#ABC News

 

Today thus far has been an extremely active day for health care social media #hcsm .

Tweet chat, #abcdrbchat from ABC news is  number six on the twitter trend list this AM at 10:30 AM Pacific time. It appears that there were  many tweeps  from non health related sites in this chat.

And here is how to join any tweetchat.

Anyone who thinks #social media is not relevant to #medicine is about to become a  #dinosaur.

Some of the most popular hash tags revolve around #emr #hitsm #hcsm #d4pc #mhealth  Check the web site  Symplur for all the tags relating to health care and medicine.

During the past year physicians have engaged in social media with increasing frequency.

Despite these positive upticks there are those who are reticent to engage in social media.

Here are some things you may have experienced:

In the past year have you experienced:

          Nausea, due to keeping up with the rapid changes in the social media space ?

Y or N

Anxiety, due to the looming threat of an online flare up surrounding your organization?  Y or N

Frustration, due hospital exec rejecting your social media ideas?

Familiarize yourself with three targeted tracks in healthcare communications

1. PR and Marketing

2. Employee Communications

3. Social Media for Medical Professionals

 

Paul Sonnier at Digital Health lists the growing number of Digital Health Events between June 20113-June 2016 which number more than sixty.

During August;

HIMSS ASIAPAC13 Greater China eHealth Forum

National Forum on Data & Analytics in Healthcare @ Gaylord National R

Mobile Healthcare: Innovations in Telemedicine @ The George Washin

Digital Health Days – Stockholm

Aug 21 – Aug 22 all-day Conference Digital Health Europe

August 26, 2013 (Monday)

NIH-UCLA Summer Institute on Mobile Health (mHealth) Technology Research

Aug 26 – Aug 30 all-day California Course Los Angeles United States

August 27, 2013 (Tuesday)

BIOCOM’s 7th annual DeviceFest Conference @ Sheraton Carlsbad

Aug 27 @ 8:00 am – 6:30 pm California Conference Diagnostic Medical Device San Diego United States

August 28, 2013 (Wednesday)

The Quantified Patient @ athenahealth's Visitor Center (Building 400)

Aug 28 @ 6:00 pm – 9:00 pm Big Data Consumer Digital Health Health IT Healthcare Massachusetts Medical Device United States Wearable Tech Wellness big data HealthcareSocialMedia healthstartup mobile Wearables

This unique event will feature forward thinking entrepreneurs, researchers and companies who are redefining healthcare through the use of self-tracking systems, behavior change psychology, and [...]

August 29, 2013 (Thursday)

Seattle Health Innovators Meetup @ SURF Incubator

Aug 29 @ 5:30 pm – 8:15 pm Accelerator Digital Health Healthcare Life Sciences Meetup Precision Medicine United States Wasghington Wellness

The purpose of the Seattle Health Innovation Forum is to support the individuals actively making health innovation happen. This community draws on entrepreneurs in businesses, [...]

 

For the Schedule for the remaining portion of 2013 and beyond […….] events.

Technorati Tags: digital health events,paul sonnier,himss asiapac13,china ehealth forum,mobile healthcare,telemedicine,digitalhealth days stockholm,nih-ucla summer institute,bicom 7th annual device conference,the quantified patient,athenahealth,seattlel health innovators,surf incubator acm joint conference,ata fall forum transform 2013

Does The Open Letter have a place in Health Care?

 

Wrong !                                              Correct !

             

Hospital mergers, acquisitions and the development of integrated hospitals systems is one of the results of the Affordable Care Act’s model for Accountable Care Organizations.  It will become a fundamental business practice.

An ongoing themes of  mergers, acquisitions and cooperative agreements will create different organizational culture clash.

These clashes apply to group practices and hospitals.  Executives of these entities are faced with a myriad of tasks, not the least of which is human interaction with can be unpredictable if not guided with introductory process as well as implementation guidelines.

Perhaps medicine can take a lesson from mergers such as Amazon and the Washington Post, as well as Tony Hseih of  Zappos.  The common theme was their guiding hand.

Likewise the pen of Jeff Bezos on the Post purchase outlined openly the acquisition  and his goals.

Mergers or acquisitions often take place in the setting of economic changes, anxiety and fear. The number one concern for employees is whether they will have a job.  Fear and anxiety can lead to a loss of productivity, loss of faith, trust and loyalty. The Open Letter should address all of these factually and honestly.

Frequently health care organizations merge or acquire to accomplish one of the following;

1. Increase market share

2. Consolidate many administrative functions, with a possible reduction in work force.

3. Provide complimentary services, or add a center of excellence

4. Improve asset/liability ratio, to acquire financing or to expand physically.

5. Close a competing facility or expand physical locations.

 

 

An Effective Open Letter

So what does a great open letter take? If you are looking to use this form of communication as a leader to offer your point of view in a more powerful and emotional way, there are three elements that should to be at the top of the list:

1. Humanity – Great open letters have a human tone of voice. They don’t use corporate speak and actually sound like something that a leader might say in a conversation as opposed to an investor presentation. They express emotion and feelings, and share a personal point of view.
2. Timeliness – An open letter is usually delivered in response to a piece of news or announcement. As a result, the timing of getting that letter out is often vital. Having it completed and published early ensures that conversation and media attention will incorporate the views shared in the letter. Also, having it done early is essential to demonstrate that the viewpoint is a proactive one, and not in response to some sort of crisis or criticism.
3. Visibility – The final element is making sure the letter is published in a place where it is highly likely to be seen and shared. Bezos publishing on the homepage of Amazon or on  Washingtonpost.com are obvious choices … but sharing your open letter through an op-ed piece on another website, or on a highly visible corporate blog that is easily found from your company homepage can both be good choices.

As more companies use the Internet and social media to communicate a corporate point of view directly to their audiences, using the open letter will become a more and more important element of corporate communications. There may be a time soon when any communicators developing a media engagement and public relations strategy for corporate announcements or product launches will need to consider an “open letter strategy” as a part of their efforts.

Social media strategy will be an important vehicle for these ‘open letters’.

 

Technorati Tags: social media,open letter,zappos,amazon,washington post,bezos,mergers,acquisiitions,humanity,timeliness,visibility

October Residency Approved for AMA PRA Category 1 Credits™

 

This amazes even me. The original skeptic and cynic whose attitudes and social media mores and ethics carefully developed an honed after 40 years of practicing medicine.  God bless the United Social Media of Medicine (U.S.S.M). 

The goal for Social Media Residency is that participants will develop a plan for strategically applying social media tools in their work. Download Sample Agenda/Curriculum, and see the Social Media Residency page for more background on the program.

See the Social Media Week page for an overview of the entire week's events, and for links to where you can register.

How relevant is social media to physicians?   The title speaks to it all.  This amazes even me. I mean I have been working at this for years, and I never imagined I would earn CME courses.  Will I be ‘grandfathered’ as a certified social butterfly?

Will I have to meet CME requirements annually to participate on twitter, Facebook or Google plus, as well  ?  Since I have about ten years of experience on social media I want to nominate myself to be on the     ‘Board’ of the Joint Commission of Social Media in Medicine’. My credentials include a self-nomination’ as expert in social media, SEO, semantics, entrepreneur, one of the original founding users of Google plus and a pioneer of Hangout heavens.

Social Media Week

Mayo Clinic designates this live activity for a maximum of 11.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: To applicants:

There are two parts to this examination:

1.Written: Participant will converse on four social media sites simultaneously.

2.Oral examination: Google  hangout with 9 other social media (all certified by the board.) (meaning me !) Participants will have the option of choosing  Zoom.US Google Hangouts, Skype or Facebook for this portion of the examination. Note: All participants are bound by the EULA of the host media.

There is a fee, REGISTER HERE

choose your method of payment.

Requirements are broadband internet and a modern computer capable of video, a webcam and either a Mac, any brand of tablet, or Window PC. Note Windows Vista or above.

Technorati Tags: : AMA,cme,Credits,medical education,PRA Category 1,residency,training,windows,Mac,broadband,hcsm,hitsm.smhn

Concierge or Direct Pay Care

 

Some say that Concierge medicine and Direct Pay are two different forms of payment.  Not so.

This should not be complicated.

Medical Access USA is an old and well established method for patients to access quality health care and were discussing how to build a system.

Accountability is a trust relationship and is a one-on-one transaction. Our goal at Medical Access is to restore the relationship between patient and provider to ensure that connection. Our mechanism is a fee-for-service model. Despite recent moves to discourage and eliminate this mechanism for many reasons unrelated to practicing quality health care, it should not disappear.  It provides a simplicity without complex indecipherable regulations.  It also reduces the overhead of billing (64% for an individual primary care physician )according to some sources)

How do we go about changing health reimbursement in a meaningful way for many patients. Notice I did not say all patients.  That would be as foolhardy as what the Democrats and President Obama accomplished with the Affordable Care Act.

The prime directive for our plan is patient welfare and the ability to access primary care easily and affordably.  It does not take a rocket scientist to analyze what needs to be done.  The Affordable Care Act favors a medical home. This used to be called a family or general medical practice.  The name changed but the core premise remains the same. Another term would be ‘holistic medical practice’.  Patients do well and favor having a physician who can manage most of their issues.  Many health related  problems have an underlying psycho-social component and requires a transference between patient and physician. This is reinforced by visiting with the same physician.

The basic care unit is one doctor and one patient. Patient pays doctor for services, a one-on-one contract with no intermediary.

Dave deBronkart (e-Patient Dave) well known patient advocate, frequent keynote speaker for advocacy groups, and TEDMED.

Much of medicine has been misdirected, fixing ‘train wrecks’ rather than taking care of early disease.

 

Technorati Tags: direct payment model,concierge medicine,health insurance premium,e-patientdave,medicalaccessusa,fee for service,accountable care act

The Real Price of Incentives: Loss of Trust

 

Are Incentives a bribe ?

 

Incentives, rewards, penalties, fines, deadlines. Are they counterproductive? Probably so,  amongst professionals.

Many of these issues also apply to healthcare and medicine. Rushing to satisfy requirements for new technology and unproven organizational models often leads to loss of productivity, inappropriate expenditures, and disaster for organizations.

You might be thinking “why else would people work if not to enrich themselves?” This is certainly the view of human nature that dominates economics. In The Wealth of Nations, the father of modern economics, Adam Smith wrote:

 

It is in the inherent interest of every man to live as much at his ease as he can; and if his emoluments are to be precisely the same whether he does or does not perform some very laborious duty, to perform it in as careless and slovenly a manner that authority will permit.

Thus, for Smith, if you wanted people to do an honest day’s work, you had to make it pay. The discipline of economics has been guided by this assumption ever since. And the management practices of organizations in all areas of life have borne the mark of this view. But even within this framework, people realized that there was more to work and life than instrumental incentives. For example, Goldman Sachs, the investment bank that was one of the villains of the financial collapse, was guided in its earlier days by “service to client” as its touchstone. It was only after Goldman Sachs became a public company that it evolved into a money-making machine.

Does this sound like health care ? The cost of doing business, health or otherwise increases with bureaucracy, and like “teaching to the test” creates more efficiency to produce more income and incentivizes the wrong goals.

Yes, “what’s in it for me” was a part of human nature, but so were virtues like honesty, integrity, loyalty, pride, responsibility, duty, commitment, and courage. Indeed, even Adam Smith made it clear in The Theory of Moral Sentiments, that he didn’t think the economic side of human beings told the whole story. But nowadays, we tend to see human motivation as uni-dimensional, at least when it comes to designing our institutions. What is odd is that although we seem readily to accept this view when it comes to other people, we reject it completely when we’re thinking about ourselves.

There is no doubt that some incentives are smarter than others. But incentives are, by their nature, limited in what they can accomplish, and thus not the right tool for every objective. Worse yet, incentives can have perverse effects, undermining the moral commitments people might otherwise have to pursue the telos of their chosen profession.

Psychologists have known this for years, but policy makers have not been paying attention. In this connection, it is interesting to note that the “normalization” of incentives is a relatively recent historical phenomenon. In earlier eras, they were regarded with distaste as nothing more than bribes. They were not the same as rewards and punishments, because rewards and punishments imply merit or desert. They were just levers that one could use to make people do what you wanted them to do. Owing, I think, to the pervasive influence of economics, and to developments in the discipline of management science, incentives slowly evolved into morally neutral management tools. One consequence is that questions about what the right thing to do is were less and less commonly asked.

If people aren’t asking themselves what’s the right thing to do, they are not likely to do the right thing. And as a result, the public will stop trusting them, as indeed, it should.

 

Technorati Tags: incentive payment,reward,penalty,trust,management tools,bribes,adam smith

The Real Price of Incentives: Loss of Trust

 

Are Incentives a bribe ?

 

Incentives, rewards, penalties, fines, deadlines. Are they counterproductive? Probably so,  amongst professionals.

Many of these issues also apply to healthcare and medicine. Rushing to satisfy requirements for new technology and unproven organizational models often leads to loss of productivity, inappropriate expenditures, and disaster for organizations.

You might be thinking “why else would people work if not to enrich themselves?” This is certainly the view of human nature that dominates economics. In The Wealth of Nations, the father of modern economics, Adam Smith wrote:

 

It is in the inherent interest of every man to live as much at his ease as he can; and if his emoluments are to be precisely the same whether he does or does not perform some very laborious duty, to perform it in as careless and slovenly a manner that authority will permit.

Thus, for Smith, if you wanted people to do an honest day’s work, you had to make it pay. The discipline of economics has been guided by this assumption ever since. And the management practices of organizations in all areas of life have borne the mark of this view. But even within this framework, people realized that there was more to work and life than instrumental incentives. For example, Goldman Sachs, the investment bank that was one of the villains of the financial collapse, was guided in its earlier days by “service to client” as its touchstone. It was only after Goldman Sachs became a public company that it evolved into a money-making machine.

Does this sound like health care ? The cost of doing business, health or otherwise increases with bureaucracy, and like “teaching to the test” creates more efficiency to produce more income and incentivizes the wrong goals.

Yes, “what’s in it for me” was a part of human nature, but so were virtues like honesty, integrity, loyalty, pride, responsibility, duty, commitment, and courage. Indeed, even Adam Smith made it clear in The Theory of Moral Sentiments, that he didn’t think the economic side of human beings told the whole story. But nowadays, we tend to see human motivation as uni-dimensional, at least when it comes to designing our institutions. What is odd is that although we seem readily to accept this view when it comes to other people, we reject it completely when we’re thinking about ourselves.

There is no doubt that some incentives are smarter than others. But incentives are, by their nature, limited in what they can accomplish, and thus not the right tool for every objective. Worse yet, incentives can have perverse effects, undermining the moral commitments people might otherwise have to pursue the telos of their chosen profession.

Psychologists have known this for years, but policy makers have not been paying attention. In this connection, it is interesting to note that the “normalization” of incentives is a relatively recent historical phenomenon. In earlier eras, they were regarded with distaste as nothing more than bribes. They were not the same as rewards and punishments, because rewards and punishments imply merit or desert. They were just levers that one could use to make people do what you wanted them to do. Owing, I think, to the pervasive influence of economics, and to developments in the discipline of management science, incentives slowly evolved into morally neutral management tools. One consequence is that questions about what the right thing to do is were less and less commonly asked.

If people aren’t asking themselves what’s the right thing to do, they are not likely to do the right thing. And as a result, the public will stop trusting them, as indeed, it should.

 

Technorati Tags: incentive payment,reward,penalty,trust,management tools,bribes,adam smith

Culture of Disrespect

 

 

In a Culture of Disrespect, Patients Lose Out

 

When doctors tolerate a culture of disrespect, we aren’t just being insensitive, or obtuse, or lazy, or enabling. We’re in fact violating the first commandment of medicine.

• 
  The Scope of the Problem
  • Disruptive behavior
  • Humiliating, demeaning treatment of nurses, residents, and ...
  • Passive-aggressive behavior
  • Passive disrespect
  • Dismissive treatment of patients
  • Systemic disrespect
• The Effects of Disrespectful Behavior: Why Is It ...
• The Causes of Disrespectful Behavior
  • Endogenous factors
  • Exogenous factors
• Summary
• References
• Cited By

Part II

• Abstract
• Cultural Transformation
• A Leadership Challenge
  • Motivate and inspire
  • Establish preconditions for a culture of respect
  • Lead the establishment of policies regarding disrespectful ...
  • Facilitate engagement of frontline workers
  • Create a learning environment
• Responding to Disrespectful Behavior: Codes of Co...
  • Implementation
  • Reporting
  • Prevention of disrespect
• Cultivating a Culture of Respect

 

Disrespect goes far beyond the nurse-doctor patient interface with patients. We are leaving out the most disrespectful aspects of our present system. 

These are the under-insured and uninsured patients. 

The middle level managers with cookbook guidelines to denials and authorizations for diagnostic procedures, treatments and access to expensive pharmaceuticals.

The insurance company unreasonably denying treatments, the endless waiting in a phone queue only to be answered by a robot.

The informed consent written by attorneys that are unintelligible. The Medicaid system which treats recipients with disdain and rules that are byzantine, with addendums and empty promises of a safety net, obsolete and irrelevant poverty figures as well as month to month eligibility which obviates any form of managed care or case management.

The incompetent legislatures who rule from above with no concept of safe and/or effective healthcare.

The autocratic and dictatorial methods of the Department of Health and Human Services.

CAeHQ---The Status of Health Information Exchanges in California

 

California is large enough to be called a ‘nation-state’ with 35 million citizens, it is larger than many sovereign states in the world.  The diversity of it’s demographic is challenging not only for health systems and providers, and with social engineers as well.

The development of health information exchanges in California is a microcosm for what must take place nationally in regard to health reform and ObamaCare.

Early study and planning for HIX began in 2004 with a major impetus by the newly formed Office of the National Coordinator for Health Information Technology (ONCHIT). Rather than forming one monolithic organization a model for regional information exchanges evolved over time.

Simultaneous interoperability standards were developed to ensure a common system of harmony between disparate EMR system, laboratory systems, pharmacy systems and more.

Federal incentives in the form of the HITECH Act has fueled significant growth in HIT since 2009.

The most recent meeting of the CAeHQ nicely summarizes the progress of health information exchanges, and it’s relationship to the national plan. It is anticipated that as the system matures individual HIOs may vanish to be replaced by the national HIE.

The development of each individual health information exchange has been sporadic and dependent upon local interests and the development of sustainable business models. Other items include trust agreements among the users of the exchanges.

Whilst some HIXs are working well, each one delivers different data fields and the comprehensiveness of it’s data. Some are simple messaging functionality, some allow transmission of continuity of care records, while  others are more complete.

As yet there is little if any transparency from an electronic medical record. Rather than true integration of the data into a trusted partner’s EMR a separate portal must be engaged to retrieve patient data.

The ONCHIT Direct program remains a national infrastructure, while each region has it’s own network.  There is no uniformity of size.  The current size appears to be guided by the hospital systems and the individual state. Few cross state jurisdictions except for a few.

The CAeHQC recent stakeholder meeting took place on July 18,2013 via a webinar.

The slide deck of the meeting (24 slides) is linked here. (may take a moment to load)

ref: CAeHC Webinar July 18,2013  Recorded TBA available at www.ehealth.ca.gov

 

Technorati Tags: caehq,onchit,rhio,hix,california hix,emr.interoperability,hitech act,trusted framework

CAeHQ---The Status of Health Information Exchanges in California

 

California is large enough to be called a ‘nation-state’ with 35 million citizens, it is larger than many sovereign states in the world.  The diversity of it’s demographic is challenging not only for health systems and providers, and with social engineers as well.

The development of health information exchanges in California is a microcosm for what must take place nationally in regard to health reform and ObamaCare.

Early study and planning for HIX began in 2004 with a major impetus by the newly formed Office of the National Coordinator for Health Information Technology (ONCHIT). Rather than forming one monolithic organization a model for regional information exchanges evolved over time.

Simultaneous interoperability standards were developed to ensure a common system of harmony between disparate EMR system, laboratory systems, pharmacy systems and more.

Federal incentives in the form of the HITECH Act has fueled significant growth in HIT since 2009.

The most recent meeting of the CAeHQ nicely summarizes the progress of health information exchanges, and it’s relationship to the national plan. It is anticipated that as the system matures individual HIOs may vanish to be replaced by the national HIE.

The development of each individual health information exchange has been sporadic and dependent upon local interests and the development of sustainable business models. Other items include trust agreements among the users of the exchanges.

Whilst some HIXs are working well, each one delivers different data fields and the comprehensiveness of it’s data. Some are simple messaging functionality, some allow transmission of continuity of care records, while  others are more complete.

As yet there is little if any transparency from an electronic medical record. Rather than true integration of the data into a trusted partner’s EMR a separate portal must be engaged to retrieve patient data.

The ONCHIT Direct program remains a national infrastructure, while each region has it’s own network.  There is no uniformity of size.  The current size appears to be guided by the hospital systems and the individual state. Few cross state jurisdictions except for a few.

The CAeHQC recent stakeholder meeting took place on July 18,2013 via a webinar.

The slide deck of the meeting (24 slides) is linked here. (may take a moment to load)

ref: CAeHC Webinar July 18,2013  Recorded TBA available at www.ehealth.ca.gov

 

Technorati Tags: caehq,onchit,rhio,hix,california hix,emr.interoperability,hitech act,trusted framework

HIPAA NEVER EVENTS

Never events refer to hospital mishaps in procedures and patient identification which often lead to severe complications, loss of a limb and/or death. Perhaps the term should also be applied to privacy rules:

It is forbidden:

The Privacy Rule allows a covered entity to de-identify data by removing all 18 elements that could be used to identify the individual or the individual's relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity also must have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following:

1. Names.
2. All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census:
   1. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people.
   2. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000.
3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older.

4. Telephone numbers.
5. Facsimile numbers.
6. Electronic mail addresses.
7. Social security numbers.
8. Medical record numbers.
9. Health plan beneficiary numbers.
10. Account numbers.
11. Certificate/license numbers. **
12. Vehicle identifiers and serial numbers, including license plate numbers. **
13. Device identifiers and serial numbers. **
14. Web universal resource locators (URLs).
15. Internet protocol (IP) address numbers.
16. Biometric identifiers, including fingerprints and voiceprints.
17. Full-face photographic images and any comparable images.
18. Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re-identification.

These categories are subject to fines, and penalties and in some cases prison sentences for violations (if repeated, and uncorrected)

It extends to insurance agents, insurers, Medicare, providers, hospitals and other health care entities, including health information exchanges,health benefit exchanges, government web sites (CMS, Medicaid), Social Security Records,social media, blogs, including archived storage media, cloud storage, and the Internal Revenue Service should they act as an enforcement agency for the terms of the individual mandate (subject to final rulings of the  affordable care act.

In essence HIPAA extends privacy rules to anyone in contact with digitized or written information about patients, INCLUDING NAVIGATORS. Let us anticipate they will be trained in HIPAA regulations.

Covered entities may also use statistical methods to establish de-identification instead of removing all 18 identifiers. The covered entity may obtain certification by "a person with appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable" that there is a "very small" risk that the information could be used by the recipient to identify the individual who is the subject of the information, alone or in combination with other reasonably available information. The person certifying statistical de-identification must document the methods used as well as the result of the analysis that justifies the determination. A covered entity is required to keep such certification, in written or electronic format, for at least 6 years from the date of its creation or the date when it was last in effect, whichever is later.

 

 

Technorati Tags: hipaa,privacy,confidentiality,navigator,cms final rule,medicare,hipaa fines,social security records,never events

What is a “Navigator”?

 

 1581: Francis Drake, having completed the first circumnavigation of the world a few months earlier, is knighted by Queen Elizabeth aboard his ship, the Golden Hind

Do we need navigators on the high turbulent seas of the Affordable Care Act ?

The Department of HHS as part of the Affordable Care Act mandated a Navigator program to help people enroll in insurance plans.  Why they did this is no mystery.

They estimated that licensed insurance brokers would ‘gain the system’ to their  advantage. I wonder what the evidence is for that?

There is much evidence which justifies  these concerns found on the internet just by searching for “Medicare enrollment”.  A search will take you to many sites for health insurance, besides Medicare….most seem to be profit driven Medicare advantage of private insurance companies of varying credibility.  The actual CMS or Medicare.gov sites are buried several pages down in the search results.

CaliforniaHealthLine   ( A publication of the California Health Care Foundation) reports:

Individuals who work in the Affordable Care Act's "navigator" program for the law's health insurance exchanges must be affiliated with certain community organizations, such as churches. The workers must undergo at least 30 hours of training to before they can be qualified as a "certified application counselor," the rule issued by CMS states

CMS Releases Final Rule for Affordable Care Act's 'Navigator' Program

Under the ACA, exchanges that will be operated solely by or in partnership with the federal government are required to have at least two certified navigator entities, one of which must be a not-for-profit. HHS has allocated $54 million in funding grants to train and pay navigators in the 37 states with federally run exchanges.

Navigator workers must provide "fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process." They also must provide additional assistance to:

• Consumers with disabilities, limited proficiency in English; or
• Consumers who are unfamiliar with health insurance.

Lawmakers in recent months have raised concerns about the workers' level of training and access to consumers' personal and potentially sensitive data. In particular, some GOP leaders have stepped up their scrutiny of the navigator program and a separate "in-person assisters" program in states that will operate their own exchanges. The ACA prohibits federal funding for the assisters program because it does not have to meet the same criteria as the navigators program..

More Details of Final Rule

Under the final rule, traditional insurance agents cannot be selected and trained as navigator workers, who must not be affiliated with the insurance industry ("Healthwatch," The Hill, 7/12). Navigator workers and in-person assisters can provide information only about specific topics.

• The exchanges' qualified health plans and insurance affordability programs;
• The tax implications of enrollment decisions;
• Eligibility for premium tax credits; and
• Cost-sharing reductions.

 

Jones, Groups See Fraud Potential in Covered California Enrollment

California Insurance Commissioner Dave Jones (D) and consumer advocacy groups are concerned about the potential for fraud and identity theft when individuals enroll in the California Health Insurance Exchange .

Privacy, Fraud Concerns

Jones and consumer groups say that the exchange is not doing enough to ensure that people hired as enrollment counselors -- individuals who will provide consumers with in-person assistance in signing up for health plans -- are adequately screened and monitored.

The network of more than 21,000 enrollment counselors could have access to consumers' personal and financial information, such as ID cards and medical histories.

According to Jones, the exchange does not have a plan for investigating any complaints that could arise once the counselors begin their work.

Jones said that it will be possible for the counselors to "obtain information that will allow them to build the trust they have with the individual they're working with and potentially sell them all manner of bogus products, steal their identity, gain access to certain assets they might have ... The list is virtually endless."

He added, "We can have a real disaster on our hands." Unless the navigators are certified as HIPAA compliant entity

 

Technorati Tags: hipaa,aca,affordable care act,covered california,navigaator's program,cms final rule,chcf,healthline,medicare cms