Frustrated with the high cost of providing medical insurance for its 12,000 employees, Quad/Graphics decided to set up its own health care system. In an article in the Wall Street Journal (available by subscription only), staff writer Vanessa Fuhrmans describes a fast growing company that was able to think way out of the box to solve an intractable problem. Quad/Graphics spends about $6,000 per employee on medical costs, fully 30% less than the average company in its home state of Wisconsin.
This is certainly not a model that most companies could replicate. You need a large concentration of employees in just a few locations. Perhaps even more important, you need a high level of trust between management and workers. Fuhrmans points out that Quad has a long history of harmonious relations between management and workers. If the workers distrusted management, they would not entertain the idea of going to management’s own doctors — not just for their own medical services, but for their entire families as well.
Quad employs its own internists, pediatricians and family practitioners. It operates its own labs, pharmacies, and rehab centers. They contract directly with local hospitals and specialists for advanced care. It is also important to note that doctors’s bonuses are tied to patient evaluations and health outcomes — unlike our mainstream medicine which values the number of contacts above all. Quad doctors have a full half hour to spend with patients, which leads, naturally enough, to a highly effective disease prevention program.
Workplace Injury
The article did not address how workplace injuries were handled, so I sent Ms. Fuhrmans an email inquiry. She responded within minutes, explaining that Quad does indeed handle many of its own workers’ compensation cases. “This is where they see a lot of their savings.” It makes perfect sense that workers would trust the same physicians who treat their families to manage workplace injury and illness. I would surmise that their in-house rehab facilities are quite capable of managing workplace injuries. Even though “occupational medicine” was not listed in the article as an available specialty, a progressive company with an inhouse medical capacity would naturally keep a strong focus on returning injured employees to full duty as quickly as possible.
The Quad model has been so effective, other employers have contracted with QuadMed LLC to provide in-house services. The article cites Briggs & Stratton and Rockwell Automation, both of which have asked QuadMed to operate full-service clinics for their employees in Wisconsin.
Confidentiality Conundrum
Fuhrmans points out that employees do have some concerns about privacy issues. They obviously don’t want personal details about their health (or the health of family members) to end up in a supervisor’s hands. Quad medical staff sign confidentiality agreements, promising to keep patient information within the clinic. Their computer systems are separate from those of the factories.
This is all well and good. But there certainly is an opportunity for ethical tensions. Here’s just one example. A worker comes to the clinic with a knee injury suffered while playing hockey on the weekend. He cannot afford to miss any time from work. Should the doctor release him to regular duty? Let’s assume the worker does continue at his job. What if he comes in the next day claiming that work has aggravated (or even caused) his knee problem? How should the doctor respond?
It is not difficult to envision doctors getting caught in the middle of some very challenging issues. Workers’ compensation places tremendous leverage in the doctor’s hands. The assumption is always that the doctor is a disinterested party. But when the doctor is in effect an employee of the same company, this may create the potential for a conflict of interest.
Finally, I wonder about the separation between Quad and QuadMed. Is the latter a “third pary medical provider” and thereby subject to lawsuits for malpractice? Federal confidentiality standards are very strict on the personal health side (and more flexible on the workers’ comp side). Once again, it is not hard to imagine circumstances where the doctors are truly caught in the middle.
Quad/Graphics deserves a lot of credit for tackling the health care dilemma directly. In many respects, it’s the classic American story. Faced with a huge national problem, creative managers figure out a way to solve it on the local level. From our perspective, the roots of the solution lay in the fundamental trust that existed between management and workers. There is simply no substitute for that kind of trust, which may be the most powerful collateral for change in the ever-challenging world of business.
Archive for February, 2005
Company Docs in the 21st Century
Friday, February 11th, 2005The Original “No Exit” : The Triangle Shirt Waist Factory Fire
Thursday, February 10th, 2005In the rush of events, we may succomb to the notion that we are constantly seeing things for the first time. In two previous blogs, we mentioned employers who locked exits to prevent theft after hours, leaving cleaning and maintenance crews vulnerable to disaster. Well, the most famous incident of locked exits occurred on March 25, 1911: the Triangle Shirt Waist factory fire in New York City that killed 146 workers, mostly women. The fire led directly to an unlikely alliance between the reform movement and Tammany Hall and became a catalyst for a paradigm shift in safety standards.
We heartily recommend David Von Drehle’s riveting account of the disaster, Triangle: The Fire that Changed America. The paperback version was released recently and is available at your local bookseller or at Amazon.com. The book provides a compelling social history of the time. Von Drehle points out how the garment industry had changed from a home-based, free-lance business to huge factory floors in high rise buildings, with row after row of sewing machines. (The ladders of fire trucks were not tall enough to reach the workers nine stories up.) The classic turn-of-the-century “sweat shop” was not just hot — it was the pace of work that caused the sweat. Because the owners feared theft of the popular shirt waists, they locked the doors. Or did they? That became the heart of the criminal trial that followed the disaster.
The story of the criminal trial may be the most intriguing part of the history. Begin with a trial judge who in a prior life had been a Tammany housing commissioner, fired after 20 people died in a tenement fire. His sympathies were clearly with the owners of the company. Then add a brilliant lawyer for the defense, Max Steuer, whose dazzling cross-examinations raised doubts that the doors had been locked (even though it became clear in retrospect that they had). Steuer achieved a legal triple play: his clients were acquitted of criminal negligence charges, they collected the maximum from their insurance companies and they successfully fought off all civil suits. He was the original “dream team” of one.
We are left with shadows of the many victims: mostly immigrants from eastern Europe and Italy. Not satisfied with their anonymous deaths, Von Drehle names as many of them as he can and provides a brief profile of their impoverished lives. At first, over 90 years after the event, I thought this was an exercise in futility. On second thought, I applaud Von Drehle for not allowing these victims of workplace neglect to disappear without a trace.
February is workplace eye safety month
Tuesday, February 8th, 2005The American Academy of Ophthalmology (AAO) has declared February as Workplace Eye Safety Month and they
When it comes to safety, make sure you speak the same language!
Monday, February 7th, 2005Many employers have workers who are not proficient in English. They may be recent immigrants, or they may have lived in non-English speaking enclaves here in America for many years. So how can you ensure that these workers understand your safety procedures? How confident are you that they can follow your lockout/tagout procedures, or bloodborne pathogen exposures, or fall protection?
Fortunately, the world of the internet provides a wealth of resources. In what might appear to be an unlikely resource, the workers compensation fund in Utah offers a deep and well contructed library in safety materials, most of which are available in Spanish. If you have Hispanic workers who are limited English speaking, these materials could be very valuable. A quick search of the internet will provide resources in other languages as well.
One note of caution. Many immigrants are illiterate in their native language. In many countries, elementary education is considered optional and is often pre-empted by the need for children to go to work. It does no good to provide a Spanish language “hand tool safety” program to an Hispanic worker who cannot read it. And I know from my background in adult literacy programs that many adults will try to hide the fact of their illiteracy. This is a sensitive area, where a mistep by management could lead to grievances and even lawsuits.
So approach your workers with respect and care. Even if they are unable to read, they may be able to use the materials in conjunction with a family member or friend who is literate. The bottom line is relatively simple. You need to protect all of your workers by providing training and access to effective safety materials. You must take steps to ensure that your safety procedures are understood by each and every worker — and this means providing materials that they can readily understand.
Managers’ tool kit: new healthcare, socioeconomic, and interactive resources
Monday, February 7th, 2005It’s been awhile since we’ve added new resources to the toolbar on the right. We hope to create a one-stop shop of valuable workers compensation, HR, medical, and health & safety resources for industry practitioners, as well as for workers. Here are some recent finds:
Since 1997, Pam Pohly’s management guide for healthcare executives has been seeking and posting a broad array of healthcare resources, including legislative and compliance updates, professional association directories, employment search services, practice management tools, healthcare news and more. The site contains hundreds of links, including toolkits for health administrators, physician executives, HR managers and nursing managers. The glossary of managed care terms is a handy tool for workers comp managers, and the calendar of health observances is good reference for safety and wellness programs.
EconData.Net has thousands of links to socioeconomic data sources, arranged by subject and provider, pointers to the Web’s premiere data collections, and a list of the ten sites they judge as being the best sites for finding regional economic data. Need to find population or demographic data or trends? Employment statistics? Labor force by occupation? Wage trends? You’ll find resources at this deep site.
Interactive Tools
The Liberty Mutual incidence calculator allows you to determine your own incident rates and compare your rates to other companies in your SIC group.
American Express has an interactive hiring tool that helps you to think through the skills and characteristics you need to create a job description, and lets you generate a worksheet to use in your interviewing process, and provides questions that may be helpful in interviews.
If you are an employer in Michigan, you can use an online calculator to estimate your workers’ compensation costs. This analytic tool uses ” … your work force data to provide you with a general case study looking at your potential costs. Your actual results in the “open market” will vary depending on a number of factors.”
Blackberry Thumb?
Thursday, February 3rd, 2005A recent posting on WEB MD raises the specter of an ailment for the new milennium: “Blackberry thumb.” The prognosis comes from hand specialists who see potential risk in the way people enter data onto their Blackberry devices.
Alan Hedge, PhD, director of the human factors and ergonomics research group at Cornell University in Ithaca, N.Y.is quoted in the article as saying “the thumb is not a very dexterous part of the hand. It is really designed as a stabilizer for pinch gripping with a finger. That is why you only have two of them, not eight. It is the fingers that have dexterity, not the thumb.”
The full-size typing keyboard was designed with this in mind. The more dexterous fingers are used for quick strikes on the letter keys. The relatively clumsy thumbs are limited to striking the spacebar. You know the expression: someone is “all thumbs.”
“When you switch that around (by relying heavily on the thumbs to enter data) you put a lot of strain on the thumb,” Hedge says. “So if you persist in typing a lot of information with your thumbs, you risk injury.”
Hence Querty keyboards may well pose a specific problem for people old enough to be developing arthritis. Hand surgeon Prosper Benhaim, MD, associate professor of orthopaedic and plastic surgery at UCLA, points out that there different types of tendinitis. One is trigger thumb. The other is de Quervain’s tenosynovitis, involving the tendons on the side of the wrist right where the forearm joins the wrist. These tendons participate in controlling the thumb and are very sensitive to repetitive motions.
What’s the treatment for BlackBerry thumb? “Lay off thumb typing,” the experts say. Do they really believe that Blackberry devotees will agree to that?
“If people have true tendinitis, I might give them a cortisone shot,” Benhaim says. “Or I might use a thumb brace, maybe. I would certainly tell them to rest it. And then to minimize the stress and strain. Do more typing on your keyboard and then sync over to your BlackBerry rather than typing longer messages on BlackBerry itself.”
A Word to the Wise
Ok, we are not recommending that you give up on your Blackberry. In fact, none of the hand experts who consulted for the article has seen a single patient with BlackBerry thumb. At this point, it’s all conjecture. But think back to those ergonomic videos of the early 1990s, where the symptoms of carpal tunnel were described in delicious detail. Half the viewers walked away convinced that they felt a distinct tingling in their finger tips.
So readers with Blackberry devices, how are your thumbs feeling today? If you decide that you do indeed have a thumb problem, it’s probably work related. So please do us a favor. If you decide to pursue a workers compensation claim, let us know how it turns out. (Perhaps we should say, let us know how long it takes for the claim to be denied!) In any event, we will try to stay ahead of the curve on trendy diagnoses.
Cell Phones and Driving, Revisited
Wednesday, February 2nd, 2005Back on July 19 we blogged the issue of cell phone use while driving. Even as a few states were requiring headsets for drivers who want to carry on a phone conversation, there were studies indicating that head sets did not reduce the danger of distraction — and accidents. Now the Journal of Human Factors (subscription required) has come out with a study that reinforces the earlier concerns. The study showed up as a news bite on my MSN homepage.
“If you put a 20-year-old driver behind the wheel with a cell phone, their reaction times are the same as a 70-year-old driver who is not using a cell phone,” said University of Utah psychology professor David Strayer. “It’s like instantly aging a large number of drivers.” That is a scary thought!
The study indicates that cellphone distraction causes 2,600 deaths and 330,000 injuries in the United States every year.
The new study found that drivers talking on cell phones were 18 percent slower to react to brake lights. While cell phone users did keep a 12 percent greater following distance. they also took 17 percent longer to regain the speed they lost when they braked. Hence, they interfere with the all-important flow of traffic.
As we all know, a delay of mere seconds when you are traveling 75 miles an hour translates into a lot of pavement. With delayed reactions, stopping distances increase by multiple car lengths.
Once again, LynchRyan cautions employers to establish written policies on cell phone use and provide training to employees who routinely drive as part of their jobs. Prudent companies will discourage the use of driving time to conduct business on the phone. If, on the other hand, your company encourages employees to conduct work while driving, you may be liable for the inevitable driving mistakes that employees make while chatting away. It’s not hard to imagine a jury imposing huge financial penalties for negligence on any company that requires its employees to “multi-task” on the road. Written policies should encourage employees to do any serious and detailed phone work at a rest stop.
The Law of Deep Pockets
Keep in mind the “law of deep pockets.” Those who have deep pockets (insured businesses) attract those who do not — in this case, members of the general public who may be harmed by your employees. Need I add that you should not be reading this blog on the screen of your hand-held device while barreling down the freeway? In this season of enhanced driving hazards, keep your eyes on the road ahead.
See also:
Driving and Talking: Are headsets the answer?
SEC reserve inquiry of Interstate Bakeries intensifies
Tuesday, February 1st, 2005Roberto Ceniceros of Business Insurance reports that the SEC intensified its probe of Interstate Bakeries, moving from an informal to a formal investigation of its workers comp reserves. The company employs more than 30,000 workers and is the nation’s largest wholesale baker. Think Twinkies, Hostess, Drakes, and Wonderbread.
According to Columbus Business First, the inquiry began last July when the Kansas City-based company said it might have incorrectly accounted for reserves. More recently, the company filed for Chapter 11 and ousted executive staff:
“Interstate Bakeries in December removed its treasurer and senior vice president of finance after identifying a “material weakness” that allowed the $40 million workers’ comp charge to go unreported for two quarters.
According to unaudited financials the company recently released, the $40 million charge accounted for most of the company’s swing from a $27.5 million profit in fiscal year 2003 to a $25.8 million loss in fiscal year 2004.”
$40 million is a lot of cupcakes. Reserves have been the demise of more than one company, let’s hope this large employer will be able to weather the challenge. We recently discussed reserve problems in the context of a Kentucky self-insurance group (SIG) that was grossly under-reserved, and also discussed what happens to workers comp claims when an insurer defaults. This bears watching.
