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Return-to-Office Mandates: Layoffs in Sheep’s Clothing
https://www.reworked.co/employee-experience/return-to-office-mandates-layoffs-in-sheeps-clothing/

Companies demand employees come into the office for many legitimate reasons. But in some cases, it appears to be a tactic to force employees out.
Companies, large and small, are asking employees to return to the office at least a few days a week. But in some cases, these return-to-office (RTO) policies appear to be a passive-aggressive approach to eliminate roles, rather than doing layoffs.
Case in point: AT&T recently said it would require thousands of managers from across the country to work in person at just nine locations. One manager referred to the move as “a layoff wolf in return-to-office sheep’s clothing.”
Dell stated employees who chose to work fully remotely won’t be eligible for promotion. Google plans to factor an employee’s in-person attendance into their performance evaluation.
While there are several reasons companies could be using RTO to avoid actively laying people off, Maurice Cayer, lecturer and coordinator of the master of science human resources program at the University of New Haven, said it could backfire.
“It’s a blunt instrument,” he said of the tactic.
A Disconnect Between Employers and Employees
Research from the University of Pittsburgh found companies use RTO mandates at times for “power grabbing and blaming employees for poor performance,” yet the results harm employee satisfaction and fail to improve performance.
Still, 90% of organizations plan to implement RTO policies this year, and 80% will track in-office attendance, such as via badge swipes and desk sensors.
Most employees prefer remote or hybrid work. Nearly 50% said they would quit their jobs if their employer mandated a full-time RTO policy, according to the Integrated Benefits Institute.
Employees’ feelings about in-office work are clear. So why are companies choosing to enforce such an unpopular — and ineffective — tactic?
One reason is that some organizations, especially tech companies, overstaffed as they rebounded from the pandemic and now have too many employees, Cayer said. The introduction of new technology, like artificial intelligence, also might be behind a reduction in staff.
Others may be using RTO as a test. The mandate in those cases screens employees to determine “who’s the most committed to the organization” and open to a more traditional work model, said Colleen Flaherty Manchester, a professor in the Work and Organizations department at the University of Minnesota.
The tactic highlights the disconnect between employers’ perceptions of flexible work and employees’ desires to work remotely for personal or productivity reasons, she said.
Requiring employees to return to work in person may have some advantages, such as improved communication and more opportunities for mentorship, but organizations typically haven’t experienced extensive productivity issues with remote work, said Carrie Urrutia, a labor and employment attorney at Eastman & Smith in Toledo, Ohio.
“Many companies simply want things to revert to the way they were before COVID,” she said.
The Consequences of Using RTO to Trim Staff
Companies risk losing their best people with RTO policies, said Cayer.
“Organizations are placing bets, and they’re willing to live with the consequences of losing some highly desirable people in the process,” he explained. “But, maybe they’ll make up for it by having people who are engaged at work.”
Quietly laying off workers under the RTO guise could anger employees and damage an organization’s reputation, which might impact future hiring and meeting business goals, Urrutia added.
Yet the approach is attractive to companies. “It could be a less-costly way to achieve a goal of reducing the workforce without a formal reduction in force,” said Urrutia.
Employees who quit as a result of RTO mandates wouldn’t be eligible for unemployment compensation and typically wouldn’t receive a severance package as opposed to those who were laid off, she explained. “Generally speaking, employees who voluntarily resign are not entitled to those benefits.”
However companies would be better served implementing hiring freezes or enabling more flexibility, she argued. Urrutia said organizations should examine their current remote or hybird work arrangements and assess what’s working for them and employees. If RTO is mandated, they should clearly articulate the business reasons why it’s necessary and why remote work isn’t working.
“Aim to find a sweet spot that achieves the manager’s goals of in-person connection for innovation and group productivity, yet also meets some of the needs of employees,” Manchester said.
Are Quiet Layoffs Legal?
As a rule, employees don’t have a legal right to work from home, so employers are free to require in-person work as a condition of employment, Urrutia said. Workers therefore typically don’t have legal recourse if they feel a RTO mandate is designed to make them quit.
One exception is if an employee had a contract that specifically stipulated they’re allowed to work remotely, Urrutia explained. Another is unionized employees, where RTO could be a subject of collective bargaining.
Organizations also must ensure their RTO decisions aren’t discriminatory or unfairly impact groups protected under the Civil Rights Act, Cayer said. The law prohibits employment discrimination based on race, color, sex, national origin, age, disability and medical history.
Employers are also required to provide reasonable accommodation under the Americans with Disabilities Act or Pregnant Workers Fairness Act, and that might include allowing remote work, Urrutia added.
“Employees who work from home are not a protected classification, but many employees who work from home are in protected classifications,” she said.
Still, employees could file a lawsuit if they feel they RTO policies unfairly led them to quit, Cayer added. Organizations can choose to protest the suit. “A lot of times that leads into some settlement,” he said.
Sign of the Times – Answers
House subcommittee focuses on need for 340B transparency

| On Tuesday, health system leaders testified before the House Energy and Commerce Subcommittee on Oversight and Investigations about potential changes to the 340B Drug Pricing Program. The committee was receptive to witnesses’ claims that the program is essential to the financial survival of many systems, but representatives stated that “the status quo is not acceptable” and that they had a responsibility to “step in and provide oversight.” There was little interest expressed in broad overhauls to the program, but both witnesses and representatives focused on how it could benefit from greater transparency, for example requiring hospitals to disclose 340B revenue, how savings are used, and which patient populations are served through the program. Meanwhile, Republicans and Democrats in both houses have introduced multiple bills this session that focus on various aspects of the 340B program, including transparency. |
| The Gist: It’s encouraging to see members of congress recognize how essential the 340B program is to health system finances, and of the potential reforms on the table, increased transparency is a relatively palatable option. Congress is exploring statutory tweaks to the program in response to the myriad legal challenges concerning it, many of which involve the Department of Health and Human Services. Several of these lawsuits stem from more than 20 major drugmakers restricting 340B discounts at contract pharmacies, which has led multiple states to enact legislation protecting these discounts, in turn prompting further lawsuits. The mess of conflicting rulings these cases have produced so far is a clear sign that the 340B statute will be amended, and health system advocates should continue working with Congress to find solutions that preserve the integrity of the program. |
Many states now scrutinizing healthcare consolidation

This week’s graphic looks at the plethora of state-level mergers and acquisitions (M&A) oversight laws that are now in place, part of a recent trend that adds further scrutiny to healthcare consolidation.
Thirty-five states currently have laws that require not-for-profit healthcare entities that meet certain requirements, usually based on revenue size, to report M&A activity to state regulators. Fourteen of these states extend these requirements to for-profit healthcare entities as well.
These state laws vary in scope but generally target healthcare deals that fall below the federal reporting threshold for transaction size, updated to $119.5M in 2024.
Two states with particularly strong healthcare M&A oversight laws are Oregon and Minnesota. The Oregon Health Authority must pre-approve any healthcare transaction of at least $35M in size.
Passed in 2023, Minnesota’s healthcare antitrust law sets the deal size reporting requirements at $10M,
but the state commissioner of health and the attorney general do not have to pre-approve all healthcare mergers. Minnesota also requires merging parties to disclose extensive details on the transaction agreement, market impact, service cuts, and more to state regulators, who have broad authority to block mergers on public interest grounds.
Although some believe that these state laws will help preserve healthcare competition and access, they will increase the complexity, cost, and timeline for healthcare entities seeking to merge and could make survival for smaller providers even more difficult.
Hospital at home programs at a critical juncture

| Published in Health Affairs last month, this piece explores the history of hospital at home (HaH) programs and examines some of the barriers currently limiting their growth. HaH programs were introduced in the US back in the 1990s but remained rare due to a lack of reimbursement. That changed in 2020 when the Centers for Medicare and Medicaid Services (CMS) introduced the Acute Hospital Care at Home waiver, which allows fee-for-service Medicare reimbursement for providing inpatient-level care at home, prompting the number of HaH programs nationwide to swell from about 20 to more than 320 today. Although early findings from this initiative have been positive, the future of many of HaH programs is in doubt, as the waiver is set to expire at the end of 2024, barring congressional action. The authors argue that making the Medicare waiver program permanent is essential to overcome HaH’s “common agency problem,” which prevents many hospitals from building out their home-based programs to scale if they cannot receive reimbursement for all eligible patients. |
| The Gist: The Medicare waiver program has incubated many new HaH programs, but most of these programs remain very small; even for systems with the most robust programs, HaH volume only represents a sliver of their total inpatient volume. Without guaranteed fee-for-service Medicare reimbursement, the average health system will find it difficult to devote the significant resources and investment that program creation and expansion requires. If Congress moves to make the waiver program permanent, or at least extends it for several more years, state Medicaid programs and private payers may be more incentivized to follow suit and provide reimbursement for the care model. Although legislation has been introduced to this end in Congress, action on this front in an election year is going to be challenging. |
Dollar General ends mobile health clinic pilot

| Discount retail giant Dollar General announced late last week that it will end its mobile health clinic pilot program, run in partnership with mobile medical care provider DocGo. Launched in Jan. 2023, the mobile clinics provided basic healthcare services—including annual physicals, vaccinations, urgent care, and lab testing services—several days per week outside three Dollar General stores near the company’s Goodlettsville, Tennessee headquarters. A Dollar General spokesperson said that ending the mobile clinics program was a mutual decision between Dollar General and DocGo and did not provide additional details on the decision. |
| The Gist: Dollar General’s small healthcare delivery pilot received significant attention when it was announced, due to the retailer’s extensive footprint in rural and medically underserved areas. Although the discount retailer never touted a healthcare strategy on the scale of Walmart or Walgreens, which have each also walked back their healthcare delivery ambitions this year, Dollar General did hire a chief medical officer in 2021, and many thought that this pilot could be the company’s first step toward broader healthcare delivery. Instead, Dollar General’s role in improving the health of rural Americans for now remains limited to its retail offerings: it continues to expand its DG Fresh initiative, now selling fresh produce at more than a quarter of its 20K locations, and its DG Wellbeing section, which now accepts supplemental health benefits for its selection of more than 300 over-the-counter medicines and supplements. |
OHSU and Legacy sign definitive merger agreement

| Late last week, Oregon Health & Science University (OHSU) and Legacy Health, both not-for-profit health systems based in Portland, OR, shared that they had signed a definitive agreement to merge after first announcing their intent to combine last August. The combined system would be the largest in the Portland region, with 12 hospitals and a total annual revenue of about $6.6B. As part of the deal, OHSU has promised to invest about $1B over ten years to upgrade Legacy’s facilities. The systems are expected to apply this summer for review by Oregon’s Health Care Market Oversight Program, which was established in 2022 and has the authority to deny or attach conditions to healthcare mergers in the state. |
| The Gist: If finalized, this merger would connect OHSU’s academic medical center to Legacy’s network of community hospitals and clinics, as well as secure Legacy a needed capital infusion. Next steps include review by both federal regulatory agencies and Oregon, which is among a growing number of states to implement M&A oversight laws. |




