM to include more contract language or performance guarantees, reviewing their PBM partner status, and either issuing an RFP or working with a consultant to choose a new PBM.
Return to Headlines

"10 Ways to Avoid Mistakes When Selecting a Healthcare Plan"
Office Solutions (07/07) Vol. 24, No. 3, P. 28; Donovan, Brian F.

Organizations with between 20 employees and 250 employees have been hardest hit by rising healthcare expenses, but can take measures to offer quality coverage while also containing costs. First, employers should gather renewal and alternate quotes at least two months before the renewal date, as a delayed review can lead to a hasty decision. Employers must be flexible and willing to change their ways, as existing plans may not be the most valuable or cost-effective. Smaller companies also should consider self-insuring a higher hospital deductible; doing so could generate significant premium savings. Additionally, it is helpful to engage employees in the plan selection process because they can provide feedback regarding plan design. For instance, employees may appreciate being offered dual options of healthcare plans or may be interested in benefit perks, such as discounts on health clubs or massage therapy. Employers should review family statuses annually to take advantage of savings that may accompany a higher ratio of single parents or couples. Finally, companies should educate employees by having the health plan’s representative speak to the company about the program and by explaining why any changes were made to the old healthcare system.
Return to Headlines

"Employer Wellness Programs and the New HIPAA Regulations"
Kingsport Times-News (08/06/07) Donelson, Baker

An International Foundation of Employee Benefit Plans study indicates employers use wellness initiatives to lower their healthcare expenditures and losses related to employee absences and productivity reductions from ill workers. Of the 62 percent of employers surveyed who indicated having a wellness plan in place, many provide workers with access to fitness centers, wellness education, healthcare screenings, and other services. However, many employers also found workers were not eager to sign up for these voluntary benefits, which is why firms began offering lower premiums for those in wellness plans and a number of other perks. Experts, on the other hand, warn these incentives could place firms in violation of the Health Insurance Portability and Accountability Act (HIPAA), which prohibits employers from charging workers different premiums due to specific health factors. To stave off these claims, the U.S. Department of Labor recently issued new HIPAA guidelines with regard to wellness plans to ensure those plans available to all workers, with built-in rewards for signing on, are not deemed discriminatory. If the program offers rewards for the achievement of a particular health-related goal, the program could be in violation of HIPAA unless it meets five specific requirements: reward is less than 20 percent of the cost of a workers' health insurance plan; it is designed to promote health and disease management; allows workers to qualify for one reward annually; the plan is available to all workers with similar situations; and must include an alternative standard for achievement.
Return to Headlines


Physicians

"The Upside of Portals"
Marketing Health Services (09/07) Vol. 27, No. 3, P. 15; Divis, Kathy L; Hardie, Margaret; Iuliano, Blase B

Healthcare facilities are creating Internet portals to improve communication with physicians and increase efficiency and customer satisfaction. Successful portals often include a single point of access for business and clinical functions at a hospital, for example, and offers opportunities for various staff members to collaborate and interact with multiple sources of data. Experts also indicate a single log-on name and password for use at any access point can help administrators track usage. By streamlining the process and making it easier for physicians to refer patients, an organization can increase the number of referrals and ensure physicians will keep recommending certain facilities. The Children's Hospital of Philadelphia (CHOP) created an Internet portal in response to complaints from referring physicians regarding the difficulties of patient information sharing. CHOP's portal contained real-time information updates--including lab results and appointment histories--all of which could be printed out and added to a patient's medical file. Although some initially had privacy concerns, access is only granted to pediatric practices if a parent signs a consent form. Case studies, including the CHOP Internet portal project, offer insight into the best way to create an Internet portal. Portals should be monitored, and the creator should take suggestions from physicians to make it as effective a tool as possible.
Return to Headlines

"On-Call? No Thanks"
Hospitals & Health Networks (08/01/2007) Vol. 81, No. 8, P. 42; Huff, Charlotte

One of the toughest challenges for hospitals is trying to get specialists to take on-call surgical emergencies. According to a report by the American Hospital Association, 55 percent of hospital administrators noted having problems obtaining necessary specialty coverage. There are a number of issues that make specialists reluctant to take emergency calls including liability, lack of compensation, and excessive time away from their families. Some hospitals are putting together regional networks in an effort to increase specialist access, while others are relying on robotic technology and telenetworking to set up long-distance consults. These solutions may widen a hospital's selection in specialists, but they do little to make emergency calls more enticing for physicians. For many administrators, the obvious solution is for hospitals to compensate surgeons out of pocket for taking calls, but experts say this method can only go so far. To address liability problems, hospitals should offer to cover surgeons in the event legal action is taken against them over the outcome of an emergency call. Minimizing a surgeon's time away from their personal life can be a bit trickier, but hospitals can help by offering the best surgery times to physicians willing to take emergency calls. They also may choose to make all staffing and equipment arrangements for surgeons, decreasing the time they spend at the hospital. Other perks, like prime parking spots and waiving medical staff dues, can go a long way towards enticing specialists to accept emergency calls.
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