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Nicotine Screenings Snuff Out Some Employment Offers at Health Care Companies

Health care providers, which see their employees as 'role models and advisers to patients,' are among the organizations requiring tobacco testing for new hires.

April 30, 2013

Job opportunities are going up in smoke for applicants who use tobacco products—particularly among health care organizations, which are screening for nicotine use as well as drugs before new hires can start working.

One health care organization tapping into the trend is Baylor Health Care System, which implemented a nicotine screening policy in January 2012. "We just have to practice what we preach," says Becky Hall, Baylor's vice president of health and wellness. The Dallas health care system is highly regarded for its treatment of cancer and heart disease.

It joins the 4 percent of companies—in states where smokers aren't part of a protected class—with a policy not to hire nicotine users, according to the 2013 Employer Survey on Purchasing Value in Health Care of 583 employers by consultancy Towers Watson & Co. and the National Business Group on Health.

Helen Darling, president of the National Business Group on Health, says most of those companies are health care systems, which see their employees as "role models and advisers to patients."

For Baylor, implementing the policy was the next step in a wellness journey that began in 2007. When the program launched, Baylor offered tobacco cessation sessions to employees and their spouses, even if they weren't members of the system's health insurance plan.

Baylor then became a smoke-free campus, and in 2011 it began charging smokers $25 more per pay period, or $625 per year, for health insurance, Hall says.

Less than 10 percent of Baylor's more than 20,000 employees smoke. When the surcharge was implemented a few complained, but the majority said, " 'It's about time. I'm tired of paying for them,' " Hall recalls.

Last year, the health care system started screening out those who use tobacco. Its online application asks if job seekers are smokers. If they answer "yes," they can't continue with the application and are directed to resources to help them stop smoking, Hall says. They can reapply after being nicotine-free for 90 days.

Anyone with a preliminary employment offer goes through drug screening, which includes nicotine screening. The test will detect any kind of nicotine product, including cigarettes, a nicotine patch, nicotine gum and e-cigarettes. So far, 69 of about 400 offers have been rescinded, she says, and there is no evidence Baylor is losing out on top-notch talent because of the screening.

Testing is possible because nicotine users are not a protected legal class in Texas. Currently 29 states and the District of Columbia offer legal protection to smokers, according to the American Lung Association.

If a company in one of those states is considering establishing a nicotine-screening policy—which is typically conducted as part of pre-employment drug screening—it's essential that potential hires be aware that companies will be testing for nicotine, says Stephen Fink, a partner specializing in employment and labor law in the Dallas office of the law firm Thompson & Knight. If the screening for nicotine isn't disclosed, potential employees can argue it's a violation of their privacy.

Under federal law, smoking is considered an activity, rather than a medical condition, so it's not protected under the Americans with Disabilities Act, Fink says.

In 2010, nearly 20 percent of American adults smoked, according to the Centers for Disease Control and Prevention.

Fink contends the move to nicotine screening and other wellness policies is aimed less at cutting health care costs and more at maintaining employee productivity. "Employers have a real stake in employees being able to report to work and do their jobs on a fairly regular basis."

Cigarette smoking costs more than $193 billion annually—about half in lost productivity and half in health care expenditures, according to the CDC.

While health care providers are the main organizations now trying to extinguish nicotine usage, it's slowly spreading to other types of businesses. Hall gets calls at least once a week from companies such as manufacturers, retailers and restaurants, inquiring about the prohibition.

And the Towers Watson and National Business Group on Health survey found 2 percent of organizations plan to implement such a policy next year, driven by a desire to keep health care costs down. "What you pay as an employer is very substantially driven by how much [tobacco] usage there is," Darling says.

According to a report by the American Lung Association, employees who smoke cost employers an average of $1,429 more in health care costs than nonsmokers.

Broadway Bank, based in San Antonio, started nicotine screening of potential new hires on Feb. 1. Next year, employees who smoke will pay an insurance premium surcharge. The amount has yet to be determined, says Carlos Torres, senior vice president of human resources and wellness director.

Less than 10 percent of the bank's 650 employees smoke. "The only pushback has been, 'How are you going to help us quit smoking?' " Torres says. The bank has teamed up with the American Lung Association to offer counseling and medical resources to employees or their family members who smoke.

Torres expects it will only cost the company a couple of hundred dollars per employee who go through smoking cessation programs. Many resources are available for free or at minimal cost from groups such as the American Lung Association.

So far only six employees have signed up for smoking cessation courses. "We think it will take hold over time," he says.

Neither the bank nor Baylor screen current employees for nicotine usage, and have no plans to do so.

Baylor employees who complete a smoking cessation course have their health care premium surcharge halted for that year, Hall says. Sometimes it can take repeated attempts before they finally kick the habit.

It's too early to see how the nicotine screening policy will influence health care costs, but Hall expects them to start to fall in two to three years.

Susan Ladika is a writer based in Tampa, Florida. Comment below or email editors@workforce.com. Follow Workforce on Twitter at @workforcenews.