It's an exciting and important time for our voices and leadership to be heard in Washington, D.C.," said Lon O'Neil, president and CEO of the Society for Human Resource Management, during the organization's employment law and legislative conference.

In March, O'Neil spoke before nearly 650 attendees at the three-day event, which focused on employment laws and legislation affecting how corporate America manages its workforce.

"The issues that are being debated in this city and on the airwaves are our issues. They are HR issues," he added, noting the first law President Obama signed was an HR-related law, The Lilly Ledbetter Fair Pay Act.

But it doesn't stop there. The economic stimulus package contains a number of measures related to HR polices, including COBRA and unemployment insurance, and even more proposals are in the pipeline, such as the Employee Free Choice Act, Healthy Families Act, new anti-discrimination rules and health care reform. "All of which," O'Neil said, "will need our involvement and our collective leadership."

Dealing with FMLA and fair pay

At one conference session, a few HR professionals pointed out that more physicians are charging hefty fees to fill out medical certification forms required by the Family and Medical Leave Act.

FMLA permits employers to require workers who seek leave protection to submit within 15 days, a medical certification form that substantiates the duration for the leave to be taken.

Some attendees said that a growing number of physicians are charging anywhere from $100 to $150 to complete the FMLA- required forms, which can sometimes result in a bureaucratic delay in granting the FMLA leave. Others added that physicians who charge costly fees for certifying FMLA forms classify the procedure as an administrative function, so some health plans will not cover the cost.

"If a doctor is charging, I recommend that you check with your plan to make sure it is covered," said Manesh Rath, a labor and employment law attorney at the Washington, D.C.-based firm Keller and Heckman, LLP.

"Yet as you all know, whether a plan covers the fees is going to be unique to each health plan," he added. "Plan coverage specs are going to change from plan to plan, even within the same carrier and from year to year." Still, Rath acknowledged that he is hearing more stories about doctors charging fees to complete FMLA medical certification forms.

Employers have to decide whether to cover those charges or allow the employee to bear the cost, he said. "Either way, that employee has an obligation to comply with an employer's request for medical certification. I would not encourage employers to release the employee from those obligations simply because of fees tied to medical certification forms."

Rath's session also discussed The Lilly Ledbetter Fair Pay Act, which eliminates, in part, the 180-day statute of limitation on pay discrimination claims. Yet the 180-day requirement was of practical importance to the HR/benefits community.

The deadline provided HR/benefits managers and directors with a sense of finality to cases involving pay discrimination, Rath explained. HR professionals could wrap up those investigations and send the files to offsite storage because, to a certain extent,"managing the company's human resources is also about managing paper."

Don't forget health care

Of course, lobbying Congress on what employers expect of health care reform is bound to take center stage at any forum on employer-sponsored health benefits - especially when it's held in D.C. Also in March, the National Business Group on Health threw its Business Health Agenda conference in the nation's capital.

Richard Stephens, senior vice president of human resources and administration at The Boeing Company, presented one of the keynote addresses at the three-day event.

The Seattle-based company, which is the world's second-biggest builder of commercial jets, provides health care coverage to nearly half a million workers and their dependents. The company's annual health care cost is about $2 billion, Stephens said.

Boeing's goals are simple when it comes to health care reform. First, lawmakers need to preserve the tax and legal framework for employer-based health coverage, ensure affordable access to health care for all and make our health care system as effective and efficient as possible.

Equally important, Stephens urged Congress to allow employers the flexibility to design health benefits plans according to their workforce and business needs without imposition of specific mandates.

Still, Stephens realizes that health care reform doesn't let employers and employees off the hook in reducing costs. The company advocates individual responsibility and accountability through wellness and preventive programs "to help our employees to understand the value of using efficient treatment and providers," he said.

For example, the company created an outpatient program for workers and their family members who have complex and challenging medical conditions. The program offers participants the opportunity to receive individualized high-quality care from a dedicated physician. This includes 24-hour access to the doctor via e-mail, phone or a home visit. "It's coordinated and proactive care that improves an individual's health," Stephens asserted.

From a cost perspective, the program is lean because it delivers efficient and evidence-based medical care. Moreover, it provides a feedback loop that measures results and offers continuous improvements on medical care.

Stephens emphasized that reforming health care today is also about establishing a legacy for the future. "The systems and processes that we put in place today will have a lasting impact on our country's competitiveness and ability to create innovative products."

The largest retailer in the United States sees itself as carrying out three roles in the health care arena, said Linda Dillman, executive vice president of benefits and risk management at Wal-Mart Stores, Inc.

The company, which operates nearly 8,000 stores and employs about 1.4 million associates, has a role as a retailer of pharmacy prescription drugs, a role as an employer to its associates and their family members, and a role as an influencer.

"We try to leverage all three roles in the health care space," said Dillman during her keynote address. For example, the company has taken the concept of inexpensive generic drugs and applied it to the smoking cessation program under its health plan.

"We offer a two-week nicotine patch for $9. This is the first time that participants who are trying to quit smoking have access to a quality smoking cessation tool that costs less than smoking cigarettes," which is key in helping members to quit smoking, said Dillman.

The Business Health Agenda forum also included a session that rolled out the findings from the 14th annual study on health care trends conducted by the NBGH and Watson Wyatt. Theodore Nussbaum, director of group and health care consulting at Watson Wyatt, and Helen Darling, president of NBGH, presented the research.

Overall, smart employers refuse to let a bad economy stifle their efforts to stabilize their health care costs, according to the research. Best-performing employers saw a median health care cost trend of only 0.5% for 2008.

Darling told attendees, many of them HR/benefits professionals, that U.S. employers can expect their health care cost trend to remain steady at 6% for 2009, although that's twice the rate of inflation. Companies that struggle with reducing their health care costs - the poor performers - can expect to see their median cost trend hit 10.5% for 2009, up slightly from 10% in 2008.

That the best performers were able to cut their health care cost trend by half a percentage point, from 1.0% in 2007 to 0.5% in 2008, "tells us that the best performers have differentiated themselves to even a greater degree from all others in terms of their ability to manage two years of annual trends," said Nussbaum.

Watson Wyatt and NBGH studied 489 companies providing benefits to more than 8 million individuals. The survey was conducted from November 2008 to January 2009, and the survey participants spend more than $56 billion in health care expenses each year. Some companies have aimed to hit a zero cost trend by the end of 2009, Nussbaum said.

"Two years ago, we might have said that's not a realistic goal, but with the best performers producing one-half of a percent of trend this year and 1% last year, it may not be a totally unrealistic goal, but whether it's sustainable is another question," he added.

The study shows that best-performing employers and companies that have managed their health care cost increases at or below the median cost trend of 6% take a broad approach to lowering health care costs by investing in many programs and strategies.

For example, these employers were more likely to focus on appropriate financial incentives, effective information delivery, metrics and evidence, quality care delivered efficiently, and maximizing health and productivity.

It's not any one of those tactics, or a great performance in only one of those categories, that drives results, explained Nussbaum. "Successful employers consistently do many things that are in each one those categories. That's what produces the best results."

Nussbaum doesn't buy the argument that some employers are more comfortable in making layoffs than making changes to their health care programs. "There are many companies that are reducing hours and days in order to keep their good workers," he said. (See No stone unturned)

"Past recessions have taught companies that it takes time to establish a strong employee-employer relationship," he added. "It's not a trade-off between making changes to your health care plan and making layoffs that is driving the unemployment rate."