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Daily Archives: February 2, 2016

Bosses Find Part-Time Workers Can Come With Full-Time Headaches

Starting in 2016, the federal health law requires small employers to offer their full-time workers health insurance. In anticipation of the change, some fast-food restaurants looked to get around the law by making more workers part time. Now some owners are rethinking that approach.

At a Burger King off Highway 99 in California’s Central Valley, a half-dozen workers in black uniforms scurry around, grabbing packets of ketchup and stuffing paper bags with french fries.

Tiana Mua has worked here part time for almost a year. She’d like to be full time, but at this Burger King only the managers are full time. (The company didn’t respond to an interview request.)

Mua said that’s the situation at fast-food joints all over town. “They’re cutting back on all the jobs, and a lot of people have been let go and everything already,” Mua said.

One reason: The local economy is bad. People aren’t eating out as much, and sales are down. But there’s another reason that might explain why fast-food employees aren’t getting more hours: Obamacare.

Starting Jan. 1, businesses with 50 or more full-time employees must offer health insurance to all full-time staff or pay a hefty fine. Employers with 100 or more workers had to start offering coverage last year. But smaller businesses that operate on lower margins, especially restaurants, complained loudly about the cost.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News. It can be republished for free. (details)logo npr

And some fast-food franchise owners figured out a way to avoid paying for coverage: Just make as many workers as possible part time. A U.S. Chamber of Commerce survey found nearly 60 percent of small franchise businesses said they would make personnel changes like this.

“The ones that did it successfully did it three or four years ago,” says Kaya Bromley, an attorney who helps employers comply with the Affordable Care Act. But, Bromley said, some of the restaurant owners who cut hours to sidestep the health law now regret it.

“A lot of the fast-food franchisees that did this,” she said, “are now coming back and saying, ‘It was a great idea for reducing the number of people that I have to offer benefits, but now I can’t run my restaurants.’ ”

They tell her it has been a nightmare trying to manage a part-time staff.

“Because you’ve got people who are less loyal, you’ve got people who are less skilled — who don’t understand the business,” she said. There’s also more employee turnover.

Bromley has seen many of those restaurants reverse course. “Employers think that there’s a shortcut here or there, and then they realize, yeah, that shortcut really hurt me more than it helped me,” she said.

The people hurt most by all the workforce management gymnastics are the people at the bottom of the restaurant pecking order who want to advance, but can’t, said Angelo Amador, vice president of labor and workforce policy for the National Restaurant Association.

“Someone who’s working part time, but wants more hours so they can move up the ladder, they can’t get the hours,” he said. “It ends up taking out that middle rung of employees.”

Amador said Obamacare has made restaurants less flexible, mainly because it defines full-time work as 30 hours a week or more, and most other laws restaurants have to comply with, like overtime pay, define full time as 40 hours. He thinks the Affordable Care Act should be changed for consistency.

“It would be much easier if we could have one definition of full time,” he said.

At the Carl’s Jr. in Chowchilla, California, manager Silvia Campos tries to keep as many workers full time as possible. She says it makes her job easier. “It’s a small town,” she said. “For me, it’s hard to find a really good employee.”

But some workers don’t want more hours. Their part-time salary is low enough that they’re eligible for government coverage in California through Medicaid.

Some workers say they’re better off making less money and getting their coverage free from the state.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

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Study Finds No Harm In Allowing Surgeons-In-Training To Work Longer Shifts

Patients suffered no extra harm when doctors training to be surgeons were allowed to work longer shifts, a study released Tuesday concludes, adding to a push to relax the strictest limits on resident hours.

The New England Journal of Medicine study comes as the Accreditation Council for Graduate Medical Education is reassessing requirements that prevent residents from working extremely long stretches or back-to-back shifts. Those rules were enacted in 2003 and strengthened in 2011 amid concerns that sleep-deprived residents were more likely to make serious errors.

surgery 770Since then there has been push back from residency program directors concerned that the rules created new dangers for patients by abruptly forcing interns to leave in the middle of treating a patient or surgery. They also complain the rules interfere with resident education because it is harder for a trainee to follow their patients.

The study released Tuesday conducted a direct experiment by tracking patient outcomes after loosening the rules for doctors in 58 surgical residency programs. It found that their patients did not die or suffer complications any more than at 59 residency programs that did not waver from the current rules.

“We believe the trial results say it’s safe to provide some flexibility in duty hours,” said Dr. Karl Bilimoria, the main author and a professor of surgery at the Feinberg School of Medicine at Northwestern University in Chicago.

Some previous studies had come to similar conclusions, but this one has been anticipated because of its more rigorous methods. The trial has drawn protests from Public Citizen and the American Medical Student Association, which said researchers put patients and residents at risk by waiving the rules.

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This KHN story can be republished for free (details).

The groups assert that the experiment, funded by the American Board of Surgery, the American College of Surgeons and the accreditation council, was never likely to find a significant difference in patient outcomes, since most elements of patient care — the physicians, specialists, nurses and other clinical workers — remained unchanged.

“Research on the deleterious effects of chronic sleep deprivation is just overwhelming,” said Dr. Deborah Hall, president of the medical student association. “I’m concerned we’re going to walk away from a lot of progress that’s been made without overwhelming data [showing] that residents aren’t subject to the ordinary limits of human neurobiology.”

In an editorial also published in the journal, Dr. John Birkmeyer, chief academic officer at Dartmouth-Hitchcock, a health system in New Hampshire, came to a different conclusion than Bilimoria did. Birkmeyer wrote the experiment’s results “effectively debunks concerns that patients will suffer as a result of increased handoffs and breaks in continuity of care.”

Rather than roll back the rules on duty hours, he argued that surgeons should find safer ways to treat patients without relying on “overworked” residents.

“To many current residents and medical students, 80-hour (or even 72-hour) workweeks and 24-hour shifts probably seem long enough,” Birkmeyer wrote. “Although few surgical residents would ever acknowledge this publicly, I’m sure that many would love to hear, ‘We can take care of this without you. Go home, see your family, and come in fresh tomorrow.’”

The research was conducted in the academic year that began in fall 2014. One group of residency programs followed the existing rules, while the other programs were allowed to remove several strictures.

Residents in the experimental group could stay at the hospital longer than 28 hours in a row, the current maximum. They did not have to be given at least eight hours off between shifts. Residents who worked a 24-hour shift no longer had to wait 14 hours before returning to the hospital. And first-year residents could work more than 16 hours in a row, a limit set in 2011.

After analyzing medical records for 65,849 patients in the control group and 72,842 in the experimental group, the researchers found no significant difference in death or complication rates. They also surveyed 4,3Ǿ general surgery residents and found that those with the more flexible schedules rated their overall well-being and morale no different than did those with strict rules.

“We’re very encouraged by the findings,” said Dr. Maya Babu, a neurological surgery resident at the Mayo Clinic and president of the Resident and Associate Society of the American College of Surgeons. “We feel very strongly that flexibility is important to provide opportunities to learn and to have patient ownership, to see patients from the time they’re admitted through surgery the next day.”

Seven percent of residents exempted from the duty limitations said they left during an operation at least once a month, while 13 percent of those following the rules said they left. Thirty percent of the experimental group said they missed an operation at least once a month, while 42 percent of those with standard rules said they missed one. A third of the test group said they turned a patient over to another doctor in the middle of dealing with them, while nearly half of the control group recalled doing so.

Dr. Michael Carome, director of Public Citizen’s Health Research Group, a patient safety advocacy organization, said the study should have objectively assessed the hours residents worked and the effects on their health and patients, rather than rely on surveys. He said the study also did not track whether residents in the control group adhered to the stricter limits on how long they could work.

“The study didn’t collect any meaningful data on resident health outcomes,” Carome said.

The most major restrictions on resident duty hours put into place in 2003, such as a maximum workweek of 80 hours a week and a minimum of one day off every seven, were not tested in the study and are expected to remain in place.

The paper was scheduled to be presented Tuesday at the Academic Surgical Congress in Jacksonville, Florida. A similar experiment, looking at internal medicine residents, is still in progress.

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Viewpoints: Questions About Obamacare Sustainability; The Real Costs Of Repealing The Cadillac Tax

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State Highlights: N.M.’s Cost Concerns On Medicaid; Fla. Weighs Hospital Transparency Bill

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Kansas Medicaid Eligibility System Leads To Long Waits For Determination

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DNA Testing May Prove Key To Employee Wellness Programs

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WHO Declares Zika A Global Health Emergency

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Hospitals Explore Communication Strategies To Address Quality, Empathy Issues In Changing Medical Environment

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Drug Executives: Price Hikes A ‘Reality’ In Competitive Marketplace

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What Will Cancer ‘Moonshot’ Cost? Obama Seeks $1 Billion That Researchers Say Is Not Enough

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