Part 1: Managing Human Resources Through the Time of Turbulence

Kem Tolliver, CMPE, CPC, CMOMPresident, Medical Revenue Cycle Specialists

Taya Moheiser, MBA, CMPE, CMOMOwner, ITS Healthcare LLC

Presenters report no conflicts of interest at time of presentation.

• Analyze the impact of COVID on HR policies and procedures

• Examine updated processes and procedures to promote diversity and inclusivity

• Outline action plans for recruiting, onboarding, and workforce retention

Learning Objectives

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Kem TolliverCMPE, CMOM, CPC, BS

Medical Revenue Cycle Specialists

Authors of MGMA’sRevenue Cycle Management

Don’t Get Lost in the Financial Maze

Taya MoheiserCMPE, CMOM, MBAIt’s Healthcare, LLC

Hosts of the “Slice of Healthcare”

Podcast

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Workforce Safety OSHA ETS

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OSHA – Emergency Temporary Standard (ETS) Summary

https://youtu.be/YIB1TZS3pBE

ETS Goal: Protect workers facing the highest COVID-19 hazards

Non-Exempt facilities to conduct a hazard assessment Written plan to mitigate virus spread Requires healthcare employers to provide some employees with N95

respirators or other PPE Ensure 6 feet of distance between workers or; Erect barriers between employees where feasible. Provide workers with paid time off to get vaccinated and to recover

from any side effects. employees who have coronavirus or who may be contagious must work

remotely or otherwise be separated from other workers if possible, or be given paid time off up to $1400 per week.

For most businesses with fewer than 500 employees, tax credits in the American Rescue Plan may be reimbursed through these provisions.

ETS exempts fully vaccinated workers from masking, distancing and barrier requirements when there is no reasonable expectation that any person will be present with suspected or confirmed coronavirus.

www.osha.gov/new/newsreleases/national/061021

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OSHA – Emergency Temporary Standard (ETS)

Which Employers are included?

Hospitals Nursing Homes Assisted Living Facilities Emergency Responders Home Health Ambulatory Care Settings Public sector state and local government

workers, including educators and school staff

Employees working in health care settings where suspected or confirmed coronavirus patients are treated are covered under ETS.

www.osha.gov/new/newsreleases/national/061021

This sets an unusual precedent, even during the AIDS crisis the industry focused on infection protocols over disease-specific protocols. Especially if this is intended to last beyond the PHE. It would make much more sense to improve upon existing documents.

Though the mission behind this is noble the actual implementation is quite burdensome to the practice which is in direct opposition to other HHS initiatives. 28 states have already implemented Covid protocols that this will neither supersede nor replace.

Employers may not require employees to get vaccinated, however, if all the employees are vaccinated then the requirements of the organization are much different than if the employees are not all vaccinated. In addition, employees who are not vaccinated may contract COVID.

Precedent Administrative Burden The Vaccine Challenge

OSHA – ETS Employer Burdens

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Reimbursement for missed work due to illness

HIPAA – Usually protects employees from disclosing PHI to employers.

OSHA ETS – Employer Strategies

Purchasing Materials Gougers Facility

AssessmentsPaying

Employees Real World

Vendor Management Cost Elevations Plan & Hazard Assessment Criteria

Factoring in additional expense

of new PTO

Nationwide staffing shortages

Supply & Inventory Evaluation

Increased demand Free Standing vs Non-Free Standing

Inability to control employees external

COVID exposure

Baked in time and expense for

workforce training

Masks, Gloves, Physical Barriers

Supplier stock uncertainty

Access to HVAC Limitations

Current and future payroll budgeting

Organizational comment period

Wait Room & Workspace Redesigns

Remodel Permission Limitations

Request “good faith effort” while we

learn

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Federal COVID-19 FMLA Guidelines

COVID-19 Vaccine Mandates

Employers with at least 100 employees to make sure their workforce is fully vaccinated OR require unvaccinated

workers to get a negative test once a week

$14,000 fine per violation

Vaccination requirements for healthcare providers who accept Medicare and Medicaid

Vaccination requirements for all federal employees & contractors, staff of Head Start programs, DOD Schools

and Bureau of Indian Education-Operated schools.

The Department of Labor's Occupational Safety and Health Administration (OSHA) is developing COVID-19 vaccine rules

www.dol.gov

Federal COVID-19 FMLA Guidelines

The requirement for employers to provide paid sick leave and expanded FMLA expired on 12/31/20

Employers who provide employees with above PTO between 1/1/21 - 9/30/21 may be eligible for tax credits.

DOL is developing vaccination requirements for healthcare providers who accept Medicare and Medicaid

Vaccination requirements for all federal employees & contractors, staff of Head Start programs, DOD Schools and

Bureau of Indian Education-Operated schools.

Families First Coronavirus Response Act (FFCRA) expired 12/31/2020

www.dol.gov

FAQ’s

www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws

www.dol.gov

Can employees stay home from work under FMLA to prevent getting

COVID-19?

• No. PTO taken for the sole purpose of avoiding exposure is not protected under FMLA.

Can adults take off of work to take care of a child whose school or day care is closed for COVID-19 reasons?

•There is no federal law covering non-government employees who take off for this.

May an employer require a doctor’s note for an employee who

is out sick with COVID-19?

• Yes. So is a medical exam, or a period of time of being symptom-free.

Diversity & Inclusion

Why it matters…• Using a person’s preferred pronouns is a sign of respect and a good

foundation for an inclusive environment

• Ignoring a person’s preferred pronouns is reflects the opposite and can be incredibly hurtful and alienating whether that was intentional or not

• Assuming gender based on appearance or name can create mistakes

• For example, assuming a person named Ashley is a woman or that a person with short hair is a boy

You will make mistakes.

Recognize them and aim for improved inclusivity continuously.

Personal Pronouns

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Pronouns are a Serious Matter

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“Taking pronouns seriously signals that you’ve thought about what trans and gender-nonconforming people face…

…It is not appropriate for people who aren’t in danger of being fired, evicted or even murdered for their gender identity to decide that pronouns are a joking matter.”

– The Washington Post

• Offer your own pronouns – out loud, in your email signature, on your Zoom profile, etc. • “Hi, I’m Taya I use she/her pronouns”

• Don’t apply pressure – bullying people into providing their pronouns isn’t okay, use “they/them” in the interim to make it evident you care respect their individuality

• Don’t get mad when you are corrected and don’t put someone in the situation to have to keep correcting you.• If you make a mistake and someone corrects you, say "Thank you" instead

of "I'm sorry" to own the responsibility for your mistake. – ADP• Be understanding that official documents take time to update and may not

reflect their chosen pronouns or preferred name

What to say and expect

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Personal Pronoun Chart from University of California

Retrain Your Brain

Friends and ColleaguesGood morning team!

YesThank you

The person in the blue hatThe two people on the left

They/them

Ladies and gentlemenYes, sir

Yes ma’amThat lady

The guy over thereHello boys and girls

He/She

Instead of… Try these!

• https://www.mypronouns.org• https://www.colorado.edu/cisc/resources/trans-queer/pronouns• https://outandequal.org/wp-content/uploads/2020/05/Pronouns-

Guide.pdf• https://www.thehrcfoundation.org/professional-resources/talking-

about-pronouns-in-the-workplace#:~:text=These%20employees%20may%20opt%20to,the%20more%20inclusive%20%E2%80%9CMx.%E2%80%9D

• https://www.adp.com/spark/articles/2021/06/best-practices-for-using-pronouns-in-the-workplace-and-everyplace.aspx

Pronoun Resources

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Non-Discrimination

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1. State your non-discrimination policy and post it visibly2. Agree to provide reasonable accommodations for medical or

religious reasons3. Identify how discrimination can be reported4. Prohibit retaliation and maintain confidentiality of anything

reported5. Respond quickly, thoroughly, and impartially6. Outline the consequences of violating the non-discrimination

policy and abide by the policy you’ve created7. Ensure your policy meets the national and state laws

Print This for Free from AMA

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Be Inclusive Of Those With Disabilities As Well

https://askjan.org/publications/employers/em

ployers-guide.cfm

The Job Accommodation Network (JAN) is a free service of the U.S. Department ofLabor’s Office of Disability Employment Policy

You are biased. So am I.That doesn’t mean we are intentionally, but…

we do have to work intentionally to overcome implicit bias.

Harvard has an Implicit Bias Test

Use this tool to help educate yourself on what implicit bias is.

The Implicit Association Test (IAT) measures attitudes and beliefs that people may be unwilling or unable to report... You may believe that women and men should be equally associated with science, but your automatic associations could show that you (like many others) associate men with science more than you associate women with science.

https://implicit.harvard.edu/implicit/selectatest.html

Overcoming BiasThe AAFP has a wonderful resource for overcoming implicit bias

STEP DESCRIPTIONIntrospection Explore and identify your own implicit biases by taking implicit association tests or through other means.

Mindfulness Practice ways to reduce stress and increase mindfulness, such as meditation, yoga, or focused breathing.

Perspective-taking Consider experiences from the point of view of the person being stereotyped. This can involve consuming media about those experiences, such as books or videos, and directly interacting with people from that group.

Learn to slow down Pause and reflect on your potential biases before interacting with people of certain groups to reduce reflexive reactions. This could include thinking about positive examples of that stereotyped group, such as celebrities or personal friends.

Individuation Evaluate people based on their personal characteristics rather than those affiliated with their group. This could include connecting over shared interests or backgrounds.

Check your messaging Embrace evidence-based statements that reduce implicit bias, such as welcoming and embracing multiculturalism.

Institutionalize fairness Promote procedural change at the organizational level that moves toward a socially accountable health care system with the goal of health equity.

Take two Practice cultural humility, a lifelong process of critical self-reflection to readdress the power imbalances of the clinician-patient relationship.

New Federal Holiday: Juneteenth (June 19th)

• Commemorates the ending of slavery in the United States

• Paid Holiday for some• Most federal employees will have it as a paid day off• Some private employers, such as Allstate, Citigroup, Best Buy, Nike,

Target and Twitter, already do

• Other ways to celebrate• Amazon and Google canceled meetings all day and created a day for

learning and reflection instead • Close the office early• Allow employees to use their floating holiday

Wages

Minimum Wage (MW)

Federal Minimum Wage is $7.25 as of July 24, 2009.

States with variable minimum wages or where the federal minimum wage applies, are not listed on this chart.

Navigate here for more info.

29 states have either matched, not met, or not listed their minimum wage. In those states, the federal minimum wage amount applies.

State MW 2021 (2022)

Alaska $10.34

Arizona $12.15

Arkansas $11.00

California $14.00 ($15.00)

State MW 2021 (2022)

Colorado $12.32

Connecticut $13.00 ($14.00)

Delaware $9.25

DC $15.00

Florida $8.65

Guam $8.75

Hawaii $10.10

Illinois $11.00 ($12.00)

Maine $12.75

Maryland $11.75 ($12.50)

Massachusetts $13.50 ($14.25)

State MW 2021 (2022)

Michigan $9.87 ($10.10)

Missouri $10.30 ($11.15)

Montana $8.75

Nebraska $9.00

New Jersey $12.00 ($13.00)

New Mexico $10.50 ($11.50)

New York $12.50

Oregon $12.00 ($12.75)

Rhode Island $11.50

South Dakota $9.45

Vermont $11.75

Healthcare Wages are on the RiseIn addition to changing minimum wages, clinical support wages are at an all-time high.

POSITION LOWEST 10% MEDIAN HIGHEST 10%

Medical Assistant (MA) $26,930 $35,850 $50,580

Licensed Practical Nurse (LPN)

$35,570 $48,820 $65,520

HIT Specialists $29,130 $51,840 $105,690

Medical Records Specialists

$28,800 $44,090 $73,370

Medical and Health Services Managers

$59,980 $104,280(private practice median $94,240)

$195,630

2020 Data provided by U.S. Bureau of Labor Statistics

Pay Equity: Being part of the solution

#1 Perform a Pay Equity Audit• Compare the wages of employees doing like positions• Assess differences in wages• Account for reasonable differences like work experience, performance,

credentials

#2 Investigate remaining differences and rectify

#3 Leverage HR resources to help create improvement plans to eliminate unfair wage gaps in the future

#4 Use Available Resources:• Harvard Business Review https://hbr.org/2020/11/how-to-identify-and-fix-pay-

inequality-at-your-company• EEOC https://www.eeoc.gov/equal-paycompensation-discrimination• HR Executive https://hrexecutive.com/follow-these-7-steps-to-an-effective-

pay-equity-audit/

Work From Home: Wages & Benefits FAQ

Can I pay my remote workers less? Technically if you are able to evidence legitimate reasons (like significant geographic cost of living variance). However, we do not recommend this as it often leads to staff attrition. See this USA Today article on the cons of decreasing wages for remote employees.

Do I have to pay for my employee's internet and office supplies when they work from home?There is no widespread mandate though some states do have individual statutes outlining when reimbursements are required. We recommend consulting your HR experts or attorney for more information and to validate information that you can find online such as this article. Keep in mind, many of these statutes outline that reimbursement is only required if work from home is the only option given to the employee.

Where can I find more information on writing policies and communicating benefit changes to staff who change to work from home models? Like any other human resources policy, you are going to want the guidance of HR experts as well as your legal counsel. We do not recommend making changes to position requirements and compensation without having first perfomed that research and due diligence.

Unemployment Fraud

Unemployment Insurance Fraud

What to know...• Fraud can be committed by the employer as well as the claimant (former employee).

• Examples include knowingly submitting false information, continuing to collect when you aren't eligible, or intentionally not reporting additional income.

• Penalties, by federal law, must be 15% or more of the fraudulent payments made.• The DOL tracks overpayments and improper payments. Between 4/1/20 - 3/31/21 an

estimated $14.3 Billion in fraudulent payments were made. States higher than 5% Fraud• The DOJ has established an Unemployment Insurance Fraud Task Force coordinating with

over 10 Federal agencies across all 50 states.• A large portion of unemployment insurance fraud is committed through identity theft.

Resources:

DOL: https://www.dol.gov/agencies/eta/unemployment-insurance-payment-accuracy/UIFraudReportingDOJ: https://www.justice.gov/coronavirus/national-unemployment-insurance-fraud-task-force

Kem Tolliver

Kem@MedRevenueCycle.com

@KemTolliver

https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/

Taya Moheiser

Taya@ITSHealthcareConsulting.com

@TayaMoheiser

Linkedin.com/in/TayaMoheiser

Thank You!