Supreme Court Upholds Health Care Reform Law

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On June 28th, 2012, in a 5-4 decision, the U.S. Supreme Court that the individual mandate portion of the health care reform law (the Patient Protection and Affordable Care Act), which requires that most Americans buy health insurance or pay a fine, is constitutional as a tax.

The Court agreed that while Congress could not use its power to regulate commerce between states to require individuals to buy health insurance, Congress could impose a tax penalty using its tax power for individuals who refuse to buy health insurance.

Because the mandate is constitutional, the Court did not need to determine whether other parts of the law were constitutional, according to the SCOTUS Blog.

The individual mandate was set to be implemented in 2014, however, many provisions of the health care reform law had already gone into effect in 2012. The ruling suggests that employers will still be responsible for the carrying out the provisions of the law which affect their organizations.

For more information about the Supreme Court decision, please visit the links below.

Source: SCOTUS Blog

Salaries in Healthcare Sector Reflect Demand

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Here in Northeast Ohio the prominence of our healthcare industry is often touted as one of the region’s greatest strengths. In terms of sheer volume, health care represents a significant proportion of the workforce- approximately 16% according to the 2012 Current Employment Statistics survey for non-agricultural jobs in the Cleveland-Elyria-mentor Metropolitan Statistic Area (MSA).

However, for those 155,400 individuals employed in healthcare/social assistance, being part of the workforce for this booming industry does not always translate into higher levels of compensation. In fact, using data from several ERC Compensation Surveys to perform an occupation specific analysis for 40 job categories placed two occupational subcategories within the healthcare industry, i.e. Patient/Client Services and Social Work, among the 10 lowest paying job categories in Northeast Ohio. Conversely, Clinical Healthcare Practitioners and Nurses came in as two of the 10 highest paying job categories in the region according to this 2012 data. 

Nursing, coming in as the fourth highest paid occupation in the analysis, is one of only a few positions that pay above the national median salary reported by the Bureau of Labor Statistics. As noted in a recent article from Crain’s Cleveland Business, registered nurses in particular can expect to remain in high demand across local healthcare systems. Clearly this demand for specialized, skilled talent is a key factor driving up rates of compensation within Nursing and among Clinical Healthcare Practitioners more generally.

At the opposite end of the spectrum the Patient/Client Services category includes a wide variety of jobs in healthcare, but with two important items in common, fairly low education and skill requirements and often highly repetitive job duties. A notable exception to this generalization that lower skills equate to lower pay, is in the field of Social Work. According to the 2011 ERC Non-Profit Benefits Survey, one way organizations often look to counteract this low market valuation of Health and Human Services positions such as Social Workers is to offer a unique array of other non-cash benefits that serve to enhance the total rewards package employees in these positions receive.

Additional Resources

ERC Non-Profit Compensation & Benefits Surveys
ERC, in partnership with United Way of Greater Cleveland, has created compensation and benefits surveys to help non-profits in Northeast Ohio gauge their compensation and benefits practices. Through this exclusive partnership, United Way Agencies that participate in these surveys will receive the survey results for no cost. Participate in our Compensation and Benefit Surveys by clicking here.

*The average median base salary figure for each occupation was calculated using data excerpts from the following surveys conducted by ERC: 2012 ERC Salary Survey, 2012 ERC Wage Survey and 2011 ERC Non-Profit Compensation Survey. Please note that the salary figure reported for each occupational category is an average of median salaries across applicable job titles from entry level up through management level positions.

Make a Difference in Productivity and Your Bottom Line!

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ERC encourages you to select CareWorks as your new MCO. CareWorks can help make a difference in the health and productivity of your employees and your bottom line. There are no direct costs for an MCO, fees are already included with your BWC premium. As Ohio’s most selected MCO,* CareWorks:

  • Medically manages nearly one out of every three workplace injuries in Ohio.*
  • Had the #1 return to work performance on the 2012 BWC MCO Report Card*and over a nine-year period.**

Even if you already have a TPA, your MCO choice matters! Learn more about CareWorks here.

(*Source: BWC’s 2012 MCO Report Card).
(**Source: Average of BWC’s Quarterly MCO DoDM Results from 1st Quarter 2003 through 4th Quarter 2011.)

An Important Enrollment

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By Pat Perry

Next week, the Ohio Bureau of Workers’ Compensation is providing a one month open enrollment for employers relative to selecting a Managed Care Organization (MCO). MCOs are a key player for many organizations in keeping their workers’ comp costs in control through proactive case management and a solid transitional work program. Employers pleased with their MCO do not need to take any action. Employers seeking a new MCO can do so at no cost and it only takes about 5 minutes.

There is plenty of information about MCOs at the Bureau’s web site and more data about Ohio MCOs will become abundant starting next week. If you do not know your company’s MCO, you can simply click here to find the MCO assigned to your organization.

Over the next several weeks, ERC will be providing information about the MCO selection process and other critical data to provide organizations facts upon which to make an informed decision. As this open enrollment only occurs every two years, this decision is extremely important.

Since the MCO Open Enrollment period starts April 30 and ends May 25, we will continue to provide you with information throughout to assist you in your choice of a MCO.

Most Companies Can Benefit From a Plan Audit

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401(k), 403(b), pension plans and health insurance plans are wonderful perks to offer employees. But, many companies don’t understand the compliance required by the Department of Labor (DOL) and the Internal Revenue Service (IRS) that goes along with offering these benefits to employees.  The DOL and IRS have various filing and audit requirements that are applicable to these types of plans. Understanding what they need is imperative in making sure the plans maintain their tax-exempt status. 

When is a benefit plan audit required?

As a general rule – most benefit plans are required to file a Form 5500 (Annual Return/Report of Employee Benefit Plan) on a yearly basis. The amount of information included on the Form 5500 will vary depending on the type of plan in place.  If a plan has over a certain number of employees, they may need to have an annual audit of their plan performed, as well.

What actually triggers the plan audit requirement is the number of eligible employees a company has. Generally, when a company has more than 100 eli­gible employees, an annual audit is re­quired. However, you can’t just count all the people participating in the plan to determine whether or not you need the audit; you need to take into consideration eligible employees, as well. Eli­gible employees are those currently par­ticipating plus those who elected not to participate in the plan.

Companies with less than 100 eligible employees only need to file the Form 5500 as a small plan; they do not need an audit. But, companies with more than 100 eligible employees have to file the tax return along with the annual audited financial statements.  There are also certain exceptions for some types of plans with less than 100 eligible employees, stating that a Form 5500 is not required to be filed at all.

The due date of the filings for both the Form 5500 and audited financial statements relates to the due date of the Form 5500. For a calendar year-end plan, the Form 5500 should be filed by July 31, 2012. They also have the option to file for an extension, which gives them until October 15, 2012. Typically, April or May is when companies start to get questionnaires and draft Form 5500s from their third party administrators. This is a good time to address the audit requirement question.

The DOL imposes strict financial penalties when the Form 5500 either isn’t filed at all or is filed im­properly. These penalties are assessed per day and can be as high as $50,000 per report, per year for a deficient filing.


If an annual audit is required, what’s next?

The next step would be to find a firm to perform the audit work. Many com­panies look at the firm that does their annual accounting and tax work to see if they perform employee benefit plan audits, as well. Some accounting firms have separate employee benefit plan audit departments with dedicated staff; others do not. Once you find a firm to handle the audit, ask questions: How many other plans does the firm handle? Does it handle all types of benefit plans?

There are three types of benefit plans:

  1. Defined contribution plans – one example of which is a 401(k).
  2. Defined benefit plan, where the participants don’t contribute, but the company does — the most common ex­ample of which is a pension plan.
  3. Health and welfare plans – that offer health insurance and disability-type insurance to employees.

Firms that specialize in employee benefit plan audits have dedicated staff that work on the audits and go through specialized training, and have a streamlined audit process. Companies will also want to find out if the accounting firm is a member of the American Institute of Certified Public Ac­countants Employee Benefit Plan Audit Quality Center. They should also ask what the audit process is going to entail. How much as­sistance is going to be required on the company’s part? They should know go­ing forward how much time their em­ployees would spend assisting the firm with getting the audit completed.

Who will be involved on the company side?

Human resources and/or the accounting department will work closely with the au­ditors because they handle payroll and ben­efits and have all the documentation for what people choose to contribute, along with per­sonnel records and payroll information. Those people are the ones who will put the most effort into getting the documen­tation ready for the auditors.

How long does the audit process take?

It depends on how quickly the auditors can get the information. Typically, the actual fieldwork, where the firm is on-site reviewing original documents, takes anywhere from a day to a week, depend­ing on the size of the benefit plan. Many times the auditors will leave, but have items they want to follow up on. The whole process – from fieldwork to issuing the financial statements to getting the open items cleared – is usually a four- to six-week process.

The Form 5500 and annual audit process can be confusing for those that are new to the process or for those that don’t fully understand all of the compliance requirements that go along with operating the plans.  It really makes sense to talk to a specialist to make sure all of the plans are filing the appropriate documentation on a yearly basis.

Source: Gisondo, D. (2012). Skoda Minotti

Exclusive! ERC member companies can receive their 2011 Benefit Plan Audit at no cost and Lock in their 2010 Rate for the Next Five Years. Click for more details on Benefit Plan Audits, or contact Dani Gisondo at 440/449-6800.

Why Your Business Can't Afford to Ignore Wellness

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If your organization thinks workplace wellness is just a passing trend, think again. Investments in workplace wellness programs are paying huge dividends for employers. Plus, many organizations are finding that workplace wellness programs are a strategic priority when it comes to saving money, engaging employees, and creating a more productive workforce. Here are a few reasons why your organization can't afford to ignore workplace wellness.

Wellness programs reduce costs.

It's the most obvious benefit: wellness programs save your organization money on health insurance and reduce a number of other associated costs including use of sick time, workers' compensation, disability management, and absenteeism. Health benefits are arguably the second largest employee expense for organizations and one of the most volatile costs from year to year. Wellness programs are one of the best tools available to reduce health care costs over the long-term.

Smaller businesses are more affected by poor health.

Smaller organizations are more affected by poor employee health than larger organizations. They are less able to absorb additional health care costs, and extended absence or frequent use of sick days can significantly affect their business operations. Additionally, decreases in productivity or engagement (even by just one or a few employees) because of poor well-being can also affect smaller businesses more than larger organizations.

The demands of the workplace are increasing.

More and more is being demanded of employees. Longer hours, expanded work weeks, and higher standards mean that employees face increased stress and worse well-being at work. These risks can lead to poor physical and mental health, which in turn affect costs. Wellness programs can enhance employees' ability to function and perform well in spite of these demands and also help employees cope with the stresses of work.

Healthy employees are more engaged.

Beyond reduced costs, healthy employees tend to be more engaged. Studies find that employees who are engaged and interested in their work are more likely to report better overall well-being and healthier outcomes, such as improvements in cholesterol and blood pressure and lower stress, than their less engaged counterparts. They are also less likely to be absent from work, and more likely to be productive, energetic, and have higher performance.

Employees want to work for organizations that care about their well-being.

It's not uncommon for employees to cite that their organization's investment in their health and care for their well-being are key reasons that they stay at their employers. Employees want to work for organizations, leaders, and managers that care about their well-being and who provide appropriate levels of support and flexibility to lead healthy, balanced lives. ERC's employee engagement research has found significant relationships between whether employees believe that their organization cares about their well-being and their perceptions of leaders, supervisors, and the overall workplace.

Wellness programs are becoming a standard benefit.

With their increasingly popularity, wellness programs are becoming a standard part of an employer's benefits package. According to our surveys, the majority of local employers offer some wellness benefit to their employees, such as health screenings, wellness coaching, access to trainers and/or dieticians, on-site clinics, healthy food options, fitness/weight management programs, or health education seminars. Also, wellness perks can be an attractive benefit to prospective employees, and especially for candidates that care about being healthy. Several leading employers, such as our NorthCoast 99 winners (, promote their wellness initiatives to attract talent.

Wellness programs change lives.

Beyond the cost and productivity benefits of wellness programs, one of the greatest gifts you can offer your employees is a better quality of life. There are countless success stories resulting from corporate wellness programs inclusive of employees that have overcome a chronic condition, lost significant amounts of weight, and reduced serious health risk factors. These programs aren't just saving money for businesses - they're improving lives. Wellness initiatives inspire and motivate employees to change their behavior and provide them the tools to better themselves.

The business case for wellness should be clear: lower costs, higher engagement, productive employees, and a healthier business. With these diverse positive benefits and the current volatile climate of health care, your organization truly can't afford to not invest in employees' wellness.

Health Tip: Aim for 5 Per Day

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By Heather Butscher, MS, RD, LD
Outpatient Clinical Dietitian
University Hospitals Health System

Americans are just not meeting the fruit and vegetable recommendations. If fruits and vegetables are so important, then why aren’t Americans eating enough? The United States Department of Agriculture suggests a minimum of two servings of fruit per day and three servings of vegetables per day. However, a 2012 study shows that only 33% of adults eat enough fruit and only 27% of adults eat enough servings of vegetables per day. The statistics are even worse for high school students. Less than one third of high school students eat enough fruit and a dismal 13% eat the minimum servings of vegetables daily.  

Eating enough fruits and vegetables are a part of a healthy diet. Fruits and vegetables are important as they contain nutrients such as vitamins A, C, and vitamin K as well as potassium, fiber, and magnesium. Fruits and vegetables are associated with the reduced risk of many chronic diseases and since they are relatively low in calories, they can replace higher calorie foods to aid in weight loss. If fruits and vegetables are so important, then why aren’t Americans eating enough? 

Consuming more fruits and vegetables does not have to be hard. Below are some pratical tips for making sure you get your five a day: 

  • Make half of your plate at each meal fruits and vegetables.
  • Focus your meal around vegetables such as beans instead of meat.
  • Keep a bowl of whole fruit on the table, counter, or in the refrigerator for easy access. 
  • Always travel with a fruit for a snack. 
  • Stock up on frozen vegetables for last minute addition to meals and easy cooking in the microwave. 
  • Buy produce from local farmers and buy-in season.

Interested in bringing this message to your employees? ERC member organizations receive discounts on corporate wellness services through University Hospitals, including nutrition seminars brought on site to your organization.


Fitness Tip: Starting a Fitness Program

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In the beginning, your fitness plan should not be overly aggressive.

One of the biggest problems most people encounter when starting a fitness program is rapidly depleted motivation after only a few weeks due to an overly ambitious fitness plan.

Two days per week of 20-minute low-intensity cardiovascular exercise (walking, jogging, biking, swimming); and two days per week of 30-minute light resistance training (using weights or resistance machines) is adequate in the beginning.

As you become acclimated to the lifestyle “shift” you can add more days and get improved results. But beware: if you try to do too much too fast, you may end up quitting altogether.

If you’ve tried and failed doing it alone, get a training partner or personal trainer who will help you sustain your motivation.

Established in 1996, Fitness Together has led the industry for one-on-one personal fitness training. 

Healthy Tip: How to Avoid Excess Salt

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By Heather Butscher, MS, RD, LD
Outpatient Clinical Dietitian
University Hospitals Health System

According to the United States Department of Agriculture (USDA), Center for Nutrition Policy and Promotion, adult Americans in 2012 consume double the amount of salt and sodium recommended – much of this can be blamed on eating “faster food choices”. The 2010 Dietary Guidelines for Americans recommend that Americans reduce salt and sodium intake to less then 2,300 milligrams (mg), and further reduce intake to less then 1,500 mg among persons who are: 51 and older, those of any age who are African American, have hypertension, diabetes, or chronic kidney disease. USDA recommends preparing (from scratch) more meals at home where there is more control to use little or no salt seasonings.

If going out to eat, watching sodium is imperative.

Individuals should use the following strategies when dining out:

  • Ask how foods are prepared and request that meal be prepared without added salt, MSG, or salt-containing ingredients.
  • Use alternative low sodium spices to add flavor – pepper, oregano, curry or crushed red pepper.
  • Know the terms that indicate high sodium foods such as pickled, cured, soy sauce, and broth.
  • Move the salt shaker away.
  • Limit condiments, such as mustard, catsup, pickles, and sauces with salt-containing ingredients.

These tactics can really help to reduce the amount of sodium consumed when dining out.

Eating away from home can be healthy. Strive to include measures that help to reduce salt and sodium by selecting lower sodium foods and limiting added salt. So become a savvy diner and you can still enjoy dining out; most importantly, you will also be able to enjoy your good health.

University Hospitals, one of the nation’s leading health care systems, has partnered with ERC to offer significant discounts to its members.

Healthy Employees: Staying "Heart Healthy"

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By Ron Todaro, RN, COHN-S

Cardiovascular diseases are conditions that affect the heart and blood vessels, such as heart disease, high blood pressure, high cholesterol, deep vein thrombosis (DVT), and stroke. Some of these conditions, such as high blood pressure and high cholesterol, have no obvious symptoms, but some may have symptoms such as pain, confusion, swelling, or shortness of breath. It's important to know your risk factors for these cardiovascular conditions and what you can do to avoid a diagnosis or manage an existing condition.

Heart Disease Prevention: Managing Your Modifiable Risk Factors

Treatment of heart disease can be difficult. That’s why it's better to try to prevent these health conditions, particularly in people with known cardiovascular disease risks. But how do you prevent heart disease? How do you maintain good heart health?

It may seem simple, but for the most part, lifestyle plays a huge role in keeping the heart healthy and reducing cardiovascular disease risks. Many of these suggestions are probably familiar to most people. They include:

  • Managing your stress levels
  • Eating fruits, vegetables, and foods low in fat and cholesterol — maintaining a mostly plant-based diet
  • Becoming active (at least 30 minutes per day) and either maintaining your current weight or losing weight if you are overweight.
  • Monitoring your blood pressure. If it’s high, get it under control following your doctor’s guidelines.
  • Screening your cholesterol and blood sugar levels. If your numbers have increased, you may be able to reverse the trend.
  • Following treatment guidelines if you have high cholesterol, high blood pressure, or diabetes

Eat right, exercise, don’t smoke, and talk to your doctor about any health concerns you have or any symptoms you notice. The earlier heart problems are detected, the better the chance you can begin treatment before any long-term damage has occurred.