Clarian Health to Dock Employees' Pay if They Don't Quit Smoking and Control Weight, Blood Pressure, Cholesterol, and Blood Sugar; Unsafe Sex Still OK

According to an article in BusinessWeek Online, Clarian Health - an Indianapolis-based hospital system with 13,000 employees - has announced a plan to begin docking their workers' pay if they do not comply with a set of health guidelines, including requirements to quit smoking and keep their weight, blood pressure, cholesterol, and blood sugar in a specified range. The policy will apparently apply only to employees who are enrolled in the company's health plan.

According to the article, each paycheck will be docked by either $5 or $10 for each failure to comply with the following requirements:

• Quit smoking and maintain smoking abstinence;
• Keep blood pressure lower than 140 systolic and 90 diastolic;
• Keep LDL cholesterol less than 130;
• Keep blood glucose under 120; and
• Keep body mass index less than 30.

The article reports that: "For employees at Clarian Health, feeling the burn of trying to lose weight will take on new meaning. In late June, the Indianapolis-based hospital system announced that starting in 2009, it will fine employees $10 per paycheck if their body mass index [BMI, a ratio of height to weight that measures body fat] is over 30. If their cholesterol, blood pressure, and glucose levels are too high, they'll be charged $5 for each standard they don't meet. Ditto if they smoke: Starting next year, they'll be charged another $5 in each check. Clarian has been making headlines for its aggressive and unusual approach to covering escalating health-care costs. Rather than taking the more common step of giving employees incentives for merely participating in its wellness programs, such as joining a smoking cessation group or using a health coach, Clarian is actually measuring outcomes. And unlike most employers, it is penalizing workers for poor health instead of rewarding them for taking healthy steps."

The Rest of the Story

Apparently, employees of Clarian Health still have the go-ahead to have all the unsafe sex that they want. Generously, they are allowed to eat whatever they want as long as they keep the specified parameters in order. They can also drink excessively without hesitation, since excessive alcohol consumption does not have a direct effect on any of the measured parameters. Magnanimously, the company will allow employees to be completely sedentary and not get any exercise, so long as they keep their body mass index below 30.

For those who are not obese to begin with, there is no incentive provided to exercise at all. These workers have the green light to become couch potatoes. Clarian workers can also feel relieved that there is absolutely no requirement that they apply sunscreen before long days in the sun to avoid costly and potentially fatal skin cancer. While they can't smoke, they can take solace in the fact that they can suck up as much secondhand smoke as they want.

Also coming as a great relief is the fact that Clarian is not requiring female employees to be screened for breast cancer. No more need for uncomfortable mammograms which could prevent death from breast cancer. Perhaps even a greater relief is the absence of any requirement for men to obtain prostate exams to prevent potentially fatal prostate cancer and for both sexes, the absence of any colon cancer screening requirement.

Pregnant women seem to be faring best under Clarian's new policy. While they cannot smoke during pregnancy, they can drink alcohol to their heart's content. Plus, they can change all the cat litter they want without fear of repercussions from their employer. Amazingly, they don't even have to reveal to their employer if they are regularly changing cat litter.

To be sure, the Clarian Health policy leaves many aspects of employees' privacy completely intact. Imagine that Clarian's employees can have sex with whomever they want and do not have to report either the number of partners or the names of those partners. There is absolutely no duty to report the number of drinks that they are having when they get home from a stressful day at work.

Moreover, while employees must submit to a blood test so that their cholesterol and blood sugar can be measured, there is no need to provide a urine sample so that they can be tested for a whole host of other serious, but easily treatable medical conditions. And they do not have to provide evidence that they have received an annual PAP smear, rectal exam, or breast exam.

Employees who are experiencing exertional chest pain come out smelling like roses. Despite the probability of serious but treatable cardiac ischemia, there is no need to either be tested for heart disease or to document having been tested.

Employees with sexually transmitted diseases fare extremely well under the new plan. Not only are they free from disclosing their conditions, but there is no requirement for medication compliance. Unlike diabetics, who have to maintain their blood sugars within rigidly controlled parameters, STDs are unregulated and there is no need to submit blood work and other specimens to determine the presence or absence of an STD. Apparently, Clarian has the utmost respect for the privacy of their employees and their autonomy in making their own off-the-job decisions regarding legal behaviors.

Unfortunately, diabetics do not fare well at all under the plan. By requiring them to keep their fasting blood sugar levels below 120, the plan forces them to go up on their evening insulin doses, putting them at great risk of developing hypoglycemia at night. Brittle diabetics fare very poorly, since even attempting to keep their morning blood sugars below 120 is unwise, as it would put them at risk of dying from hypoglycemia during the middle of the night. If diabetic employees start failing to show up for work at Clarian, you'll now know why.

Former football players and other athletes, as well as bodybuilders and guys who just enjoy working out are also in serious trouble. Many of these individuals - among the healthiest in the population - have body mass indices above 30 based on their weights, even though they have very little fat and huge muscles. In fact, all members of the Olympic gold medal rowing team would be subject to having their pay docked, as would 200 players in the National Basketball Association.

Take solace chewers! Smokeless tobacco use seems to be sanctioned by Clarian. As long as you don't smoke, your paycheck appears to be safe. And don't bother with all these new snus products coming out. Go with the real thing - Skoal, Copenhagen, and Happy DaysMint. After all, you get no rewards for switching to snus.