Volume 47

A Model for Making Rural Stronger in Your State Supreme Court Cases That May Impact Employers in 2023 U.S. Faces Shortage of Mental Health Professionals

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A Model for Making Rural Stronger in Your State Texas program a collaboration success story \ by Brant Couch It’s a bit of a brag when we say everything’s bigger in Texas. But when you think about how far people in rural areas must travel to get to the nearest hospital, not so much. Too many rural Texas hospitals are struggling to keep their doors open. And, with each closure or reduction of service, rural Texans, like the people living in the rest of rural America, are faced with diminishing choices and subsequent serious health challenges. And yet, despite what seems like an endless assault from all sides, many rural hospitals are thriving. An insurance program saves the day? At first glance, claiming an insurance program has contributed to the success of these thriving hospitals may seem odd, even suspect. But, in many substantial ways, the insurance program created by the Texas Organization of Rural and Community Hospitals (TORCH) is doing just that. As the CEO of the company managing the program for the past 15 years, I’m on the front lines with hospital leaders throughout the state, battling to not only keep each hospital open, but to find the means to deliver the best possible healthcare to the people they serve. When you take a closer look at the TORCH insurance program, you can see how the collaboration it inspires and facilitates leads to continuous innovation and ever-increasing value for TORCH hospitals. When you look through the counter intuitive lens of hating big insurance – yes, we hate big insurance – the reasons behind program’s success become much easier to see. And you even see how the program as a whole, or in some part, is a model that could work in your state. Collaboration is critical to success Here’s one example: Originating in Texas, but now available nationally, the Community Health Insurance Coalition, we call it CHIC, has been laying golden eggs for a growing number of rural hospitals. When we designed CHIC, we knew it could empower rural hospitals to take back ownership of their insurance… and it is doing just that. Its charter members were a group of 12 hospital leaders who saw how collaborating to create a medical stop-loss reinsurance company could loosen the grip big insurance has on their financial success. Not only are they paying less to cover their employee healthcare risk, they are improving benefits program performance, and receiving their share of a significant annual surplus cash distribution. Going into its fifth year, CHIC is on track to hit over $3.5 million in cumulative distributions to its owners. Collective buying power adds oomph to collaboration Another program popular among the TORCH insurance program members is Equipment Maintenance Contract Alternatives (eMCA). Maintenance contracts are a type of insurance covering the risk inherit in owning or leasing expensive equipment. By pooling their risk, hospitals participating in eMCA are reducing the cost of traditional contracts by 15 to 22% every year. The program is super simple to get into and delivers benefits including:

• Fixed cost means no more budget surprises
• A single contract reduces administrative burden
• You get to keep your current vendors
• You can save even more on parts and service
• Plus, you receive reimbursements for in-house repairs

It’s an easy program to explore as we start simply by reviewing your existing maintenance contracts to immediately show you how much your annual maintenance and service budget will be reduced. Shared wisdom is the icing on the cake Rural hospital leaders are among the most dedicated, tenacious, and creative enterprise leaders. Not only because they have to be, but because they are passionate about doing everything possible to ensure their patients and communities have access to the best possible care. This shared purpose naturally leads to a ready willingness to share wisdom: what they know works, what they’ve tried that didn’t work, and what they think might work in the future. A great example of this is the wisdom we have collectively developed around direct and manage care contracting. Managed Care Contracting solutions for today and tomorrow We’ve learned as a group that to be successful, managed care contracting requires clear, consistent, comprehensive, and concise contracts. It can also counterbalance the reimbursement shortfalls caused by Medicare Advantage plans. Most times, rural and community hospitals struggle to win the manage care contracting game because they:

 
• Have no in-house expertise
• Lack time and resources for effective management
• Often do not know what they have This leads to significant challenges including:
• Disorganized contract documentation
• Lack of clarity and transparency
• An inability to develop and leverage an effective contract modeling and payment integrity system

Thanks to services available through the TORCH Insurance Program, a growing number of hospitals are realizing the benefits of managed care contracting, not least of which is finding new and hidden revenue sources. They are also reducing bad debt related to administrative denials and/or payment issues. Additional benefits include:

• Access to best practices and regional minimum reimbursement levels
• Coordinated group arrangements or contract parameters for individual arrangements using defined standards
• Opportunities to participate in VBC (Value-Based Contract) arrangements

Direct contracting: The Good… not the Bad and Ugly Leveraging the collective experience of dozens of hospital leaders, and with a little outside expert assistance, a growing number of rural hospitals are finding new ways to protect and grow their hospitals. For example, by contracting directly with regional employers, more of the money spent on healthcare stays in the community with significant benefits going to the hospital, businesses, and the people. These benefits include:

• Reduction in patient bad debt
• Increased utilization and revenue thanks to employer benefit program design and communication that steers patients to the hospital
• Protection of current utilization, market share, and revenue by being proactive before other area hospitals implement it first
• Deeper relationships with local employers building stronger community support
• Reduced administrative denials, and payment delays
• Plan savings for the local employer and enhanced revenue for the local provider. (Both benefit instead of a national carrier keeping the margin.)
• Lower out of pocket expenses for employees
   

Program participants are also creating win/win outcomes for their hospital and employees by contracting directly with tertiary hospitals. The benefits of these contracts are many, some of which are:

• Greater cost control
• Improved care for employees with complex healthcare needs
• Improved employee morale and health-related behavior
• Bonus: Reduction in instances of bad debt for tertiary hospital
   

For both types of direct contracting, the TORCH Insurance Program provides guidance, proactive support, and direct involvement in identifying opportunities, communication with employers and tertiary hospitals, contract negotiation, TPA management, and ongoing contract management and updating. Where to from here? If there is one thing that will ensure your hospital can continue to deliver exceptional care, it is the driving principle behind the success of the TORCH insurance program and everything we do: Never Go It Alone. To bring these opportunities to hospitals across the country, my company, and the National Rural Health Association (NRHA), created the Rural Health Insurance of America (RHIA) program. If think your state association could benefit from these success strategies, or if you as an individual hospital leader want to learn more about RHIA, I invite you to contact me at your earliest convenience. Bottom line, by looking ahead together, collaborating intentionally and effectively, leveraging collective our buying power, and sharing wisdom, we will protect our communities and empower our patients.

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Supreme Court Cases That May Impact Employers in 2023

During its 2022-2023 term, the U.S. Supreme Court will hear and decide several cases that could have a significant influence on the workplace. Even though labor and employment laws and regulations change every year, the current Supreme Court term will likely have a greater impact on employers than previous terms. It can be difficult for employers to stay informed of these cases and their potential impacts on the workplace; however, it’s vital that employers are aware of them and understand how their organizations may be affected.

This article highlights the topics in Supreme Court cases that may impact workplaces in 2023 to help employers prepare for potential changes and navigate the evolving labor and employment law landscape.

Overtime Exemptions

On Feb. 22, 2023, the Supreme Court held in Helix Energy Solutions Group Inc. v. Hewitt that employees must be compensated on a salary basis to qualify for the highly compensated employee overtime exemption under the Fair Labor Standards Act (FLSA). The case involved an oil rig worker who earned more than $200,000 per year and was paid daily rather than on a salaried basis. The employer claimed that the employee was exempt from overtime under the FLSA’s white collar exemptions that apply to highly compensated employees. The Supreme Court disagreed, ruling that the FLSA plainly requires highly compensated employees to receive a salary; this requirement is not met when an employer pays an employee by the day.

It’s unlikely that many employers will have to change their payroll policies and procedures for highly compensated employees in response to the ruling in this case. However, this decision is a clear signal that courts may require strict compliance with FLSA overtime exemptions. As a result, employers should review their exempt employee classification process to ensure they meet duty qualifications and salary requirements.

Religious Accommodations

Two cases in this term could affect religious accommodations in the workplace. The first is 303 Creative LLC v. Elenis, which was heard on Dec. 5, 2022. This case challenges the public accommodation provision of Colorado’s Anti-discrimination Act, which prohibits places of public accommodation, such as businesses, from denying services to individuals based on a protected characteristic (e.g., sexual orientation). In this case, the owner of a graphic design company wants to design wedding websites; however, she is opposed to same-sex marriage on religious grounds. The owner wants to deny services to LGBTQ customers and announce her intentions to do so on the company’s website. The question raised in this case is whether a state can prohibit a business from denying services to customers on the basis of a protected characteristic when the denial is based on a religious belief. While this case does not directly affect employers, the Supreme Court’s ruling could have employment-related ramifications regarding anti-discrimination policies and religious exemptions in employment.

The second case is Groff v. DeJoy. This lawsuit was brought by a U.S. Postal Service mail carrier after being disciplined for refusing to work on Sundays due to religious reasons. The Postal Service argued that accommodating the employee would create an undue hardship on the organization and burden other employees by requiring them to work more weekends. Title VII of the Civil Rights Act (Title VII) requires covered employers to reasonably accommodate employees’ sincerely held religious beliefs, including when an employee’s religious observance conflicts with work requirements, unless doing so would create an undue hardship on the employer. There is no statutory definition of “undue hardship” under Title VII; however, the Supreme Court held in Trans World Airlines Inc. v. Hardison that requiring an employer to bear more than a “de minimis cost” is considered an undue hardship when accommodating an employee’s religious beliefs.

The Supreme Court’s ruling in Groff could significantly limit an employer’s ability to deny employee requests for religious accommodations even if those requests burden the employer. Additionally, during the COVID-19 pandemic, many employers saw an increase in employee requests for religious accommodations, such as being excused from vaccine mandates.

A Supreme Court ruling expanding religious accommodations for employees that applies retroactively could create significant operational challenges for employers. Oral arguments on this case are scheduled for April 18, 2023.

Affirmative Action

On Oct. 13, 2022, the Supreme Court heard oral arguments on two cases brought by the activist group Students for Fair Admissions addressing affirmative action in university admissions. These cases will likely be the most consequential cases the Supreme Court will decide this term in terms of altering existing legal precedent.

In Students for Fair Admission Inc. v. President & Fellows of Harvard College and Students for Fair Admissions Inc. v. University of North Carolina, the Supreme Court will review the legality of considering race in university admissions for private and public institutions. In doing so, the court will reconsider its 2003 decision of Grutter v. Bollinger, which allows universities to consider race—among other factors—in university admissions because diversity in education is a legitimate aim. Students for Fair Admissions is asking the Supreme Court to overrule this existing legal precedent, claiming it discriminates against Asians and whites based on their race.

While the Supreme Court’s ruling in these cases will likely not directly affect employers, it could impact workplace diversity, equity, inclusion and belonging initiatives, including the ways organizations promote and implement them in the future as well as employer affirmative action programs.

National Labor Relations Act

On Jan. 10, 2023, the Supreme Court heard oral arguments in Glacier Northwest Inc. v. International Brotherhood of Teamsters Local Union No. 174. This case will determine whether the National Labor Relations Act (NLRA) preempts a common law state tort claim against a labor union for intentionally destroying an employer’s property during a labor dispute. Glacier Northwest sells ready-mix concrete, and during collective bargaining agreement negotiations in August 2017, its drivers went on strike for a day without providing notice. As a result, concrete that had already been mixed for delivery was wasted.

Under the NLRA, workers’ right to strike is protected; however, they must take reasonable precautions to protect their employer’s property from foreseeable hazards resulting in sudden work stoppages. In the past, the Supreme Court has ruled that the NLRA preempts state law claims. If the Supreme Court rules in favor of Glacier Northwest, it could establish legal precedent making it easier for employers to sue and recover damages from labor unions that damage an employer’s property during a labor strike.

Employer Takeaway

These cases’ rulings could have major impacts on employers, altering established labor and employment laws and workplace practices. Being aware of these cases and their potential effects on workplaces can help employers prepare and feel confident in their abilities to navigate any changes.

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U.S. Faces Shortage of Mental Health Professionals The COVID-19 pandemic worsened underlying mental health issues for many Americans. However, mental health care and treatment barriers have existed for some time. One of the most significant barriers is the lack of mental health professionals. Experts predict that within the next year, the United States will be short between 14,280 and 31,109 mental health professionals. The latest Health Resources and Services Administration data estimates that 122 million Americans (37% of the population) live in areas with a mental health professional shortage. It would take an additional 6,398 mental health providers to fill those gaps. Mental health shortages range in severity across the nation but are most commonly found in rural areas. Although many Americans are currently dealing with strained healthcare resources, there are still some ways to receive mental health support. Telehealth is a great place to start receiving virtual mental health care, especially if you live in a rural area. Additional support resources include:

 
• Primary care doctors who can suggest further mental health resources
• Work-based wellness and employee assistance programs
• The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline, which is free, confidential, and available 24/7 by calling 800-662-HELP (800-662-4357)
• SAMHSA’s 988 Suicide & Crisis Lifeline, a three-digit dialing code offering free, confidential, and 24/7 call, text, and chat options with trained crisis counselors

Remember to check in with yourself and reach out for help if needed.

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