R&R Insurance Blog

On May 5, 2017, the Internal Revenue Service (IRS) released Revenue Procedure 2017-37 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2018. The IRS limits for HSA contributions and HDHP cost-sharing will all increase for 2018. These limits include:

It has often been said that “the only thing that is constant is change” and certainly the recent political election results translate into more change. In that vein, we at R&R Insurance Services remain “constant” in our dedication to keeping our Benefits Practice clients informed of these changes…to be your knowledgebroker.

Of course, the biggest change we have seen in the world of benefits has been the Patient Protection and Affordable Care Act (aka ACA, aka Obamacare). One of the main platforms of President-Elect Trump has been to “repeal and replace Obamacare.” In this current post-election and pre-inaugural stage, there are many prognostications about what the future may be. So, what about “repeal and replace?” We would like to share some thoughts with you as best we can and at this point in time to address questions you may have:

1. Soon after President-Elect Trump is inaugurated on January 20th, Congress could “repeal” Obamacare through “reconciliation” (only requiring a vote of 51 in the Senate). Among the challenges will be addressing the 19 million+ individuals who would lose coverage through the Exchanges with approximately 85% of them currently receiving federal assistance. Another major issue that will need to be addressed is that Medicaid expansion goes away with repeal in 31 states where enrollment increased by 16 million.
2. “Replacement” cannot be accomplished through the “reconciliation” process unless additional spending cuts are made in the budget. Therefore, “replacement” could most likely occur in a second legislative stage. How long this will take is a question.
3. Through the “reconciliation” process that would “repeal” the ACA, the reduction of funds for Medicaid and Exchange subsidies could be delayed for some time (6 – 18 months?) in order to avoid the problems mentioned above in #1.
4. The Republicans will need to have bipartisan support in the Senate to get to 60 votes. Some Democrats might be motivated to collaborate as the 2018 mid-term election will have 25 Democrat seats up for re-election in the Senate.
5. As for what “replacement” might involve, there are numerous considerations. The Trump platform has consistently promoted expansion of HSA-based coverage and selling of insurance across state lines. Additionally, President-Elect Trump himself stated that he would like to see certain parts of Obamacare retained such as coverage of pre-existing conditions and coverage of adult children to age 26. If there are any individual tax credits that might be introduced for individual medical coverage, we may see, as the “Cadillac Tax” is repealed along with the rest of the ACA, a limitation or cap on the amount that an employer can deduct for health and welfare expense to provide a revenue stream.

Narrow networks are health plans that offer their subscribers a limited choice in health care providers. Health plans contract with a select group of doctors, specialists and hospitals, making those entities considered the in-network.

Because all plan participants are directed toward certain facilities and physicians, these providers can then reduce the cost for each visit and service – operating under the idea of buying in bulk. This results in lower premiums for the consumer and cost savings for insurers.

Benefits of Narrow Networks:

• Lower premiums
• Lower costs – such as employers directing employees to providers in a lower range
• Improve the heath care relationship – doctors in-network may use the same electronic medical record system allowing coordination of sharing medical info among health care providers
• Greater consumer awareness – allows employees to better understand and budget for their health care expenses

Disadvantages of Narrow Networks:

• Possible restricted access – restrictions and finding new health care providers who aren’t in the narrow network
• Surprise out of network bills – many hospitals contract out for emergency physicians, radiologists, and anesthesiologists. So while the hospital may be in-network, the doctors performing a certain surgery may not be, resulting in huge out of network bills
• Rural care – many times there are not enough in-network providers in the area resulting in long wait times or long distances

Educating employees about narrow networks is imperative. Provider listings must be kept up to date and employees should have easy access to this information. Transparency about access and costs is key, since failing to provide accurate information could result in surprise out of network bills.  

An alternative to narrow networks is a hybrid option which takes the selective ideas from narrow networks but broadens it, so users have a choice between which provider-tier they want to work with. Members still have the flexibility to choose any provider but they may pay more out of pocket costs when they do not seek care from quality and cost effective doctors.

For further information on narrow networks and the hybrid alternative, contact your knowledge broker.

Last night TMJ4 aired a story that hits home to residents of Wisconsin. A Monroe woman was sentenced to using the identity of a Puerto Rican woman whose medical ID she bought on the black market for $1500. She used this false identity to have a liver transplant and incur over $200,000 worth of medical bills. The story also talks about a Kenosha couple who ran into problems when applying for a home loan due to unpaid medical bills that were caused by someone using the wife's medical ID.

The theft of medical information is very lucrative for criminals and target all healthcare providers as holders of this vital information.

As a healthcare provider you can be insured but the extent to which insurance applies is complex. We can review your program and advise you where you may be at risk.

OSHA recently announced they will be expanding their enforcement resources in hospitals and nursing homes. Targeting the most common causes of workplace injury and illness in the healthcare industry, OSHA will primarily focus on musculoskeletal disorders related to:

• Patient handling
• Bloodborne pathogen
• Workplace violence
• Tuberculosis
• Slips, trips and falls

OSHA states that in 2013, US Hospitals recorded nearly 58,000 work-related injuries and illnesses – amounting to 6.4 work-related injuries and illnesses for every 100 full-time employees. These numbers are almost two times as high as the overall rate for private industry.

How Can You Prepare?

Don’t wait for OSHA. At R&R, we highly recommend taking action now to develop a plan and prepare for a potential inspection. To better prepare your organization and your administrators, take time to answer the questions below and determine an execution plan for each of the key areas. We have also provided links below to audit materials centered on these key topics.

For audit materials on any of the topics below, or to learn how your organization can better prepare for an inspection, contact safety@rrins.com.

• Patient Handling
• Infection Control
• Exposure Control
• Workplace Violence
• Tuberculosis
• Slips, Trips and Falls

The Office of Civil Rights (OCR) has proposed to ramp up their Phase II HIPAA audits at some point in 2015. Unlike the initial pilot Phase I audits, the second round will require compliance from the chosen health care account, as well as be expanded to include their “Business Associates.” Business Associates being subcontractors of health care organizations that have business agreements with the selected entity.

These audits will affect between 550-800 covered entities and their associated business partners chosen at random through the National Provider Identifier database.

What will the OCR be looking for?

• Risk analysis and risk management policies
• Content and timeliness of breach notifications
• Notice of privacy practices
• Individual access
• Training procedures
• Device and media controls
• Transmission security (Encryption)

The OCR will use the Phase II Audit findings to identify technical assistance that it should develop for covered entities and business associates. In circumstances where an audit reveals a serious compliance concern, OCR may initiate a compliance review of the audited organization that could lead to civil money penalties.

If you are a health care organization or have a Business Agreement with a health care organization, this may be a good time to review your Network Security Liability coverage with your insurance agent.

Contact our knowledge brokers for more information!

“Wellness” is more than just a buzzword. Wellness means having the energy and vitality to be productive, and feel and perform your best. It’s our greatest opportunity to restore Americans and American businesses to better health. Your company’s healthy journey begins now. Step by step, employee by employee, to a new culture of health and a healthier bottom line.

Take a look around. What can you do to make your worksite a healthier environment?

• Have you checked your vending machines lately?
• Got stairs? Anyone using them?
• Are you sending out reminders about how to get healthier and avoid injuries.

Helping your employees improve their health is one of the best long-term strategies for reducing your health care costs. Most people spend 53% of their waking hours at work; you have an incredible opportunity to change the lives of the people you see and work with everyday.

The single issue driving the cost of medical, pharmacy, disability, behavioral health, worker’s compensation, absenteeism and presenteeism (coming to work when you’re sick) is the lifestyle choices people make.

• Chronic conditions such as diabetes and heart disease account for 75% of our nation’s health care costs.
• Obesity costs employers $45 billion annually in medical costs and lost productivity.
• The excess cost to employers of employees who use tobacco, factoring in increased medical cost and loss of productivity increases to approximately $3,400 per year per smoking employee.

When your employees are healthy, there’s a healthy chance that:

• Productivity increases
• Premiums or total medical spending may be reduced

When your employees experience fewer health complications, the result is a healthier, more productive workforce and potentially lower overall health care costs. It’s estimated that over 10 years, cumulative medical cost savings through reduced obesity rates could reach $282.6 billion.

Your Worksite Wellness team will assist you in choosing health screenings, health seminars and other wellness events that will work best for your employees. Help employees identify possible health risks and how they can lower them and start enjoying a healthier life or understand their benefits and treatment options so they’ll be able to make more informed decisions. Once you get a good idea, you can better choose which wellness programs will go over well, so employees will be more likely to participate. Your leaders can be your best wellness champions by sending emails directly to employees encouraging them to participate. Other ideas can include:

• Decide what the focus of your program will be: awareness, education, behavior change, culture enhancement, etc.
• How often will you have an onsite program and how long will it run?
• Who’s the targeted audience: staff only, spouses, dependents, retirees?
• Consider interventions that would impact both the low-risk and high-risk staff.
• Identify incentives that will increase participation such as low cost giveaways for participation or raffle/door prizes like fitness equipment, lunches, gift certificates or even paid time off.

Your wellness team should be a winning combination of management, front line staff and employees from every health status. Lay out a specific plan for your wellness campaign.

Great article on improving patient safety for care giving facilities such as hospitals and nursing homes. Read full article in Amednews.com, by Kevin B. O'Reilly.

These are things hospitals and nursing homes should be doing to protect patients.

1. Improve Hand Hygiene
   Rates of hand washing are low, averaging 39%, with many doctors and nurses underestimating the activity's safety value. Research shows that effective hand hygiene initiatives improve knowledge of when to clean and how to clean, require demonstration of the knowledge, ensure that alcohol-based rub and gloves are available at the bedside, and guarantee that compliance is monitored continuously
2. Use barrier precautions to stop the spread of infections
   Along with hand hygiene, barrier precautions are key to reducing the 1.7 million health care-associated infections that occur in the U.S. each year, which the CDC says kill about 99,000 patients annually.
3. Implement care bundles to prevent central-line associated bloodstream infections
   About 250,000 bloodstream infections occur each year in the U.S., and these infections can triple hospital stays from seven to 21 days. Bloodstream infection rates in ICUs fell by nearly 60% between 2001 and 2009 thanks to wider use of a prevention protocol bundle.
4. Use real-time ultrasonography when placing central lines
   Using portable ultrasound machines to get a real-time, two-dimensional view while placing the catheter has been shown in randomized trials to lower infection rates and improve other outcomes. For every 1,000 patients, ultrasonography-guided central-line placement helps avoid 90 complications, research shows.
5. Use protocols to reduce catheter-associated urinary tract infections
   The most important step in preventing catheter-associated UTIs is to reduce use of indwelling urinary catheters. At least 21% of catheters are placed in patients inappropriately — for example, as a substitute for extra nursing care — and they often are left in long after they are needed.
6. Employ preoperative checklists to reduce surgical complications
   The most well-known surgical safety checklist is one devised in 2008 by WHO, which cut mortality rates from 1.5% to 0.8% at sites in industrialized nations and developing countries. The checklist also helped reduce the surgical complications rate from 11% to 7% over six months involving nearly 4,000 procedures.
7. Improve venous thromboembolism prophylaxis
   Between 350,000 and 600,000 Americans develop deep vein thrombosis each year. One key to improving use of these prophylactic interventions is health information technology that helps identify patients at higher risk for VTE. Medical and mechanical interventions can prevent VTE, Dr. Haut says. Low-dose unfractionated heparin and low-molecular weight heparins such as enoxaparin and warfarin are effective. So are compression stockings and pneumatic compressing devices.
8. Use preventive intervention care bundles to cut rates of ventilator-associated pneumonia
   Pneumonia linked to endotracheal intubation accounts for 25% of ICU infections and is responsible for half of intensive care antibiotic use. Research shows that preventive intervention care bundles can cut rates of ventilator-associated pneumonia by as much as 40% among adults and children.
9. Avoid hazardous drug abbreviations
   About 15,000 medication errors a year have been linked to using abbreviations such as “u” for “unit” and “q.d.” instead of “once daily.” Implementation of computerized physician order entry systems also can help eliminate the vestiges of this problem.
10. Use multi-component interventions to prevent pressure ulcers
    About 2.5 million Americans develop bedsores each year, and about 60,000 patients will die from complications related to pressure ulcers acquired in U.S. hospitals. One bundle of preventive care measures has reduced pressure ulcers by 90% at a large health system, from a rate of 5.7% of patients to less than 0.5%. The bundle, dubbed SKIN, calls for continual assessment of the skin of at-risk patients, regular turning of these patients, management of incontinence to prevent soiling that can contribute to bedsores, and nutritional assessment for malnourishment that can enable the ulcers.

Health care organizations in Wisconsin wanting to know more about how to reduce their risk and liability exposures, contact knowledgebroker Jeff Thiel.

Most employers - and you may be one of them - don't completely understand Employee Retirement Income Securtity Act (ERISA), how it impacts business and employees, and the possible risks it presents. Ask yourself the following questions:

1. If you have over 100 enrolled participants in any benefit, have you ever filed a Form 5500 with applicable schedules?
   ERISA imposes an $1100 day penalty for each day this filing is late up to amximum penalty for large employer (over 100) of $30,000 annually.
2. If yes, have you ever completed and distributed a SAR (Summary Annual Report)?
3. Have you ever been subject to a DOL audit?
   Audits can be triggered through a DOL investigation reproted through other agencies (IRS), through review of form 5500 filings and most often through Employee reporting or lawsuits.
4. Do you have other ERISA plans such as a 125 plan with FSAs (flexible spending accounts) or HRAs (helaht reimbursement accounts)?
   Health FSAs and HRAs are also ERISA plans and must meet the same documentation and filing requirements.

Did you answer No to questions 1 or 2? Did you answer yes to questions 3 or 4? If so, you may be in violation of Title I of ERISA that governs health and Welfare Benefit plans.

If you have any questions regarding your ERISA compliance, obligations or anything regarding your health insurance or benefits packages; R&R knowledge broker Jane Shevey can help!

It starts off just like any other telemarketer phone call: "We are sending out new Medicare cards and have just a couple simple questions for you. Can you confirm you name, address, and phone number."

You easily reply "yes, that is correct."

The telemarketer starts listing off numbers and asks "please confirm that is your bank routing number."

RED FLAG!

Health insurance scams are increasing every day across the country. Many are preying on the mass confusion over the health care system. And unfortunately Senior Citizens are often the targets: they are home more often to answer the phone and generally have larger retirement savings for scammers access.

Due to the confusion with healthcare, other scams include offering fake health coverage, bare-bones policies being sold as full coverage, and fake Obamacare coverage.

Tips to help avoid falling victim to a scam:

• Don't answer the phone too quickly - check caller ID if possible
• Think about the question they are asking
• Think before you answer the question
• NEVER give out personal or financial information over the phone
• Just hang up the phone

Wisconsin residents with questions on how health care reform will affect you, please contact knowledgebroker Pete Frittitta.