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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Ggood Healthhttp://rsjmachining.com/capabilities/?alt_id=10e62FranciscaN Jonescheap car insurance Recent comment authors
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Ggood Health
Guest

Sad to hear this news on Penn State.

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N Jones
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N Jones

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… Read more »

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Pubic Interest Law Professor John Banzhaf
Guest

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… Read more »

Al Lewis
Guest
Al Lewis

Another county heard from!

Has anyone noticed that excluding people who are feeding at the wellness trough themselves (like Highmark), no one who is well-informed takes Penn State’s side?

Also, check out Harvard Business Review http://blogs.hbr.org/cs/2013/08/attention_human_resources_exec.html

Apparently at the same time PSU is doing this, they are expanding their selection of desserts and pastries.

Public Interest Law Professor John Banzhaf
Guest

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… Read more »

Al Lewis
Guest
Al Lewis

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.”

L. R.
Guest
L. R.

Update on how Penn State admins. stinks the PSU community:
http://www.centredaily.com/2013/09/10/3781728/debate-continues-over-wellness.html

Al Lewis
Guest
Al Lewis

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

PSU Faculty Member
Guest
PSU Faculty Member

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… Read more »

Al Lewis
Guest
Al Lewis

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?

L.R.
Guest
L.R.

[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… Read more »

L.R.
Guest
L.R.

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… Read more »

PSU Spouse
Guest
PSU Spouse

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.

R.P.
Guest

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… Read more »

Vik Khanna
Guest

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

Paul Papanek MD
Guest
Paul Papanek MD

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… Read more »

Human Resource
Guest
Human Resource

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

Jon Robison
Guest

Well Paul,

Jon Robison
Guest

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… Read more »

Vik Khanna
Guest

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… Read more »

Paul Papanek MD
Guest
Paul Papanek MD

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… Read more »

Compromised victim
Guest
Compromised victim

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… Read more »

Brian Curran
Guest
Brian Curran

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.

Vik Khanna
Guest

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

Al Lewis
Guest
Al Lewis

Latest interview on wellness at PSU http://www.pennlive.com/opinion/index.ssf/2013/08/psus_punitive_new_health_policy_is_an_invasion_of_privacy_as_i_see_it.html

Story going national within 72 hours. Stay tuned. Penn State employees are way more empowered than they thought, apparently