Is Nicotine testing common or becoming common

[Samoa]

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I will join with those that think this is an unreasonable intrusion into employee's privacy.

I have no problem with hospitals tesing for illegal substances. They are illegal, and no one should be using them. We can have a debate about whether some (or all) of them should be legalized, but until they are I'm fine with that policy. THC aside, substance use has been shown to correlate with professionalism issues, etc.

I also have no problem with hospitals making their campuses smoke free. Mine is. There are NO smoking areas. You can't smoke anywhere. I believe that if visitors go outside and are far away enough from the door (which means quite far), no one will bother them. But technically the policy covers all of our property.

But I do have a problem with hospitals demanding that incoming employees be non smokers. I am a non smoker, so this doesn't affect me at all. But I agree that people have a right to engage in any activity that is legal in their own time, off campus.

The worry is where does this stop. Not hiring people because of their weight? What about based upon their hobbies -- what if a hospital demands that no one downhill ski, since that's dangerous and you might get hurt. Or what if an employee is an avid hunter, and the hospital thinks that injures their "brand".

I also have no problem if the hospital charges higher health premiums based upon lifestyle issues. Totally reasonable to charge someone who is a smoker more, or whose BMI is high more, or someone who engages in some "dangerous" activity. In fact, I like the idea of hiring people, testinging them for cotinine, if positive give them assistance in quitting, and if positive in 3-6 months, then increasing their health premiums. Same for high BMI. Seems like a good balance -- we try to help you improve your health, if you don't then you end up paying more for the increased financial risk.

This is a better solution, as it lines up personal choices with appropriate consequences. But is it actually legal to charge some employees (in the same job category and level) more than others for the same level of benefits?

I would bet that it's not, or is at least a legally riskier approach than job-contingent pre-employment screening.

 

[deleted87716]

is it actually legal to charge some employees (in the same job category and level) more than others for the same level of benefits?

I would bet that it's not, or is at least a legally riskier approach than job-contingent pre-employment screening.

It's legal.

http://ash.org/higher4smokers.html

 

[Samoa]

It's legal.

http://ash.org/higher4smokers.html

If I read it correctly, that article actually says that it's NOT legal to charge different rates for different members of a group (i.e. employer-sponsored) health plan, based on individual risk factors, even though it is legal to do so for individual plans.

It does allow "rebates" in exchange for participating in wellness programs, but participation is all that's required. The rebate can't be conditional on achieving the desired outcome (weight loss or smoking cessation, for example).

Also, such a rebate comes from the insurer, not the employer. The article doesn't address the issue of an employer reducing the employee's portion of the insurance premium, which is typically heavily subsidized by the employer already.

I really doubt that it's legal. Employers get all kinds of leeway in choosing initially who to hire. But once someone is on the payroll, performance of the job is legally the only factor that can justify differential changes in compensation.

 

[deleted87716]

If I read it correctly, that article actually says that it's NOT legal to charge different rates for different members of a group (i.e. employer-sponsored) health plan, based on individual risk factors, even though it is legal to do so for individual plans.

Note the following:

We also note that section 2702(b)(2) clarifies that the prohibition on discriminating based on health status does not prevent an insurer from using premium discounts or rebates, or modifying copayments and deductibles, "in return for adherence to programs of health promotion and disease prevention."

What this means is that they can charge more for smoking by giving a discount for not smoking.

 

[Samoa]

Note the following:


What this means is that they can charge more for smoking by giving a discount for not smoking.

I added more while you were writing. What it means is that the insurer not the employer, can give a rebate for trying to quit smoking.

 

[Samoa]

I added more while you were writing. What it means is that the insurer not the employer, can give a rebate for trying to quit smoking.

And that if the insurer wants to give a rebate to nonsmokers, it must also sponsor a program to help smokers quit, and give the same rebate to anyone participating in the program, even if they never succeed at all.

That probably costs more money than it saves, in a group plan.

 

[Godax]

Looking back at some of the posts who support this, you guys realize that there are other forms of tobacco and nicotine inhalers which do not in any way bother patients correct? Reeking of smoke and coming to talk with patients is one thing but having your job in jeopardy or not being hired because of alternatives which do not affect patients is pure idiocy.

 

[deleted87716]

I added more while you were writing. What it means is that the insurer not the employer, can give a rebate for trying to quit smoking.

Yes, although many employers these days self-insure (we do).

And that if the insurer wants to give a rebate to nonsmokers, it must also sponsor a program to help smokers quit, and give the same rebate to anyone participating in the program, even if they never succeed at all.

Health incentives (e.g., discounts) and wellness programs like smoking cessation go hand-in-hand. Typically, you don't get the discount unless you actually quit, however. Otherwise, what's the point?

Keep in mind that the link we're referencing relates to insurance plans covering Medicare patients (e.g. Medicare Advantage plans). This represents a worst-case scenario for legality. Commercial insurers (non-Mediare/Medicaid) typically have much greater latitude, as they're regulated by the individual states.

That probably costs more money than it saves, in a group plan.

Actually, no.

http://www.riskandinsurance.com/story.jsp?storyId=533332876

http://www.achi.net/TobaccoDocs/120731 Lars Report Tobacco Brief - Issue Brief 4 CC.pdf

http://www.businessgrouphealth.org/tobacco/return/index.cfm

Obviously, they'll save even more money if they don't hire smokers in the first place.

 

[deleted87716]

Looking back at some of the posts who support this, you guys realize that there are other forms of tobacco and nicotine inhalers which do not in any way bother patients correct? Reeking of smoke and coming to talk with patients is one thing but having your job in jeopardy or not being hired because of alternatives which do not affect patients is pure idiocy.

You're assuming that the sole reason a company might prefer not to hire smokers has to do with patients and/or corporate image. That might be part of it. However, as others have mentioned, the overriding issue is more likely the high cost of insuring and treating smokers.

If you want to know their rationale for testing potential employees for nicotine, just ask.

 

[Godax]

You're assuming that the sole reason a company might prefer not to hire smokers has to do with patients and/or corporate image. That might be part of it. However, as others have mentioned, the overriding issue is more likely the high cost of insuring and treating smokers.

If you want to know their rationale for testing potential employees for nicotine, just ask.

I'm not a cigarette smoker though and yet they would still be treating me like one as I would have nicotine in my system. I would also be willing to pay extra for the insurance but I guess that doesn't matter to them, they simply put it under the lie that it is to promote a message of health or some other HR response. Oh well, I guess when it comes time to choose residency, I will be applying to foreign ones if problems occur as I have no little to no desire to practice medicine in the USA in the first place.

 

[Godax]

Yes, although many employers these days self-insure (we do).



Health incentives (e.g., discounts) and wellness programs like smoking cessation go hand-in-hand. Typically, you don't get the discount unless you actually quit, however. Otherwise, what's the point?

Keep in mind that the link we're referencing relates to insurance plans covering Medicare patients (e.g. Medicare Advantage plans). This represents a worst-case scenario for legality. Commercial insurers (non-Mediare/Medicaid) typically have much greater latitude, as they're regulated by the individual states.



Actually, no.

http://www.riskandinsurance.com/story.jsp?storyId=533332876

http://www.achi.net/TobaccoDocs/120731 Lars Report Tobacco Brief - Issue Brief 4 CC.pdf

http://www.businessgrouphealth.org/tobacco/return/index.cfm

Obviously, they'll save even more money if they don't hire smokers in the first place.

These cessation programs and cessation aids go hand in hand with putting money in the pockets of many people. The level of corruption here is astonishing.

 

[Dwindlin]

Get over it. No one is stopping you from using what ever tobacco product you want. Just means you can't work at this particular place. That whole "freedom" thing works both ways, you can smoke/dip/chew/e-cig/etc, they can choose not to hire nicotine users. These are private organizations, don't like it, don't interact with them.

 

[deleted87716]

These cessation programs and cessation aids go hand in hand with putting money in the pockets of many people.

Yeah, money is the root of all evil. Thank goodness everyone here is completely selfless. 🙄

 

[Slade]

get over it. No one is stopping you from using what ever tobacco product you want. Just means you can't work at this particular place. That whole "freedom" thing works both ways, you can smoke/dip/chew/e-cig/etc, they can choose not to hire nicotine users. These are private organizations, don't like it, don't interact with them.

+1

 

[Godax]

Yeah, money is the root of all evil. Thank goodness everyone here is completely selfless. 🙄

When did I ever state that? I'm stating how corrupt this whole anti-tobacco lobby is in the fact that it is mainly to put money into the pockets of people who produce cessation products. There are cheaper alternatives to stop smoking that actually work but corrupt organizations like the FDA always try blocking them. Why would I want to live in a country which lies so much to the people?

 

[Godax]

+1

Nice to know you are so easily deceived with propaganda and you accept invasion of privacy. You will be a good future citizen of the ultimate nanny state.

 

[deleted87716]

Why would I want to live in a country which lies so much to the people?

Riiiiiight. Because, y'know, nothing like that ever happens anywhere else. 🙄

I'm not even sure what you're talking about, frankly. If you're somehow suggesting that it's cheaper for society to have people smoke rather than not smoke, you're delusional.

Incidentally, this thread has nothing to do with the policies of the US government. It has to do with private employers who choose not to employ individuals who will very likely be a financial drain on their organization.

 

[Godax]

Riiiiiight. Because, y'know, nothing like that ever happens anywhere else. 🙄

I'm not even sure what you're talking about, frankly. If you're somehow suggesting that it's cheaper for people to smoke than not smoke, you're living in a dreamworld.

It happens but other countries don't put up as much of a phony HR response.

 

[deleted87716]

It happens but other countries don't put up as much of a phony HR response.

Again, this is not a matter of national policy.

 

[Godax]

Again, this is not a matter of national policy.

Go and take a look at the reasons institutions are doing this. On every site I've read something akin to "To promote health and wellbeing". If this isn't HR speak then I don't know what is.

It doesn't matter in the long run. I have citizenship to another country and although I would prefer to be around my family, my freedoms are more important to me as well as living in a country where people don't lie down and let their personal lives be trampled on.

 

[deleted87716]

Go and take a look at the reasons institutions are doing this. On every site I've read something akin to "To promote health and wellbeing". If this isn't HR speak then I don't know what is.

"HR speak" isn't national policy.

my freedoms are more important to me as well as living in a country where people don't lie down and let their personal lives be trampled on.

What utopian paradise are you referring to?

 

[Godax]

"HR speak" isn't national policy.



What utopian paradise are you referring to?

When did I say utopia? You know that on this earth there are places with equal or better standard of living than the USA with less political correctness and more freedom of speech right?

 

[deleted87716]

You know that on this earth there are places with equal or better standard of living than the USA with less political correctness and more freedom of speech right?

Actually, no. Again, what country are you referring to? Hopefully, it's not Bhutan.

Smoking is recognized as a serious health problem world-wide, and smoking bans are not just a US phenomenon.

http://www.telegraph.co.uk/health/healthnews/8371205/Anti-smoking-measures-around-the-world.html

 

[Dwindlin]

When did I ever state that? I'm stating how corrupt this whole anti-tobacco lobby is in the fact that it is mainly to put money into the pockets of people who produce cessation products. There are cheaper alternatives to stop smoking that actually work but corrupt organizations like the FDA always try blocking them. Why would I want to live in a country which lies so much to the people?

Only we're not talking about a government agency here jack, these are private businesses that absolutely can violate your privacy (to an extent) if you want to take money from them. Again, the answer is simple, don't do business with them.

 

[notinkansas]

Only we're not talking about a government agency here jack, these are private businesses that absolutely can violate your privacy (to an extent) if you want to take money from them. Again, the answer is simple, don't do business with them.

As I've been thinking about this, I have been running this argument through my head. It gets a bit muddy, though given that these hospitals take Medicare and Medicaid. One could make the case that they are not truly private. This could be similar, perhaps to the argument people make against a school voucher program allowing students to use the vouchers (which are taxpayer money) for private schools that teach "creationism"

I also wonder where it can end- how far can a private company go in regulating it's employees behavior on their own time. Could a company refuse to hire employees who belong to the NRA, for example?

 

[notinkansas]

You know that on this earth there are places with equal or better standard of living than the USA with less political correctness and more freedom of speech right?

Please enlighten us.

 

[deleted87716]

It gets a bit muddy, though given that these hospitals take Medicare and Medicaid. One could make the case that they are not truly private.

Accepting government insurance doesn't have anything to do with it. I'm in private practice, and accept Medicare. That has no bearing on the hiring standards in my office.

 

[Dwindlin]

Accepting government insurance doesn't have anything to do with it. I'm in private practice, and accept Medicare. That has no bearing on the hiring standards in my office.

This.

As I've been thinking about this, I have been running this argument through my head. It gets a bit muddy, though given that these hospitals take Medicare and Medicaid. One could make the case that they are not truly private. This could be similar, perhaps to the argument people make against a school voucher program allowing students to use the vouchers (which are taxpayer money) for private schools that teach "creationism"

I also wonder where it can end- how far can a private company go in regulating it's employees behavior on their own time. Could a company refuse to hire employees who belong to the NRA, for example?

As long I'm not basing the decision on your skin color, sexual orientation, or gender I can do what ever I like.

 

[MDAnderson]

Does anyone here know the brand of test they use to screen for cotinine? I know that hospitals are probably not using GS/MS and are probably using an immunoassay. Curious to know which kind.

 

[Mad Jack]

My hospital was testing for nicotine, but only on those that claimed to not smoke when choosing insurance. Smokers had higher premiums, and you could be terminated if you lied about being a nonsmoker to get a cheaper health plan premium.