OP-ED

The Other Penn State Scandal

It’s one thing to lead by example and quite another to be made an example of.  The executive leaders of Penn State University, who have managed to generate quite enough terrible publicity over the past couple of years, have now gone boldly where no employer has gone before.  By implementing a coercive, intrusive, and wasteful “wellness” program during the academic year’s summer doldrums and miscalculating that it would go unnoticed, they have invited the wrath of their own faculty.

The PSU wellness initiative like so many before it relies on the hydra of preventive medical care, which is both clinically and fiscally ineffective; a personally intrusive health risk appraisal; and, a whopping incentive/penalty of up to $1,200 per year if you don’t play ball, which is double the national average.  Penn State faculty, led by political science professor Matthew Woessner of their Harrisburg campus, have responded with outrage and a petition for withdrawal of the program, which now has 1,500 digital signatures.  Penn State’s HR team, led by VP Susan Basso, has doubled down on its own ignorance claiming that the opposition is “unfortunate and sad.”  What’s unfortunate and sad is that employees of a college can’t do math or read .

Penn State faculty are right to oppose the wellness program on both ethical grounds and economic grounds.  Their creativity on how affected faculty and staff should respond is applause-worthy.  Entering bogus data on the HRAs (both legal and harmless to employees because HRAs are anonymous) and refusing to get any of the preventive care recommended are useful guerilla steps.  They are also discussing a blanket refusal to participate, which means either everyone gets hit with the penalty or no one does.

However, there is an alternative approach, and one that will break the bank in HR: get every preventive test possible and then get all the follow-up care you can for every conceivable dubious or positive result, many of which will be false positives.  Faculty should also use their paid time off to rest up from the physical and emotional stress of getting all this unnecessary medical care and perhaps even think about filing workers comp claims since these stressors are all directly job related.

PSU’s stab at wellness is all the more unctuous because of the way it was rolled out.  It is aimed at non-unionized, white collar employees (and their spouses), whom the University clearly expected to behave like lemmings.  Ironically, given the strong inverse relationship between education, income, and health risks, these people were the least likely to need help, but it was much easier to surprise them than it was to renegotiate contracts with the Teamsters Union.  PSU’s executive leadership would do well to climb off this particular ledge, admit their multiple errors, and trash their wellness program until they can design something that actually makes sense and builds a bridge of goodwill with employees.  Otherwise, this chapter in wellness history will show that Penn State’s leaders could not resist the opportunity to do something to their employees instead of for them and with them.  Of all the places on earth that ought not to be doing things to people anymore, it’s Penn State.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog.  He is also the Wellness Editor-At-Large for THCB.

Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health CostsHow to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.

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  2. I work an average of 40 hours a week at Penn State, but I don’t receive employee health benefits, or any of benefits most full time PSU employees receive, because I have been classified by Penn State as a part time employee. Under HR Policy 88 ( and many other Penn State policies and guidelines), I should qualify for full employee health and other benefits, because I definitely meet full-time equivalent (FTE) employee standards.

    Why am I being mis-classified? I have been asking our Human Resources department that very question for almost one year now, and for every email I send or meeting I have with them, I get the same response–“We’ll have to look into that and get back to you”. As of today I am still waiting for their response. To put this into perspective, my first email (or the first of many emails sent, that I can find in my inbox) was sent January 3rd, 2013, it is now December 9th, 2013, 11 months and 6 days later, and I am still waiting to hear back!

    With the advent of the Affordable Care Act, I’ve discovered that I could end up paying a fee if I don’t choose a healthcare plan through the exchange or my employer, but what can I do? Penn State “graciously” offered me “Part-Time” Employee Benefits today for $260 a month, with NO Vison or Dental coverage, while ObamaCare wants $150 to $280 a month for a similar plan. If I were classified as a full time employee by Penn State, which according to every policy and guideline they publish I should be, I would pay less than $75 a month for Medical, Dental, Vision insurance coverage, all together. Do I sign up for ObamaCare and save over the over-priced Part-Time Benefits package offered by Penn State (which, by the way, only covers 50% of prescription costs), or do I hope that Penn State’s HR department finally (magically) stops being so magnificently incompetent and gives me the benefits I should have received for years now? I’ve worked for Penn State for 5 years, 3 of which were in my current department. I’ve never personally seen HR solve a single person’s problem or give a straight answer to anyone’s questions, but maybe I’ll get lucky.

    However, these are the people that told a girl in my department, after she reported that a man who worked down the hall from us had a concealed handgun in his desk, and who also made a few very scary comments about killing thieves and immoral people…they told her that she should just try avoiding him in the future. And guess what, he still works there, even after several other people went to HR to complain about his bizarre behavior. What is wrong with the HR department at Penn State? And why would an organization like Penn State so constantly mired in scandal and controversy, not do something to improve the work environment of their employees, or at the very least have an HR department that can answer questions from employees sooner than a year after they are asked?

    We are Penn State? Penn State Lives Here? Instead of spending $6 million on a slogan campaign, how about treating your employees equally, or at the very least hiring competent employees? Penn State can keep manipulating it’s outward image with catchy phrases, but internally it is being eaten alive by cronyism and incompetence. Penn State Lives Here, indeed — well there goes the neighborhood!

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  4. Gotcha — my understanding was that the $63MM was , in her i (justifiably) humble opinion, to be saved from making people heathier. THAT’s the part that’s impossible. Saving $63MM the other ways is possible but only if you define “saving” as “making someone else pay.”

    That then raises the question: if they aren’t saving money in wellness itself, why do it? Why invade everyone’s privacy? Why force them to go to the doctor all the time and get screened far in excess of government recommendations?

  5. [Penn State, Ms. Basso says, did consider alternate ways of introducing a cost-containment strategy — like artificially inflating employees’ premiums by 35 percent and then offering a discount to those willing to participate in the wellness program. But administrators felt that the $100 surcharge was more transparent. “It was an intentional design to drive participation,” Ms. Basso says, “and it is driving participation.” ]

    [The reaction may have caught Penn State by surprise, because administrators did not extensively examine the WebMD program before signing up for it. When I asked Ms. Basso who at the university had reviewed the questionnaire for scientific validity and ethical propriety, she said: “We have a relationship with Highmark. This is their tool. If we were going to use a health risk assessment, it was going to be theirs.”]

    Source:
    http://www.nytimes.com/2013/09/15/business/on-campus-a-faculty-uprising-over-personal-data.html?_r=0

  6. As a female faculty member who also completed the HRA early on, I concur with every word of your post.

  7. Mr. Lewis,

    Apparently you have not read Ms. Basso’s earliest explanation of the actuarial analysis carefully. Thus, you have a naive understanding of what it means to “save.”

    Ms. Basso was very clear initially that the amount of the “surcharges” were set not to drive compliance (although that’s what she has said more recently) but by actuarial analysis to determine which surcharge levels would result in the target “savings.”

    So, I have tried out some sample sets of assumptions to see what that means. If we assume that:
    * 30 percent of spouses have available but significantly inferior employer-sponsored health insurance,
    * 16 percent of the total number of employees either smoke or have spouses who smoke (could assume a lower percentage if both smoke)
    * 20 percent of employee/spouse pairs do not comply in entirety with the wellness initiative.

    Then that would save PSU a tidy $63MM over 5 years at the set surcharge levels. That’s without considering those who opt for a less expensive plan, or who drop their spouses or their whole families from the PSU plan. The surcharges are not being considered in their presentations of employee contributions, but as reduced healthcare expenditures; one can deduce that by looking at their estimated numbers with and without the plan for next year.

    It’s clear to me how PSU HR defines savings, and that under that definition $63MM is certainly possible. You just haven’t kept up with Ms. Basso’s “transparent” definitions.

  8. This is hogwash. They can’t save $63MM because they don’t spend $63MM on wellness-sensitive medical events over 5 years.

  9. Hey, I’m not saying BMI is a GREAT metric, but it is a metric which strictly speaking is “scientific” by any reasonable definition. Really, what else does “scientific” mean except you can measure it pretty accurately; and in this case it’s also interesting because it happens to correlate with other interesting things, such as the risk of hypertension, metabolic syndrome, fatty liver, obstructive sleep apnea, and other outcome measures.

    To say flat out that BMI is not scientific, as you did, would therefore be incorrect. I would not want to discourage my patients from knowing their BMI and what percentile they’re in. Telling a patient that BMI’s are “unscientific” is likely to discourage them from inquiring about that.

  10. If your metric is something is worth using because it’s cheap and available, then not only are you on thin ice, but the ice is shattering right under your feet.

    Below are just a few things that are cheap and readily available in health care that are also so over-utilized and, in most cases, clinically worthless, that even the specialty societies charged with protecting the economic interests of the physicians who use them the most are starting to say STOP.

    In almost all these cases (and many more), these relatively inexpensive (but always reimbursable) steps are what you can do to avoid having a real dialogue with a patient, which is the same reason to rely upon BMI. Inappropriate prescribing, referring someone out for unnecessary diagnostic testing, or throwing their BMI in their face is cheaper, easier, and less time consuming than talking to the patient. It is certainly cheaper and easier to tell a patient that he or she is obese by BMI than to explain that excess adiposity is actually a complex clinical situation and that their state of cardiometabolic health and fitness are likely the key factors in their prognosis.

    Routine ECG in asymptomatic patients (I’ve lost count of how many times that has been pushed on me)

    Routine dental exams and xrays (same as above)

    Antibiotics or imaging for common rhinitis

    Imaging for uncomplicated low back pain

    Pap smears on women <21 or who have had a hysterectomy

    This list of cheap, available (and billable), and worthless health care services could go on forever. Readers can read details of these and more at: http://www.choosingwisely.org.

    BTW, in the earlier comment, no one was pointing to Peggy Noonan or the WSJ as "experts". The notation was merely that there were two thoughtful pieces worth reading, and you apparently missed the boat on both counts.

  11. Well Paul,
    Following your line of reasoning, I will take one important comment of yours to ask how we can feel good about the bases of what you are saying. You say the BMI is scientific because “you can measure it and it predicts things.” The first part of that statement is, of course, not very impressive – Just because it can be measured is hardly an endorsement of validity or anything else for that matter. So, on to the second part – “it predicts things.” What exactly does it predict? Body fat %? – not well. Blood pressure?, not well, fitness?, not well. Morbidity and mortality?, not well – It doesn’t predict these things very well partially because it does not take into account age, gender, ethnicity, or muscle mass. Yes it does correlate with outcomes but clearly you know that correlation does not imply causation – after all there is a positive correlation between baldness in men and heart attacks but that does not mean you can reduce a bald man’s risk by giving him a toupee.
    Furthermore, it was not created for the purpose of being used as a measure of or even proxy for health – (read about its creation – google – Quetelet index)
    As far as the math behind the BMI, it has been thoroughly trashed by NPR’s science guru Dr. Keith Devlin – (Google Do You Believe in Fairies, Unicorns or the BMI). Oh yes, and I almost forgot, your own scientific advisory council recommended against naming obesity a disease because of its lack of validity. So, in one sense you are correct, it is cheap and available – and when those two terms become synonyms for accurate and efficacious I would agree we ought to embrace it.

  12. Any chance you could provide citations for the studies evidencing the (preferably long term) effectiveness of Penn State’s type of intervention? Thanks.

  13. You’re quoting Peggy Noonan and the Wall Street Journal as authoritative sources?? Oh brother.

    So now I’m wondering if the rest of your concerns are comparably baseless.

    Your concerns about privacy are, of course, important. And yes, it sounds like the decision to use WebMD without additional privacy safeguards was a blunder.

    But your bland dismissal of the effectiveness of this type of preventive intervention, including HRA’s (Health Risk Appraisals) is, to me, unpersuasive. There actually is quite a bit of data about such interventions going back a decade or more. Yes, a specific set of prevention interventions will almost always need review and periodic improvement. Some will work; some won’t. Preventive programs are intrinsically a moving target. Yes, respondents can lie on their HRA responses, but mostly they don’t. Yes, such preventive plans can be poorly tailored, but often they help quite a bit. Maybe this roll-out was “ham-fisted” as you say, but that doesn’t mean the overall intent, and the evidence base supporting such programs, can be easily dismissed.

    The literature on workplace preventive interventions for employer-sponsored plans (covered in Section 1201 of the ACA) is extensive. Annual reductions in health care costs ranging between 5% and 10% are typical following successful roll-out of such programs, and are accompanied by significant improvements in other health measures in that workforce. Often very cost-effective.

    Of course, employers also look for improvements in productivity from their workforce, as a result of these interventions. There is no question that if some appreciable percentage of smokers can be persuaded to quit, or a percentage of sedentary folks can be persuaded to get in shape, they’ll miss fewer days of work, in addition to costing their health insurer less.

    So what’s wrong with such preventive interventions? Of course, as you suggest, they have to be carefully tailored to avoid discriminating against folks with disabilities; and the rules in ACA Section 1201 on this matter are pretty strict. Also, there’s the inevitable perception that a monetary incentive is just the reverse of a penalty for folks who don’t take advantage of it. Can’t help that, and such incentives have to be implemented very diplomatically.

    For smoking in particular, you may be aware that Congress explicitly authorized employer-sponsored plans to offer incentives amounting up to 50% of out-of-pocket medical expenses for covered patients who quit. Congress meant business on smoking cessation. God bless ’em.

    So, overall, I’m not so sure the intent and direction of this Penn State program are as bad as you are arguing.

    (PS – you state above that BMI (body mass index) is “unscientific.” Hogwash. You can measure it, and it predicts things. Is the R-squared perfect for those predicted things? Of course not, but BMI still correlates with important outcomes; and if you can change BMI, the likelihood of those outcomes also tends to change. That would accordingly make BMI “scientific,” I would argue. Are there better measures and predictors? Maybe. But this one happens to be cheap and available.)

  14. Penn State’s Mandatory Health Questionnaire Ineffective

    New Policies Largely Ignore the “Elephant in the Healthcare Room”

    WASHINGTON, D.C. (August 19, 2013): A new policy by Penn State, requiring all employees to fill out a detailed and arguably intrusive health questionnaire – covering everything from binge drinking to testicular self-exams – or pay $1,200 a year is very ineffective and inefficient in its stated purpose of holding down health care costs, while largely ignoring the “Elephant in the Healthcare Room,” says public interest law professor John Banzhaf of the George Washington University Law School.

    While more and more companies are charging employees who smoke a surcharge under Obamacare of $5,000 a year or more for their health insurance – as only partial compensation for the $12,000 a year cost each smoking worker can impose on his employer – Penn State is charging only $75 a month.

    “The cost of one monthly dinner out, or a few Starbucks drinks a week, is hardly enough to persuade a university professor or administrator to quit smoking and save his employer over $12,000 a year in unnecessary costs, whereas $400 a month – and even more for a couple – will certainly provide a powerful incentive, says Banzhaf, who lobbied hard to include the smoker surcharge under Obamacare.

    Indeed, notes Banzhaf, companies imposing the 50% surcharge are reportedly finding that it usually halves the smoking rate among their employees, and a Gallop survey shows that a majority already support charging higher health insurance rates for smokers.

    Under the new money-saving policy, Penn State employees also must get biometric screenings – including blood-sugar and cholesterol tests, and body-mass index measurements – but apparently no tests (such as for cotinene or carbon monoxide) to determine if they are still smoking.

    Mandating tests for cholesterol or blood-sugar, but failing to include a simple blood, urine, or saliva test for cotinene, is simply ignoring the elephant in the medical cost room, says Banzhaf, who participated in a case holding that employers could refuse to hire people who smoke because of the huge $12,000/year cost they each impose on their employer, and indirectly on other nonsmoking employees.

    Actually, says Banzhaf, simply requiring employees to fill out health questionnaires saves employers little if anything in healthcare costs, and may even increase spending by forcing workers to undergo extra testing and schedule additional doctor visits.

    Many people also find the questions very intrusive. Moreover, while Penn State says that the employee health information will be protected as confidential, recent breaches of computer security at major corporations and military installations suggests that any such guarantee may prove illusory.

    Smoking is the largest single preventable cause of unnecessary medical costs, says Banzhaf.

    At a time when thousands of college campuses have gone entirely smokefree, and some are even refusing to hire smokers at all, Penn State would do better to crack down on smokers than to force even its healthiest employees to fill out health questionnaires, he argues.

    JOHN F. BANZHAF III, B.S.E.E., J.D., Sc.D.
    Professor of Public Interest Law
    George Washington University Law School,
    FAMRI Dr. William Cahan Distinguished Professor,
    Fellow, World Technology Network,
    Founder, Action on Smoking and Health (ASH)
    2000 H Street, NW
    Washington, DC 20052, USA
    (202) 994-7229 // (703) 527-8418
    http://banzhaf.net/ @profbanzhaf

  15. Penn State’s Mandatory Health Questionnaire Ineffective
    New Policies Largely Ignore the “Elephant in the Healthcare Room”

    WASHINGTON, D.C. (August 19, 2013): A new policy by Penn State, requiring all employees to fill out a detailed and arguably intrusive health questionnaire – covering everything from binge drinking to testicular self-exams – or pay $1,200 a year is very ineffective and inefficient in its stated purpose of holding down health care costs, while largely ignoring the “Elephant in the Healthcare Room,” says public interest law professor John Banzhaf of the George Washington University Law School.

    While more and more companies are charging employees who smoke a surcharge under Obamacare of $5,000 a year or more for their health insurance – as only partial compensation for the $12,000 a year cost each smoking worker can impose on his employer – Penn State is charging only $75 a month.

    “The cost of one monthly dinner out, or a few Starbucks drinks a week, is hardly enough to persuade a university professor or administrator to quit smoking and save his employer over $12,000 a year in unnecessary costs, whereas $400 a month – and even more for a couple – will certainly provide a powerful incentive, says Banzhaf, who lobbied hard to include the smoker surcharge under Obamacare.

    Indeed, notes Banzhaf, companies imposing the 50% surcharge are reportedly finding that it usually halves the smoking rate among their employees, and a Gallop survey shows that a majority already support charging higher health insurance rates for smokers.

    Under the new money-saving policy, Penn State employees also must get biometric screenings – including blood-sugar and cholesterol tests, and body-mass index measurements – but apparently no tests (such as for cotinene or carbon monoxide) to determine if they are still smoking.

    Mandating tests for cholesterol or blood-sugar, but failing to include a simple blood, urine, or saliva test for cotinene, is simply ignoring the elephant in the medical cost room, says Banzhaf, who participated in a case holding that employers could refuse to hire people who smoke because of the huge $12,000/year cost they each impose on their employer, and indirectly on other nonsmoking employees.

    Actually, says Banzhaf, simply requiring employees to fill out health questionnaires saves employers little if anything in healthcare costs, and may even increase spending by forcing workers to undergo extra testing and schedule additional doctor visits.

    Many people also find the questions very intrusive. Moreover, while Penn State says that the employee health information will be protected as confidential, recent breaches of computer security at major corporations and military installations suggests that any such guarantee may prove illusory.

    Smoking is the largest single preventable cause of unnecessary medical costs, says Banzhaf.

    At a time when thousands of college campuses have gone entirely smokefree, and some are even refusing to hire smokers at all, Penn State would do better to crack down on smokers than to force even its healthiest employees to fill out health questionnaires, he argues.

    JOHN F. BANZHAF III, B.S.E.E., J.D., Sc.D.
    Professor of Public Interest Law
    George Washington University Law School,
    FAMRI Dr. William Cahan Distinguished Professor,
    Fellow, World Technology Network,
    Founder, Action on Smoking and Health (ASH)
    2000 H Street, NW
    Washington, DC 20052, USA
    (202) 994-7229 // (703) 527-8418
    http://banzhaf.net/ @profbanzhaf

  16. This whole this is BS. They are obviously selling our records to a commercial enterprise and pocketing the profits. I strongly suspect that is Jerry Sandusky hadn’t buggers those kids, we would not be being buggered now.

  17. 26% of national employer provide a lower premium to those who don’t use tobacco and 62% of employers in certain employer groups. Tobacco use is known to cost plans $2,500 annually per tobacco user. So there is real cost there. The pocketbook becomes the only way some people are motivated to move to healthier behaviors.

  18. L.R, this sounds like a FAQ written by your human resources director’s evil twin.

    I just found out that with all this money being spent on screens and tests, PSU spouses are still not allowed to access the fitness facilities without paying an additional fee.

    So much for Highmark’s claim that the Penn State program is creating a “culture of wellness.”

  19. From the FAQ file (http://ohr.psu.edu/assets/benefits/documents/TakeCareOfHealthFAQs.pdf)

    ***
    Q: I don’t trust WebMD or the other third-party companies that they sell information to. Is it mandatory that I share personal health information with third-party web businesses that I don’t trust?
    A: Completion of the WebMD Wellness Profile is not mandatory, however, if someone chooses not to complete the profile, the surcharge will be applied beginning in the January payroll.
    View more information about WebMD’s security and privacy policies at http://ohr.psu.edu/assets/benefits/documents/WebMDPrivacyAndSecurity.pdf.

    Q: Can I request that my data from the wellness profile and WebMD be purged if I leave Penn State in the future?
    A: No, if you leave the University, WebMD places the member files into a holding area in case the member ever rejoins – they do not delete/purge them. (added 8/9)

    Q: If I participate in the program this year but not next year, may I request that the data be purged during the non-participation year?
    A: No, there is not a process to delete/purge active member Rewards Program information. (added 8/9)

    ***

    So the alternative to “not mandatory” is to pay $1200/each or $2400 for two each year. Do regular faculty and staff members really have a choice? These people do:
    http://chronicle.com/article/Executive-Compensation-at/139093/#id=22084_3179
    http://chronicle.com/article/Executive-Compensation-at/139093/#id=22131_3179

    Why a doctor’s note saying this person has taken the exams is not good enough? Why would PSU administration force their employees to share extremely personal information with for-profit insurance companies and their partners?

  20. The public and PSU employees were recently promised a new era of transparency at Penn State. Where is this transparency? We were not given an opportunity to voice concerns. We simply received a notice via email stating the three things we had to do to avoid a $100 surcharge. No mention that upon compliance our medical records would be made available to WebMD. Now we must also pay an additional surcharge of $100 to keep our spouses on the same insurance plan when we already pay for the “family” plan. Staff and faculty have stuck by Penn State when the scandal brought so much shame. We told students, family and strangers that the terrible actions were those of a few. We do not deserve this treatment.

  21. The Wall Street Journal and Reuters both have critical stories up today. It’s important for PSU employees and other advocates for privacy to continue to speak up and maintain the pressure on the administration and its vendors.

    http://online.wsj.com/article/SB10001424127887323455104579014653816536802.html?mod=wsj_share_tweet

    http://www.reuters.com/article/2013/08/15/us-usa-healthcare-pennstate-idUSBRE97E19420130815

    And, in a related vein, Peggy Noonan of the WSJ has written a very thoughtful essay on the growth of the surveillance state and bureaucratic encroachment on privacy:

    http://online.wsj.com/article/SB10001424127887323639704579015101857760922.html?mod=wsj_share_tweet

  22. Letting a powerful coach use the facilities and prestige from a well-known football program to sexually assault children for a decade is a scandal. Implementing a wildly unpopular new benefits program is, at most a controversy. Comparing the two – transgression, reaction or otherwise – is a poorly-chosen way to forward your argument.

  23. I would argue that it is neither needless nor nasty. Vik didn’t create the scenario PSU finds itself in make specific reference to child molestation. All he did was recognize that, since the university failed to deal with one significant challenge (Sandusky) in a timely and responsible manner, they suffered the shi* storm. They probably should have considered that fact before creating another scenario in which it just might rain poo once again.

  24. This is the heart of the privacy matter. This and the fact that the ICH testing sites are a hotbed of privacy violations on their own, with “patient’s” results delivered verbally within earshot of others. This in an environment where we all work for the same employer. At least one complaint has been filed against this to my knowledge.

  25. The main point of opposition is – the employees are being forced to sign over their medical records, in their entirety to both WebMD and ICH – a Pittsburgh based HRA firm.

    Even if we get the HRA completed by our family physician and fill out the online HRA – its not good enough, we will still be fined $100 per month – the crucial part here is there is a connection between signing over our medical records to WebMD & ICH, and the money.

    Obviously there is financial gain to be had for us to provide our medical records to ICH and WebMD…..Selling medical records is a huge and lucrative business….do a web search and see.

    Web MD is in the news for buying compromised medical records..

    http://www.businessweek.com/articles/2013-08-08/your-medical-records-are-for-sale

    WebMD is paying for medical records…..Penn State fines us for not signing over our medical records to WebMD,

    The HRA is only a smokescreen.

  26. Penn State employees who have wellness stories that they would like to share privately should contact me. Send me an email with your experience and/or your contact information if you prefer to speak over the phone.

    We will likely write a follow-up column to this one, and nothing makes an issue like this more compelling than personal experiences.

    Email me at: Vik.Khanna.Health@Gmail.com

  27. You’re not powerless — you are being heard. Not just here but the lay media. Your colleagues have gotten the word out. I just taped a Fox TV segment and am doing some radio later today. I said that a true wellness program (Vik and I said this in the piece above) would do things FOR employees instead of TO them. They need to create a workplace that makes you feel empowered to be in control of your own health (and other issues but that is less likely)

    If you’ve been googling, you’ll find that excluding Highmark and webMD and the soon-to-be-former HR Vice President of PSU, everyone is on your side.

  28. Annie Staffer – thanks for pointing out that staff members are also subject to this policy. Yes I do feel powerless. I have no union, I have no way of earning tenure, and I feel silenced due to potential threat to my position if I spoke up – not saying I will be fired but as the bread earner I don’t want to take a chance. There are more staff members in the university than faculty (http://budget.psu.edu/FactBook/HRDynamic/fulltimeemployeesbyclass.aspx?yearcode=2012humors&FBPlusIndc=N). This is the way academia works. Staff members serve faculty and students and the campus and each other. They do behind the scene jobs. And we depend on tenured outspoken faculty to fight this battle. When you have a vulnerable population silenced, the number of petitions appears dismissible according to our HR director (http://www.insidehighered.com/quicktakes/2013/08/09/penn-state-faculty-launch-petition-against-health-care-surcharges#ixzz2bTaolqRq).
    I have worked in corporate HR before. Human resources are powerful assets when the leadership is right. When it is wrong, however, it can also do great damages.

  29. I would not be so cavalier about the HRAs being anonymous. In most of the programs that I have seen and participated in in recent years the responses are certainly known to the vendor. (How else would anyone know if you are compliant in order to reward or punish you?) This does not mean that there is significant risk in giving bogus answers as I am not aware of any legal compulsion to be truthful (the Eighth Commandment not withstanding) without the prospect of personal gain (in which case there is the prospect of fraud–although I am also not a lawyer, yada, yada, yada). In most self-funded environments there are one or more people at the purchaser (PSU in this case) with access to PHI for specific purposes, which may or may not extend to HRA data. Al is correct that people can (and do) go to jail for HIPAA violations.

  30. I work at Penn State. I would like to point out that all faculty and all staff (except for tech services employees because they are unionized Teamsters) are subject to this policy. Librarians are faculty and can earn tenure. There are many staff in various academic and student affairs departments who are not unionized and can not earn tenure. Many those at the bottom of the hierarchy can also be highly educated with advanced degrees. Finally, I have already done the HRA, and the more I learn from columns like this, the more I regret having done it. After I did the WebMD assessment, I learned that Highmark then uploaded my medical records to the WebMD site. I did not authorize that. If someone like Matthew Woessner wants to hire a lawyer to seek an injunction, I would chip in for the fees, and I predict I am not alone in this. I also predict Susan Basso’s days are numbered, primarily because she is a woman. Woman are second-class citizens at Penn State. If you don’t believe it, look at the salary data.

  31. WebMD has so many lawsuit already against them. All of our medicines and diagnosis are published by WebMD and any hacker now days can break into the computer systems. Per Rodney Ericckson our personal information will be safe through WebMD because of the medical laws and agreement with Highmark.

  32. I just have the blood work done and I was charged by our great Mount Nittany Hospital over $500.00, my doctor was 25.00 and the doctor to read the blood work was another 75.00.

  33. Who can afford to go and get any bloodwork? Two years ago, they changed our deductibles on diagnostic testing. It would cost us over $300 to get the lab work done. PSU won’t pay for that but we would. We have to pay the co-pay to have the required physical from our doctors though and also we have to use our vacation or sick time. They will however pay for our time and costs for their silly BMI/bloodwork.

  34. That is exactly what I was trying to say in my earlier comment. They are beyond reproach. Thank you.

  35. Note to readers of this post: a couple of comment authors here, as well as two emails we got privately, have expressed concern about our allusion to the Sandusky-Paterno scandal at Penn State.

    What we intended to conflate was the administration’s handling of the two scandals, not the scandals themselves.

  36. I do wish that all references to the affected employees weren’t always “faculty.” There are hundreds of STAFF that are affected by this too, and are also quite unhappy.

  37. Bill: thanks for chiming in and for your support. Your point about strategic and comprehensive is absolutely right on. The problem, of course, is that drives at culture change, which most leaders would rather avoid than embrace.

  38. As a Penn State employee I can relay the we were told they had `top men’ working on it. A tip of the hat to Indiana Jones.

  39. The reality is Jeff that if the PSU leadership had done its homework regarding cutting health costs, (if that is their true goal), they would have read that developing a wellness program is a not a viable solution. The research shows that effective programs need to be systemic, strategic, comprehensive and integrated and even these programs cost money for the first couple of years, break even the next couple of years, and then if you are lucky, might show a positive return 5 or more years out. Traditional wellness programs are not health cost savers in the near term, if at all.

  40. The common denominator between these 2 issues in my opinion is the same attitude of the adminstrators…kinda like MC Hammer…can’t touch this. The good old boys club may have gotten a little smaller, but it is still very much in existence.

  41. I agree.. as an employee, it would be much easier to swallow if the administration could show that level of analysis was done and supports the program.

  42. I would love to see the business case, if they have one. What’s more likely the case is that leadership tells HR “do something about medical care spending,” which has perhaps been allowed to run amuck for some time (if their comments about the rate of health care spending inflation at PSU are to believed).

    HR then defaults to the choice du jour, which is a conventional workplace wellness program built around HRAs and biometrics. Ironically, instead of creating a strategy to address a particular problem or set of problems, we see a framing of the problem designed to suit the chosen solution. This is how wellness spreads across the corporate landscape.

    I am willing to shift my view if they are willing to share data showing that: a) their faculty have a sufficient number of wellness-sensitive events or even wellness-sensitive diagnoses that would lead a reasonable observer to conclude that this kind of wellness program might help; b) that the place to start the wellness program was in this educated and more affluent (read: lower risk) segment of their workforce rather than with the entire workforce, so you can reach people in the administrative and support ranks (likely lower paid and perhaps generally less well educated) who are more likely to need the support that a wellness program can offer especially when it is done as cultural change; and c) that they can counter leading edge medical thinking that we have gone too far with the “screen for everything” approach.

    Their chosen strategy, then, is unstrategic, underhanded, and ignores countervailing evidence that is stronger and more logical than their business case, which is easily summarized as “do something”.

    Point taken about the allusion to their other scandal.

  43. That’s a broad brush..

    I would be careful about conflating these 2 issues.

    You are wasting a good opportunity to have a rational discussion on an important healthcare issue by attempting to tie it to the emotional baggage of the “other” scandal.

    In this case, we have the university bureaucracy advising the current leadership that changes to the healthcare plan are required to control costs. The efficacy of these changes is questionable and they are apparently unpopular, but in their eyes, there is a business justification.

    Given that information and the desire to cut costs, the leadership is implementing the recommendations of it’s bureaucrats and alienating it’s employees in the process.

    I’m not sure how that compares to a child molestation scandal.

  44. “Of all the places on earth that ought not to be doing things to people anymore, it’s Penn State.”

    That is needless and nasty. Your point would have been just as well made without using the tragedy of child molestation as a weak framing device.

  45. Actually, I think PSU’s executive leadership has had all too much experience in admitting mistakes, incompetence, and feigned ignorance. Doing so in this case should feel quite familiar and comfortable to them.

    Perhaps in the Nittany Mountains, starting over never gets tiresome.

  46. PSU’s mid level administration can be tone deaf on these issues. Someone thinks this is a good idea and now it will be difficult for them to admit they made a mistake. I think it will be unlikely they will change the requirement without staff changes.

    Also, If you search for “Hipaa data breach” on google, you see many data spills. I think it’s particularly ironic that the administration is defending the collection of biometric data by a 3rd party as protected by “contracts and law”, when PSU has announced many spills of Student and Faculty SSN data with no apparent fines or consequences.

    Once your biometrics are collected and spilled, they can’t be un-collected or un-spilled. I also think concerns about future use of the information collected are justified. What happens when this awareness program is proven to be ineffective?

  47. Figuratively not literally is what he means. Neither has lost their gigs yet even though by now you have to think someone in the administration has read the literature

  48. Penn State is doing a number of things to people in the name of “efficiency” and “streamlining” and cutting costs. They don’t seem to mind dumping money down the drain in other places, but providing benefits for people is a big deal for them. This particular policy goes along with their $75/mo. surcharge for smokers, and a $100/mo. penalty for having a spouse on your plan when that spouse is offered health insurance through their own employer.

    They’re also cutting out the jobs of about 40 low-wage people by outsourcing child care to a company that offers a terrible health insurance plans. The plans are so bad and so unaffordable that the new company’s handbook states they’ll help employees with children apply for the state-funded CHIP health insurance. Meaning they know it’s something people can’t get on their wage, and they’d love to pass that on to taxpayers.

    Pathetic.

  49. Wait, is that true? I didn’t think non-faculty or library staff could have tenure. Where did you read this?

  50. You are doubly protected. Whatever the other shortcomings of these programs, the HRAs are indeed anonymous and even if they weren’t you are protected by HIPAA. Literally someone could go to jail if they read your response

    My wife and I lie on ours just to get through them as fast as possible to collect our gift cards. Who even knows half the numbers they are asking for, most of which have surprisingly low correlation with medical event risk anyway

  51. In my professional experience (this is not legal advice and you should not construe it as such) HRA data is anonymous, so that the HRA vendor cannot connect answers to a specific person. The data are reported to the client in aggregate fashion, not linked to claims or employee records, and are not teased out at the individual except in the “report” that you get at its conclusion.

    Reporting of inaccurate or false data is a HUGE concern to HRA vendors because their ability to get repeat business from clients hinges on their ability to demonstrate that they can get accurate answers from employees. In HRAs that I have taken in the past, I breezed through and answered questions in random fashion, just to see what kinds of idiocy I would get in the final report. Finally, last year my spouse’s employer had an HR official tell employees on a conference call that it did not matter what data they entered in the HRA, just the fact of completing it would get them the discounted premium. Supposedly, this is going to change going forward, but I am hard pressed to see how.

    Al may have more to add.

  52. BTW…to all readers of this post. On the morning of 8/13, I emailed this post to HR VP Susan Basso and cc’d PSU President Rodney Erickson. I invited Ms. Basso respond here, on the record, and join the debate.

    I encourage other readers to do the same: Her email is: smb43@psu.edu. The email for the PSU President is: President@PSU.edu.

  53. Hi Vik,

    Can you provide some guidance on the legality aspect of this?

    “Entering bogus data on the HRAs (both legal and harmless to employees because HRAs are anonymous) and refusing to get any of the preventive care recommended are useful guerilla steps.”

    I am Penn State spouse and we are concerned about the legality aspect of entering bogus data. At this point, we are considering paying the penalty to protect our privacy.

  54. James D: thanks for the note. Yes, that’s exactly what Al and I would like the faculty to do…break it. They should go to their doctors and ask for every preventive test imaginable to rule out all the diseases that they do not have. Even in an HR office, it will surely eventually register that maybe, just maybe, this was not such a good idea, and it was even a bad idea done horribly.

  55. Hmmmm..,,,, What must employees do under this “wellness” program? What might constitute a useful wellness program? Do examples of properly thought out wellness programs exist ?

  56. I’m with Bobby Gladd here. That last sentence… daaaaaamn.

    I did like the “take every preventive measure possible” method. Reminds me of the phrase “if you can’t beat the system… break it.”

  57. If the HR people had read the literature Penn State’s HR people never would have gotten into this mess. But there is no excuse for not reading the ltierature now and learning that Penn State’s worst nightmare would be if the faculty actually did what they want them to do.

    Funny thing — neither the HR people nor their consultants are going to lose their jobs over this. Ironically both have tenure in these institutions.

  58. “PSU’s stab at wellness is all the more unctuous because of the way it was rolled out. It is aimed at non-unionized, white collar employees (and their spouses), whom the University clearly expected to behave like lemmings. Ironically, given the strong inverse relationship between education, income, and health risks, these people were the least likely to need help, but it was much easier to surprise them than it was to renegotiate contracts with the Teamsters Union. PSU’s executive leadership would do well to climb off this particular ledge, admit their multiple errors, and trash their wellness program until they can design something that actually makes sense and builds a bridge of goodwill with employees. Otherwise, this chapter in wellness history will show that Penn State’s leaders could not resist the opportunity to do something to their employees instead of for them and with them. Of all the places on earth that ought not to be doing things to people anymore, it’s Penn State.”
    __

    Ouch.

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