The Cost of Smoking in the Workplace

The classic workplace quandary: should smoking breaks in the workplace be allowed?

Once an inalienable tradition, now a bone of contention. There is no denying that smokers need their nicotine (despite the legislation of recent years, a 2014 Guardian article noted that over 18% of the UK’s adult population are still regular smokers) but given that smoking is a choice, should workers that smoke have more time away from their workstation than non-smoking colleagues?

The financial cost

Research published in 2014 by the British Heart Foundation found that four ten-minute smoke breaks per day are costing British business £8.4bn per year; or to break it down a little further, that £1,815 per year for each full-time smoking worker.

That’s a lot of money.

The impact on productivity

Of course, money isn’t the only measure, and in terms of overall productivity, an argument can be made for the enhanced mental focus that follows a brief break – that moment of peace and reflection may mean that a freshly-nicotined smoker is more productive than the colleague who hasn’t taken a break.

However, the commentary in the report suggests that the same smoker will have been less productive leading up to the break and the ‘dip’ and the ‘boost’ cancel each other out. Add to that the fact that smokers take more sick leave on average and the impact on productivity is definitely in the negative.

What does the law say?

To begin with, there is no legal right to a smoke break and smoking in the workplaceis acceptable but only on your official break.

The Working Time Regulations say that anybody working a shift of 6 hours or more is entitled to a 20-minute break away from the workplace but there’s no specific mention of smoking.

What’s more, enclosed spaces (i.e. anywhere inside) are required by law to be smoke-free.

The days of the staff room having tar-yellow walls are long gone.

What’s a good policy to have?

It’s entirely up you as an employer whether you want to allow smoking breaks.

So long as you’re not in breach of the regulations on rest breaks in general, then you can pretty much do what you want on the tobacco front.

However, many businesses are reluctant to set a policy; not wanting to come across as Big Brother, constantly monitoring their workers’ movements.

But any business is allowed to expect a worker to put in the time they’re contract for and the only breaks to which workers are entitled are those laid down in either the Regulations or their contract.

This is exactly why a short but clear smoking policy can be helpful.

If you want to allow smoking breaks then put it in writing, and state what a reasonable number and length of breaks is in your workplace. That way, even if there is dissatisfaction, it will be with the policy (a piece of paper) and you’re less likely to have conflict between smoking and non-smoking staff.

You can also use the policy to designate appropriate smoking zones (staff wreathed in smoke around you front door rarely create a good impression on visitors) and lay down whether staff should ‘clock out’ for a smoking break.

The latest question is whether e-cigarettes or ‘vaping’ should be allowed in the workplace – up to you. You might also take the opportunity to offer help with giving up for those that want to (see it as an investment in future productivity).

The best way forward is to talk to staff, both smokers and non-smokers, about what they want and what they think is fair.

Most smokers want (need) their breaks but it’s rare that they demand special treatment. Likewise, non-smokers might resent the extra breaks but they generally understand smokers who can’t smoke make for a more tense working environment.

Talk to everyone and try to find the best compromise for your workforce. Most people will be happy to have it spelled out.

Electronic Medical Billing and Timely Payment – Fiction or Reality?

Oligopsony (the market condition when few buyers can greatly influence price and other market factors) gives the insurance companies (buyers) tremendous negotiating power and prevents physicians (sellers) from addressing unfair payment practices. To solve this problem, all fifty states have instituted a law penalizing health insurers for late payments. In the past ten years, state courts have imposed at least $76 million in fines against insurance companies for failure to comply with prompt-pay laws, according to the AMA. The settlements between seven largest insurance companies and state medical societies amounted to more than $1.53 billion, with only $384 million for direct payments to physicians (see Dave Hansen, “The failed promise of prompt pay,” AMNews, Nov. 5, 2007).

An oligopsony, according to Wikipedia, is a market form in which the number of buyers is small while the number of sellers could be large. It’s a mirror opposite to an oligopoly, where there are many buyers but just a few sellers:

  1. World economy: Three firms (Cargill, Archer Daniels Midland, and Callebaut) buy the vast majority of world cocoa bean production, mostly from small farmers in Third World countries.
  2. American economy: tobacco growers face an oligopsony of cigarette makers, where three companies (Altria, Brown & Williamson, and Lorillard Tobacco Company) buy almost 90% of all tobacco grown in the US.
  3. American healthcare insurance: a single insurance company commanded at least 30% of the market in 299 of 313 metropolitan statistical areas. One insurer had 70% or more of the market in 74 areas, while in 15 areas one company had at least 90% (AMA’s 2007 update to “Competition in Health Insurance: A Comprehensive Study of U.S. Markets”).

In each of these cases, the buyers (payers) have a major advantage over the sellers (providers). They can play off one provider against another, thus lowering their costs. They can also dictate exact specifications to providers.

Today, forty-nine states require claims to be paid in 45 days or less. AMA’s Dr. Wilson’s proposal to the House Small Business Committee’s health panel in August 2007, listed multiple ideas for improved accountability, including:

  • A strong federal standard. Require payment within 30 days for clean paper claims and 14 days for clean electronic claims.
  • Stiffer fines than those in state laws to deter bad behavior. Assess interest on payment outstanding and increase the interest in step the claim’s delinquency. Include litigation costs when they win a claims dispute with an insurer.
  • Time limits for notification. Federal law should set a statutorily defined time limit for insurers to notify physicians that additional information is needed to process a claim. The notice should specify all problems with the claim and give an opportunity to provide the information needed. Insurers also should be required to pay any portion of a claim that is complete and uncontested.

But it takes years to pass new laws. Worse, the proposed standards ignore modern technology and lag behind other industries. For instance, the proposed 14-day healthcare insurance payment standard of clean claims is a far cry behind a Wall Street standard to settle massive volumes of trades within 24 hours, and a telecommunications standard to complete massive fee exchanges for phone calls between multiple carriers and customers within minutes of each conversation.

In addition to better accountability, comprehensive measurement and routine performance comparison must become integral to the payment process. Two physician and chiropractic billing and practice management companies, Athenahealth and Billing Precision, track and post payer performance statistics, including payment speed and percent of accounts receivable beyond 120 days:

  • Athenahealth (PayerView): the average days in accounts receivable

    1. Aetna 29.8
    2. Humana 30.6
    3. Cigna 31.9
    4. WellPoint 35.1
    5. Coventry Health Care 35.1
    6. UnitedHealth Group 38.3
  • Billing Precision Index: Percent of Accounts Receivable Beyond 120 days – September 2007 – 14.3
    1. Medicare Illinois 5.9
    2. Blue Cross Blue Shield Illinois 7.3 (up from 10 in August)
    3. CIGNA 11.2 (up to 16.4 in August)
    4. Aetna 11.7 (up from 12.7 in August)
    5. Medicare New Jersey 12.5 (up from 13.3 in August)
    6. United Healthcare 13.3 (down from 11.3 in August)
    7. Blue Cross Blue Shield Pennsylvania 14.8 (up from 28.3 in August)
    8. Blue Cross Blue Shield New Jersey 14.9 (up from 15.3 in August)
    9. GEICO 25
    10. Blue Cross Blue Shield Georgia 31.2 (down from 22.9 in August)

In summary, legal accountability, comprehensive measurement, and routine performance comparison must become integral to the medical billing and payment process.

Electronic Cigarette – Smoke Without Fire

Asked recently to write about electronic cigarettes, I have to confess that I had never heard of such a thing. Some internet research later and I discovered that electronic cigarettes are very much a quickly growing concern. A Google search revealed there is no smoke without fire as almost six million results just for the phrase “electronic cigarette” were returned.

What is an electronic cigarette?

The electronic cigarette has been in existence for almost three years and is a clever device aimed at providing smokers with a healthier option. Apparently also useful in helping to reduce and indeed quit smoking altogether.

Now in a fourth generation, electronic cigarettes have become much more user friendly than earlier versions which perhaps were a little too large to encourage a mass market appeal. The “mini” is the most realistic e cigarette to date with its length of 100mm being the same as a conventional cigarette.

An electronic cigarette contains a taste of tobacco but none of the harmful substances found in normal cigarettes allowing smokers cravings to be satisfied without inhaling the many dangerous toxins. Is it all smoke and mirrors? Or can this item really be the saviour it wants to be?

A battery, an atomiser and a renewable nicotine chamber allows the smoker to hold and smoke the electronic cigarette just as they would any other cigarette, even creating a “smoke” like vapour and glow at the end as they draw. The nicotine chamber proves very useful as cartridges are available in different strengths, permitting the user to reduce the amount of nicotine they intake until if they wish, can quit completely.

A nicotine cartridge typically lasts the same time as 15 to 20 cigarettes, thus creating a huge saving to normal costs. Standard, medium, low and no nicotine at all are the various cartridge strengths.

A healthier option altogether it seems, though the benefits don’t end there. Due to the electronic cigarette not emitting any dangerous substances, toxins or real smoke for that matter, they are perfectly legal to smoke in public. In winter in particular, normal cigarette smokers have to brave the freezing cold and the rain just for a quick smoking break but this alternative will allow them to stay in their offices, restaurants and pubs.

None smokers also will benefit, as their worries about passive smoking are rendered null and void by the electronic cigarette. A much more sociable environment then!

Upon reflection the electronic cigarette is a healthier, cheaper and environmentally friendly alternative to smoking and as the awareness and the market grows they have great potential to successfully replace the harmful cigarettes we have all come to know and many of us have come to dread and fear.

Things to Know Before Coming to Mauritius – Part 2

Before you settle down to pack up and come to Mauritius, it could be important that you know certain things about the island. First of all, anyone can fall ill. As such, the health care system in Mauritius is fairly good and fine medication techniques are employed on people who fall ill. Hospitals in Mauritius offer treatment free of charge, so if you catch a cold, do not hesitate to go for a diagnosis. On the other hand, Mauritius being a tropical island receives water in abundance. So, there are various reservoirs all over the island supplying water to specific regions of the country.

Drinking the local water may therefore be relatively safe as it is treated to ensure risk free consuming for the whole population of Mauritius. As a matter of fact, you could use the water to safely brush your teeth, bath or even cook. But as a good measure of precaution, it could be better if you boil the water before drinking it. Besides, you could even buy bottled water which is readily available in shops and shopping centres around Mauritius. Similar to other tropical countries, mosquitoes do exist in Mauritius. So, you may have to buy special cream or appropriate mosquito repellent to be able to enjoy a good night’s sleep. Some villas are even equipped with electrical mosquito repellents which can be effectively used. Tablets called ‘vapes’ are inserted in the electrical device and can remain active up to 8 hours.

Moreover, a problem that many tourists encounter in Mauritius is sun burn. Underestimating what the sun can do to your skin can be very unwise. The sunshine in Mauritius is rather strong and can do harm to your skin if you are not protected by specific lotion. A skin burnt by the sun can create very uneasy feelings and can take up to two weeks to return to normal based on how much you have been exposed. Additionally, the power supplied in Mauritius is 240 volts. The power sockets use the British standard which is three pins. So, unless you come form a country where appliances use the British standard, you may have to bring adapters with you for your devices such as mobile phones and others.

Furthermore, the official language of Mauritius is English. As a matter of fact, many people can both understand and speak it. However, the most commonly spoken language in Mauritius is French as the native language, Creole, is a derivation of the French language itself. Most people in Mauritius are bilingual which makes it an advantage for communication purposes. With this in mind, you are therefore aware that you can easily travel and shop and whenever you might need help, you could be sure that you would be understood.

An equally important thing to know about Mauritius is its mixture of different cultures and religions. Mauritius comprises of a multi ethnic society where there are Hindus, Muslims, Christians and Chinese. With this said, you could be sure that your trip to Mauritius would indeed lead you to the discovery of certain feelings you probably have never experienced before.