Obesity: Whose Business Is It?

Editor's Note: "A Hospital Stops Hiring Obese Workers: Are You OK With That?" in H&HN Daily April 10, drew several thoughtful and divergent responses. Two follow. To read more of them, go to www.hhnmag.com/HHNdaily and search by the author, Bill Santamour.

I, too, worry when folks start getting in the way of my lifestyle choices and where that can lead … BUT obesity is a lifestyle choice that actually IS my business. When I have to sit in an airplane squashed between two obese folks, it's my problem. When I watch medical insurance costs soar, largely due to obesity-induced chronic illnesses, it is my business. When I care for folks who are chronically hospitalized because of these lifestyle choices, it becomes my business. When I have to watch family members self-destruct through eating, it is my business.

When an obese health care provider wants to educate me about lifestyle choices and health care management, it is my business. Where better to start the discussion that has been tippy-toed around way too long than right where it needs to be … with health care providers.
When I was overweight, no one, not even my doctor, had the courage to say outright to me, "You are overweight and you are going to have serious consequences if you don't take responsibility for it now." When I finally decided to do something about it, I became angry at my physician because I needed straight talk and information about HOW to do it, and I think most folks do, too.

Let's start the discussion and back it up by dropping the hypocrisy and being good examples and good educators.

—Annepetherick

A Different Take

This is a slippery slope. People can have many limitations that could hinder their work. That is why the accommodations for those individuals has become a civil liberty issue. Like any protected class for discrimination, where do we draw the line at defining cherry picking only "healthy" people to work in the health care industry. Just seems a bit hypocritical to me.

—Linda Vallery

Getting Technical on ACOs

Re: "Six Key Technologies to Support Accountable Care" by John Glaser in H&HN Daily April 10

I agree with the view that IT building blocks for successful ACOs have to be interoperable, informative, intelligent and instantaneous. Web services delivered through true SaaS architecture and standard Internet protocols are the only way to make the constantly evolving interchange of data scalable, ubiquitous and accountable. Beware of "bolt-on" modules that claim to turn old client-server applications into "cloud computing." It just ain't so. Your revenue cycle management system should ensure that claims come in clean, checked for eligibility, medical necessity and clinical utility.

—Xfin

BMI and the Right to Work

Re: "Snuffing Out Bad Behaviors" by Matthew Weinstock in H&HN Daily April 12

I agree that we should "practice what we preach" and offer employees every opportunity to improve their health, but I have a hard time depriving well-qualified employees the right to work because of an elevated BMI. Could genetic prescreening be the next part of an employment physical?

—Traci Buxton

The ACO Conundrum

Re: "Four Pillars of Successful ACO Clinical Integration" by Martin Graf and Milton J. Schachter in H&HN Daily April 19

I recently produced a white paper on post-acute care integration under emerging ACO models. One of the dynamics the paper contemplated was the very scenario as offered by Graf and Schachter. To make things even more intriguing, what happens when the dominant health system ACO partners with Health Plan A wherein the second- and third-place health systems coalesce while partnering with Health Plan B? The decision whether to embrace an ACO is a tough one. The tactical decisions of how to connect so many moving parts without losing market share is even tougher.

—Phil Prosser