Detroit Chapter Hosting DOL on Thursday, Don’t Miss Out


The Detroit Chapter of ISCEBS is hosting a talk by a Senior Benefits Advisor of the U.S. Department of Labor. Sherry, a CEBS graduate, is our guest and speaker and will address various issues regarding the investigation of employee benefit plans.

Topics that are on the agenda include;

– How to be prepared for an audit,
– Self-audit and Correction Programs
– Civil versus Criminal Investigations,
– Enforcement Initiatives.

All are welcome to attend this public event sponsored by the Detroit Chapter of ISCEBS.

More information and registration is on the Chapter Linkedin page here:

http://cebsdet.org/index.cfm?display=pages&pageid=10408&sub=k

Zenefits, Short the Stock

Interviewing insurance executives at Zenefits in 2015 the problems of Zenefits were obvious. Just like the problems still are now, January 2017.

In midsummer 2015 I knew the meteoric rise of Zenefits was but a flash in the pan. Running an agency of their size relying on so few insurance staff is two mistakes. First, licensing that has exposed no respect for State protections for citizens and second, and worse than the first, is  squandering the opportunity to disrupt an industry stuck on its own existence.

There is so much opportunity to bring fundamental change to more than brokers it would be a tragedy if Zenefits new leader doesn’t get this right. Continue reading “Zenefits, Short the Stock”

How is a benefit plan like a bus route?

family_schoolbusflasher
School bus flashers are for the safety of the children on and off the bus.

A benefit office is supposed to make decisions for the benefit of the beneficiaries. A bus route should be concerned first for the safety of the children.

On the main road connected to my subdivision, two different school districts have bus routes running in opposite directions. The road is a two lane semi-rural, 50 MPH road. I’d add, drivers routinely move at 60 MPH or more.

Lake Orion School District buses travel southbound. Rochester Community Schools travel northbound on the very same road; it’s Adams Rd. for those interested in the particulars. In both districts, the bus stops on the road or shoulder but does not turn into the subdivision.

Lake Orion has chosen to tell bus drivers not to use the red flashing stop safety lights when picking up the children. And, by contrast, Rochester Community Schools does instruct drivers to turn on their red safety flashers. Continue reading “How is a benefit plan like a bus route?”

UHC and Obamacare; More of Your Money

My Answer to a customer who asked,

“This caught my eye over the weekend. Does this change our decision matrix at all?”

This customer is in the middle of making decisions today for their employees. I wrote the  email that follows to help them understand what this article is really about. The customer can move ahead as planned but should know more changes are coming for Obamacare. More importantly I explain how this article is an example of how the government and insurers do not care about your health.

If that’s important to you read on.


 

Screen Shot 2015-11-23 at 9.17.05 AM

The article includes this CEO quote,

“We cannot sustain these losses,” Chief Executive Officer Stephen Hemsley told analysts on a conference call. “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”

Source: http://www.bloomberg.com/news/articles/2015-11-19/unitedhealth-may-pull-out-of-obamacare-marketplace-stock-slides


 

My email to my business customer asking about how this UHC article may affect their present decisions for their employees.

Short answer to your question about UHC:

No, what they’re deciding makes no difference for your decision today. Your decision today will only be good until they make more changes and they do that everyday. What you decide today could change tomorrow, that’s not a joke, that’s real.

Long answer to your question about UHC:

Still, the answer is no, this won’t affect you in the short term and you can’t plan long term.

I’ve been using the words, “shifting sands” for 5 years now. The Obamacare law is 5 years old, March 23rd, 2010. Shifting sands means continuous course corrections by all system stake holders that affects more than $2-3 Trillion of the American economy. This means, today UHC is saying they’re out. But, what it actually means is they’re lobbying for more money. What we have going on here is “lobbying for position.” In the halls of congress, the industry exerts leverage in order to get more money from the government. Welcome to modern politics.

Our elected officials didn’t read the law; they had no idea what they approved and now it’s obvious. People like me have been calling attention to the cost problem for 5 years or more (my blog: https://www.donwatza.com/category/benstaff-inc/white-paper-research/) but the American public won’t listen to someone like me over articles like this. The evidence and problem is documented in my white paper posts.

Sad, but true, I can confidently say, I’ve never seen a bigger mess. Before Obamacare, Healthcare needed a fix because the insurance industry wouldn’t police itself. But, this isn’t a fix and national healthcare won’t fix it any better either (watch my video on, “US healthcare system in crisis”).

My guess about UHC? UHC and the feds will make up; the feds will give UHC more money (this will drag on over the next few months) and in order to give them money they have to make the fix look like they didn’t. In the end, just more rules, overhead, confusion and frustration; and cost.

Summary: The government is making massive changes everyday while the plane is flying. Thoughtless unread regulations created this mess and their fix is a daily stream of thousands of new patches, regulations, paperwork and confusion. I’ve been living in the trenches for 5 years trying to help employers understand and navigate. The reality and size of this law is starting to impact small employers like you.

 There has been NO improvement in health or cost because your health doesn’t matter to them (any of them). What are we going to get if we keep doing what we’ve been doing? Do you expect a different result?

My frustration is clear, we’re in an awful mess and no one cares. There’s a different voice that’s needed; here’s my hope (https://www.donwatza.com/about-2/owners-health-initiative/).

Peace,

Don

Read Don’s Huffington Post Article for Owners

PS

P.S. I will add below related articles;

“Insurers say Obamacare changes needed soon to protect companies from losses” USA Today, 11-24-2015.

“New research out this week from Commonwealth Fund shows far fewer people think their insurance premiums and deductibles — from employer-provided or exchange plans — are affordable than the government does when it defines affordability. About 40% of 2,700 people surveyed said they delay care and prescription refills when they were sick because of high deductibles, Commonwealth found.”

http://www6.lexisnexis.com/publisher/EndUser?Action=UserDisplayFullDocument&orgId=2778&topicId=100025082&docId=l:2487319212

Journalist; OB Story Wrong

So, I’m innocently reading the news and find myself researching a reporters comment.

Okay, so I’m conflicted. Either the reporter misquoted, misunderstood or is intentionally quoting incorrectly. Screen Shot 2015-09-17 at 8.32.09 AM

This is an unusually long post, but it has a number of good points. I didn’t wake up today planning on writing this post. But, it’s a good chance to write about things I’m passionate about that most people don’t spend their day thinking about.

  1. journalist integrity
  2. healthcare rules and how Universities shape our physicians
  3. how rules and word smithing is important
  4. how abortion is learned
  5. how insurance companies rely upon this training
  6. how us as Americans pay for this
  7. that rationing exists in our system today, this is an example
  8. the inconsistency in thinking that is soooooo costly

For those doctors and healthcare professionals who follow me, please engage with me on this note.

The reporter writes about, “The decades-old relationship between MU and Planned Parenthood,” says of medical school education;

Nursing and medical students were never required to work at any Planned Parenthood clinic, work at the clinic was not part of the core curriculum in either the nursing or medical schools and the placement was an optional…

Columbia Missourian, Elise Schmelzer, Sep 15, 2015; “State investigation focuses on decades-old relationship between MU, Planned Parenthood”

http://www.columbiamissourian.com/news/local/state-investigation-focuses-on-decades-old-relationship-between-mu-planned/article_de825b18-5bd9-11e5-b5d3-8b294f78e0ba.html

A small amount of digging

But, in doing a small amount of digging, I found the association responsible for setting out the rules for residence in training for OB work are required to train on abortions. My brain is a word smith brain which means I can’t reconcile what the journalist wrote with what I found in a quick look at her own link on the topic. I didn’t perform any further analysis but I’m sure the topic has much more detail.Screen Shot 2015-09-17 at 7.47.29 AM

When I read a journalists article that might be misleading I have to look for the detail. I want to know why does this not sound correct to me. I have an advantage over a young journalist with 29 years in healthcare finance. In this case, I wondered if the reporter intentionally left out an important fact, or skewed a statement. You decide. I think if they asked a few more questions they may have blown open a different discussion. And, an important one at that. They may have discovered the school is training residence on abortion, just not at planned parenthood. Makes you wonder if they use the tissue like planned parenthood, but they use it for University research. It is universities that use the tissue. The article and title make it sound like the university isn’t using planned parenthood clinic and are innocent of any relationship with the abortion business. Innocent enough I suppose on the surface, but what is the rule for OB’s? Where do the residence at this University get their required training?

A very small misquote, or misstatement changes the flavor of the article completely, upon close inspection, the phrase, “at a student’s request” conflicts with the written rule for the Universities accreditation.  Here is the authors quote, it’s there in bold.

The agreement with the medical school was required to meet Accreditation Council for Graduate Medical Education requirements that mandated schools provide training on abortion procedures at a student’s request, MU Chancellor R. Bowen Loftin said in a letter to Schaefer.

Columbia Missourian, Elise Schmelzer, Sep 15, 2015; “State investigation focuses on decades-old relationship between MU, Planned Parenthood”

http://www.columbiamissourian.com/news/local/state-investigation-focuses-on-decades-old-relationship-between-mu-planned/article_de825b18-5bd9-11e5-b5d3-8b294f78e0ba.html

It might seem silly but I live in a world of insurance where rules guide how our medical system works including how much it costs. Think about it this way, our educational institutions work because they have many rules to guide education. They are the one’s who write the rules, and these rules are used to train your favorite doctor. These rules make it possible for insurance companies to pay claims.

So, here’s my word smith problem. The quote below is a rule from a body that gives accreditation to medical education programs and this quote says it is mandatory for University programs, to be accredited, they must provide abortion training. It does not say, what the journalist wrote, “at a student’s request.” The rule as quoted says, they must train residence in abortion.

See, it says it right below in bold.

It’s on page 15 of the ACGME instructions, rules and guide (the journalist provided this link in their article). These rules are used by insurance companies to make sure doctors are properly accredited by properly accredited university training delivering the best care to the insurance company patience. These things, these rules, matter.

Screen Shot 2015-09-17 at 8.31.30 AM

“IV.A.6.d) Family Planning and Contraception IV.A.6.d).(1) Programs must provide training or access to training in the provision of abortions, and this must be part of the planned curriculum. (Core) IV.A.6.d).(2) Residents who have a religious or moral objection may opt-out, and must not be required to participate in training in or performing induced abortions. (Core) IV.A.6.d).(3) Residents must have experience in managing complications of abortions and training in all forms of contraception, including reversible methods and sterilization.”

ACGME Program Requirements for Graduate Medical Education in Obstetrics and Gynecology, ACGME approved major revision: September 28, 2014; effective: July 1, 2015, Page 15.

https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/220_obstetrics_and_gynecology_07012015.pdf

This quote is current, the document doesn’t dictate any specific place for the training, it doesn’t even mention planned parenthood.

Rationing is a phrase I use and when I do most people do one of two things; their eyes glaze over in confusion, or they object out of ignorance because they incorrectly believe rationing will never happen in America. In fact, this article, this misquote or misstatement by the person quoted leads to rationing.

Let me try a different tact.

You’ve been to school and you know from the office of the registrar to commencement day policies, paperwork and rules are required before you get your diploma. It shouldn’t surprise anyone then, that there’s rules for medical school.

Ever wonder where the rules come from?  Who writes them, why they write them a certain way? Ever wonder why these rules are important? Did you ever consider these rules influence the healthcare you pay for? Do you understand how this simple language has an evil twist for medical students? Ironically, what the author wrote would be the logical way most people would write the rule, “students have the choice if they want the training.” But, the fact is, the training is required and students at that University are getting it. I haven’t researched this, maybe, the University is outside the norm and their doing it as quoted. Then, the national standards for OB’s is not being followed and this is not a good thing….

It leaves me in this article examining the person in the article who the journalist quoted as not telling the truth, or answering the journalists question about planned parenthood with a strictly narrow answer. And, the unknowing journalist innocently took them at their word. Or, the journalist intentionally wrote an untruth.

The point? The point is OB residence are mandated to take abortion training, it’s not optional. They can opt out for religous beliefs. This is opposite what the journalist wrote. She wrote, students can opt in for that training. This would be how most Americans would assume it’s taught, as an option for medical students. It is a small, razor thin edge isn’t it.

Okay, shift for a minute with me to the actual topic of abortion

Consider that our country makes physicians learn how to perform induced abortions and kill babies. They are in fact babies because this same system pays million upon millions to keep alive babies at the exact age. The contrast to me, originally a claim payor is almost too much to bare. Why, how, as a country did our healthcare system get to a point where this contrast is so great.

It’s because the masses follow what they read from journalists, because they’re not word smiths, because they don’t have time, blah, blah, blah.

This is where the problem starts, it’s where the evil begins. It’s where medical students, in the hallowed halls of educational institutions are provided the means to promote abortion, to agree with them as a course of study and health for a women. You have promoted this behavior by paying for the medical school education, by paying insurers premium, by having policies that promote the idea this is healthcare, that new physicians are mandated to learn about and accept abortion as care. The societal endorsement for doing abortions is trained, it is a medical school endorsed practice.

For the baby, for the voice of the babies, for increased medical premiums, for rules that don’t provide health but death we need to change our methods in the US.

Editing needed

If you’ve slugged through my poor grammar today I hope the overall point was worth it. I’ll return to edit grammar and such but for now, this should suffice.

Physicians form group to advocate for Obamcare change

Physicians need a way out, we call them locked doc’s. These are doctors, especially primary care physicians who are being crowded out of doing their work. This sounds particularly harsh but have you asked your physician about staying in business?

This is a good article describing a physician PAC built to bring change.

“All these things are churning and it’s imperative that the subject of the ACA come up (in Congress),” Singer said. “The ACA is not sustainable. We want to play a role in influencing the agenda to make sure patients are first.”

Read more at http://www.sunshinestatenews.com/story/democratic-obamacare-supporters-doctors-are-watching

Contact us to talk more about a small course correction that would have a big impact.

Gabriel Roeder sued by Detroit Pensioners

This is a good article bringing into focus the struggles of Cities and governmental units who have unique decision making processes that influence the decisions of pension plans. This phrase is a quote from the article, “We just got blindsided,” it sounds like the actuaries didn’t do their job and omits the board that made decisions.

Whether the actuary did or didn’t do their job; the phrase implies the actuaries made decisions to bankrupt the retirement plan. In addition, it makes it sound like the retirement plan board had nothing to do with the decisions.

Gabriel Roeder’s job was to help Detroit’s pension trustees run a sound plan, she says, but instead the firm covered up a growing shortfall and encouraged the trustees to spend money they did not really have. Her complaint contends that the actuaries did this knowingly, “in concert with the plan trustees to further their self-interest.” The lawsuit seeks to have the pension plan made whole, in an amount to be determined at trial, and to have Gabriel Roeder enjoined “from perpetrating similar wrongs on others.” New York Times, , October 28, 2014; Link:http://dealbook.nytimes.com/2014/10/28/lawsuit-contends-consultant-misled-detroit-pension-plan/?_php=true&_type=blogs&_php=true&_type=blogs&_php=true&_type=blogs&emc=edit_dlbkpm_20141028&nl=business&nlid=66184561&_r=2&

There is a difference between being “blind sided” and blaming someone else, as quoted, and accepting the decision made as city and other governmental units have done. There needs to be a recognition that the board made decisions they should not have.