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Monday, April 19, 2010

Breaking the Taboo: Tools for Talking Price with Your Doctor

Each time I go to my neighborhood Publix I experience two pricing models. The difference between these goes to the heart of what's wrong with our health care costs as a nation. I drop my prescription off at the pharmacy, and then head off with my wife (without whom I couldn't find the front checkout much less any food item, but I digress) to grab our food for the week.

When it comes time to check out I swing by the pharmacy and pay three $10 co-pays for three generic maintenance drugs. Then we go to the checkouts and pay for everything else. By the time we're at the checkouts I can tell you almost to the dollar how much we're going to spend because I've watched that with each item that's gone into the cart. I have absolutely no idea how much my prescriptions actually cost me because "they're $10 each." That's a lot of what's wrong with health care costs, and why HSA accounts are reshaping our thinking.

With FSA accounts and PPO plans we don't care about the real cost, the balance of which is paid for by our insurance plan. We don't care, that is, until the next renewal when our premiums, deductibles and co-pays rise sharply. With our last renewal, however, we had 80 employees elect the high deductible plan, and most of these opened an HSA. Now I'm hearing encouraging changes in perspective that I want to pass along to encourage everyone.

One person stopped me in the hallway recently and said that his family was comparing drug costs for all their prescriptions at all local pharmacies. They intend to move their business where the overall monthly bill is lowest. During renewal several people in our Accounting department asked about the physician and hospital discounts in one network vs another. Both of these instances show what happens when the HSA money is yours to keep, and whatever you spend comes out of that account. Now all of the sudden we care about the full price of our health care. We should have all along and I'm as guilty as anyone.

If we start to shop at the grocery store pharmacy with the same care that we shop the rest of the store we become several hundred negotiating consumers rather than a herd of insured bodies taking whatever we get at whatever price. While some may say that health care is not where you want to save money, it is a false choice between quality and price. You feed your family within your budget without buying spoiled produce and rancid meat, don't you? You do that by being smart consumers, and that same intelligent decision making can accomplish the same result in your family's health care.

It also happens that those physicians and institutions with the highest quality often have the lowest price. The number 1 maternity facility in Nashville is Baptist Hospital, which also has an excellent reputation and is ranked on our Blue Cross Blue Shield website as having the lowest cost rating in this market. During the health care reform debate The Cleveland Clinic was cited many times as having the best outcomes simultaneous with the most reasonable pricing model.

So if you want to compare price and outcomes between doctors and hospitals, where would you get this information? For those of us enrolled in the Thomas Nelson plan with Blue Cross Blue Shield you can get it off their website at Register if you haven't already. Once you have, look to the lower left column to find typical discounted pricing information for a variety of treatments, cost rankings for area hospitals by type of procedure, and dental cost information.

Armed with this information you can do one of two things. You can ask your providers up front what they intend to charge for this procedure and compare that to the market. If you want to be less confrontational, you can check some of your old Explanation of Benefit (EOB) forms and see what they've charged you in the past. You can then ask your doctor's office why they charge more than the market average, or consider moving to a doctor whose charges are more in line. Listen for the tenor of their response; the greater their indignation the greater the likelihood that you've struck a nerve and are being overcharged.

Remember, anything is negotiable and now is the time to adopt this new posture. I recently had a dispute with one of my providers over a $25 late-cancellation charge that I declined to pay. I thought we'd have a fight, but they gave up without a word. While in there for my next appointment the provider remarked to me that their patient load was off significantly due to the number of unemployed people who had lost insurance. Remember, these are businesses and not philanthropic institutions. Now is the time to confirm where your providers charge vs. the market and, if you don't like what you discover, push back.

Friday, April 16, 2010

Demographics Will Save This Job Market

As usual the headlines on the job market are dire. News agency after news agency reported that "March job losses were 61% higher than February." Surely all signs point to a slow recovery for jobs in the near term, but long-term the outlook is outstanding. Here's the rest of the story.

March job losses were sharply higher than February's because February's 40,090 jobs lost was the lowest in four years. March's 67,611 was not great news, but let's dissect that further. First of all it was 55% lower than March 2009's 181,183 jobs lost. Now of that 67,611, 50,604 were government job cuts announced in prior months and finally implemented. The media got to count these twice as bad news: once months ago when the various federal, state and local entities announced the cut and again in March when they happened. Furthermore of these 50,604, just over 30,000of those are at the U.S. Postal service.

So take out the USPS and the governmental sector cut 20,000 or so jobs and the private sector shed just over 17,000. Those are remarkably good numbers.

This opinion is born out by the quarterly job losses for Q1 this year (181,183) vs. last year (578,510). That's a 69% reduction, not that any media outlet will quote that. Good news doesn't sell soap.

So in the short-term the job market appears to have bottomed out and is beginning to recover. What about the long-term?

I read some interesting material this week hinting at a labor shortage beginning late this decade. Doing a little original research, I have to agree. The Baby Boom generation is inching toward retirement, with the leading edge (and largest group) hitting retirment age in the next 6-8 years. After WWII the Boomers filled the cradles and spare bedrooms of America to the tune of about 50 million people. However, 32 million of those were born between 1946 and 1951. They are now ages 59 - 64 and have social security retirement ages of 65, as opposed to us later "echo" Boomers whose retirement ages range from 69 1/2 to 72.

So what happens in the next 6-8 years? Well, it's difficult to predict exactly. People are healthier and living longer, and may not want to retire. There is speculation that part-time work will become more common for seniors, as will incentive pay for companies to keep older workers on longer. Lost 401(k) and pension balances from this recession may force some people to work longer. On the other hand, the incessant implementation of new technologies may make more jobs unnecessary or obsolete, or move past what most older workers are willing or able to master.

Whichever of these factors influences the job picture more, one thing is for certain; the number of hours that people age 59 and over are contributing to this economy is about to drop off sharply. We've seen the impact of decreased hours in fields like medicine and pharmacy, where women's share of those jobs as risen sharply in the last three decades and where the aggregate weekly hours worked has plunged. Women in these high-paying professional positions can easily work fewer days and still make excellent livelihoods in order to attain work-life balance with child rearing. Great for them and their families, but the resulting shortage in doctors and pharmacists is well established.

So assume the 32 million leading-edge boomers have experienced some mortality, disability, and early retirement. Let's just say that we have only 25 million workers who retire or sharply cut back their hours? With low fertility in all subsequent generations, and with our obsessive and immoral purging of illegal aliens, there won't be enough people to fill jobs abandoned by Boomers. Look for a labor shortage, and a suburban housing glut starting about 2018 and moving on through about 2030.

Oh, and on the immigrant topic, here's a pinch of perspective. There are about 40 million first generation immigrants in this country right now. Of these, it's estimated that about 15 million are illegal. Wanna kick 'em out? Send 'em back where they came from courtesy of the Tea Party. Well, imagine the year 2020 and a roofing crew of old white guys. Good luck with that.

Monday, April 12, 2010

I'm Looking for a Temp Assistant

I've never tried this before but, hey, why not.

I am currently looking for a part-time Admin for a temporary spot that could work into a full-time job. Right now I need someone about 20 hours a week who would work as my AA about half that time and spend the rest of their time working for Travel and HR doing clerical support work.

Before you ask, no, my current AA Dawn isn't going anywhere. Our work load has expanded as has Travel, and we need to slide Dawn over to help Jack in the more traditional HR work. This position would pick up some of her slack while she's working for Jack.

As to who I'm looking for, we'd like someone who has previous Assistant experience (HR is a plus but not necessary), is professional in appearance and demeanor, has good instincts (we deal with people, after all), and is service-oriented so that our internal customers are treated well.

As an added incentive to find the right person, we're okay with someone on the "Mommy track" who wants to put their kids on the bus, come to work for a few hours, and be there when they get off the bus.

This sounds like I might get 5,000 resumes, but here's the kicker. If you are bi-lingual (English + either Spanish or Vietnamese) you go to the head of the line. I'd love to use this additional resource person to improve our communications with non-bilinguals within our company and in the greater candidate pool outside our company.

Interested? Know of someone who is interested? Send me an email that acts as your cover letter to and attach your current resume. Spam, resumes with no cover letter, and candidates who don't fit the requirements go straight to trash without a reply. I'll read and reply to the rest myself.