Archive for category: Articles

Eliminating Barriers to Virtual Care: Implementing Portable Medical Licensure

Categories: Articles

Published on: October 17, 2019 and in the January 2020 issue of The American Journal of Managed Care

By: Pooja Chandrashekar, AB; and Sachin H. Jain, MD, MBA

In this commentary, the authors argue for moving away from state-based medical licensure and describe policy, technological, and administrative changes necessary for implementing portable medical licensure.

ABSTRACT

Telemedicine offers a promising solution to the growing physician shortage, but state-based medical licensing poses a significant barrier to the widespread adoption of telemedicine services. We thus recommend a mutual recognition scheme whereby states honor each other’s medical licenses. Successfully implementing mutual recognition requires policy, technological, and administrative changes, including a federal mandate for states to participate in mutual recognition, consistent standards for using and regulating telemedicine, a mechanism to enable interstate data sharing, financial support for states, and a “state of principal license” requirement for physicians. Reforming the United States’ outdated system of state-based medical licensure can help meet patient demand for virtual care services and improve access to care in rural and medically underserved areas.

Takeaway Points

The United States’ antiquated system of state-based medical licensure creates unnecessary hurdles that reduce the potential of telemedicine to address the growing physician shortage and improve access to care in rural and medically underserved areas.

Mutual recognition, a scheme whereby states honor each other’s medical licenses, is a comprehensive potential solution to enhance license portability and eliminate barriers to virtual care.

Implementing mutual recognition necessitates policy, technological, and administrative reforms to protect patient safety, prioritize the financial well-being of states, and streamline physician reimbursement.

By 2030, the United States could see a shortage of nearly 120,000 physicians.1 Telemedicine can alleviate the impacts of this shortage by helping physicians make use of unused time and see additional patients, allowing patients to access a larger pool of physicians and connecting specialists to hospitals in rural and medically underserved areas.2 Although telemedicine is growing in use and acceptance, state licensing laws create false geographic barriers and pose a significant challenge to widespread adoption.

In the United States, state medical boards regulate physician licensing, creating a patchwork of inconsistent state licensure laws. With few exceptions, physicians must acquire and maintain a license for each state in which they practice medicine. This antiquated system of state-based medical licensure, originally enacted in the 19th century to reduce medical malpractice and protect patient safety, has profound implications for the promise of telemedicine to increase access to care for vulnerable populations and mitigate the impacts of the national physician shortage.3 In this commentary, we argue for moving away from state-based medical licensure and describe policy, technological, and administrative changes necessary for moving toward portable medical licensure.

Physicians must be licensed in each state where current and future patients are located, so physicians practicing telemedicine across state borders may be responsible for obtaining and staying compliant with up to 51 different state practices of medicine at any given time. There are some exceptions—for example, 10 states issue special purpose licenses for physicians who wish to come to their state for a limited time, scope, and purpose, such as to demonstrate a new technique or to educate medical students.3 However, these exceptions are few and far between.

The multistate licensure process is long and expensive; some states require physicians to pay annual license renewal fees, complete additional coursework, submit required documentation, and participate in interviews. Even after physicians complete these requirements, state medical boards can take several months to process licensing applications.3 Along with imposing substantial direct costs on physicians, state-specific licensing reduces competition that could lower healthcare prices, limits opportunities for physicians to gain experience by seeing more patients, and exacerbates health disparities.4 The impact of restricting telemedicine falls hardest on poor patients, the uninsured, and those who rely on state Medicaid programs, many of whom lack access to reliable transportation and cannot travel across state lines to see specialists.5

Over the past decade, the Federation of State Medical Boards (FSMB), a national nonprofit organization that represents 70 state medical and osteopathic boards, has advanced several proposals to enhance license portability and reduce regulatory barriers to telemedicine. These include the Uniform Application and the Federation Credentials Verification Service, which are both web-based applications that eliminate the need for physicians to reenter identifying information and credentials when applying for multiple licenses. Most recently, the FSMB instituted the Interstate Medical Licensure Compact, an agreement to expedite the medical licensure process among member states. Physicians in good standing can freely practice in member states as long as they possess a “full and unrestricted” license in their state of principal license (SPL). To date, only 24 states have joined the compact.4

These proposals are a step in the right direction but far from the solution. They simply streamline—not eliminate—the process of applying for multiple medical licenses. Additionally, they do not reduce the cost to doctors of maintaining multiple medical licenses, estimated at $300 million each year.6 As a more comprehensive solution, we recommend a mutual recognition scheme whereby states honor each other’s medical licenses. This model has been successfully adopted in Europe and Australia and by the Veterans Health Administration, US military, and US Public Health Service.3 Furthermore, because standards for medical education apply nationwide and physician training requirements are set by federal agencies such as HHS, mutual recognition is warranted.

Proponents of the status quo argue that mutual recognition compromises patient safety, reduces revenues from state licensing fees, and complicates physician reimbursement. To address these challenges, mutual recognition should be accompanied by (1) a federal mandate, (2) consistent standards for using and regulating telemedicine services, (3) increased data sharing among states, (4) financial support for states, and (5) a requirement for physicians to select an SPL.

Federal Mandate

To reduce barriers to interstate medical practice, some states have attempted unilateral action. For example, in 2016, the Florida House of Representatives passed a bill with a provision allowing physicians licensed in other states to offer telemedicine services in Florida. However, the Florida Senate eliminated the provision. To avoid similar situations, Congress can require states to participate in mutual recognition. In fact, legal research suggests that federal action to promote interstate telemedicine is justified based on the Commerce Clause of the US Constitution, which states that Congress has the power “to regulate commerce…among the several states.”4 Another benefit of instituting a federal mandate is a consistent set of definitions needed to support mutual recognition (eg, SPL).

Standards for Using and Regulating Telemedicine Services

Each state currently defines the “practice of medicine” differently, making it difficult to discern what constitutes an acceptable telemedicine consultation in any given state. Standards of practice, conduct, and behavior during telemedicine consultations—including requirements related to physician credentialing, patient education, and physician supervision of other healthcare professionals—vary widely among states.3 Thus, the shift to mutual recognition must be accompanied by efforts to establish consistent standards for using and regulating telemedicine services. These standards should be defined at the federal level.

Interstate Data Sharing

State medical boards are tasked with the responsibility of monitoring and disciplining physicians licensed in their state. However, due to gaps in information sharing among states, nearly one-third of physicians disciplined in one state are able to practice elsewhere without limitations, repercussions, or public disclosure. This is especially dangerous in a mutual recognition scheme in which out-of-state physicians routinely see and treat patients with little oversight.

For mutual recognition to promote patient safety, information on malpractice, medical errors, and license cancellation or suspension must be shared among states, made publicly available to patients, and used to enforce disciplinary actions across state borders. States should use resources like the National Practitioner Data Bank, established in 1986 as a central data repository for malpractice payments and state disciplinary actions, to conduct rigorous background checks before physicians participate in telemedicine consultations and deliver care across state borders.

Financial Support for States

Given the administrative and technological costs of implementing mutual recognition and dismantling the existing state-based medical licensure system, HHS could provide states with incentive payments for adopting mutual recognition agreements and eliminating state-specific licensing and renewal fees. Additionally, HHS could offer grant funding to enhance interstate data sharing systems and other functions that promote mutual recognition. While financial support for states is an important first step, mutual recognition can reduce healthcare costs in the long run as telemedicine services increase access to care for rural and underserved populations.

SPL

One challenge of mutual recognition is attributing physicians to any given state. This can complicate physician reimbursement for telemedicine services and reduce the effectiveness of state healthcare programs dependent on physician participation. A possible solution is requiring physicians to select a single SPL for questions regarding reimbursement and attribution. This requirement already exists for physicians participating in the Interstate Medical Licensure Compact. Because physicians would fall under the jurisdiction of their SPL’s medical board, the SPL could hold primary responsibility for collating information from interstate data-sharing systems and enforcing disciplinary action against errant physicians.

Conclusions

The environment of medicine is changing. More than three-fourths of patients want access to virtual care services, and patients across all age groups express a desire to use telemedicine to gain easier, more immediate access to physicians.7 To meet growing patient demand and solve our country’s critical physician shortage, we can and must reform our outdated state-based licensing system.

Author Affiliations: Harvard Medical School (PC), Boston, MA; CareMore Health System (SHJ), Cerritos, CA; Stanford University School of Medicine (SHJ), Stanford, CA.

Source of Funding: None.

Author Disclosures: Dr Jain is an employee of CareMore and Aspire Health, which are both multistate provider entities. Ms Chandrashekar reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (PC, SHJ); drafting of the manuscript (PC); critical revision of the manuscript for important intellectual content (PC, SHJ); administrative, technical, or logistic support (SHJ); and supervision (SHJ).

Address Correspondence to: Sachin H. Jain, MD, MBA, CareMore Health System, 12900 Park Plaza Dr, Cerritos, CA 90703. Email: Sachin.Jain@caremore.com.

REFERENCES

  1. Dall T, West T, Chakrabarti R, Reynolds R, Iacobucci W. 2018 update: the complexities of physician supply and demand: projections from 2016 to 2030. The Heartland Institute website. heartland.org/_template-assets/documents/publications/aamc_2018_workforce_projections_update_april_11_2018.pdf. Published March 2018. Accessed November 18, 2018.
  2. Bodenheimer TS, Smith MD. Primary care: proposed solutions to the physician shortage without training more physicians. Health Aff (Millwood). 2013;32(11):1881-1886. doi: 10.1377/hlthaff.2013.0234.
  3. Kocher R. Doctors without state borders: practicing across state lines. Health Affairs Blog website. healthaffairs.org/do/10.1377/hblog20140218.036973/full. Published February 18, 2014. Accessed November 18, 2018.
  4. Svorny S. Liberating telemedicine: options to eliminate the state-licensing roadblock. Cato Institute website. cato.org/publications/policy-analysis/liberating-telemedicine-options-eliminate-state-licensing-roadblock. Published November 15, 2017. Accessed December 9, 2018.
  5. Schwamm LH. Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Aff (Millwood). 2014;33(2):200-206. doi: 10.1377/hlthaff.2013.1021.
  6. Vestal C. Why physician licensing is a problem for telemedicine. Governing website. governing.com/news/headlines/why-telemedicine-is-a-problem-for–.html. Published March 7, 2014. Accessed December 9, 2018.
  7. Heuser EZ. What do consumers want from virtual visits? Advisory Board website. advisory.com/research/market-innovation-center/research-briefs/2017/virtual-visits-briefing. Published April 27, 2017. Accessed December 9, 2018.

Article provided by Stephen Bradley

 

Best Tradeshow Giveaways for 2020

Categories: Articles

Personalized Notebooks & Promotional Pens

Company logo branded journals and pens are the perfect corporate show gifts for networking at trade shows, conferences, and recruiting events. After all, your prospective clients and business partners will need a way to write down all the valuable information on your offerings! Adding your custom printed logo to a custom notebook and writing utensil, ensures that you will leave a noteworthy impression on your target audience!

Custom Logo Portable Chargers

If you’re looking for a promotional item that your event attendees will actually use then this is probably the product for you. Seriously, will all the travel, seminars, and breakout meetings it’s nearly impossible to keep your battery charged… unless you’ve got a portable phone charger with your custom printed logo. Your customers will thank you when they’re not fighting for outlets at the airport on the way home.

 

 

 

 

 

 

Candy and Snacks with Your Logo

They say the way to someone’s heart is through their stomach and that principle holds true when it comes to promotional giveaways too! There’s no sweeter way to spread your brand than by adding your custom printed company logo to the wrappers and labels for some of your favorite candy and snack brands. Plus, they’re the perfect size treat to tide you over during those long-winded speeches.

Reusable Custom Water Bottles & Drinkware

This is another tradeshow giveaway that attendees will surely use! Personalized water bottles, coffee mugs, and tumbler cups are the ultimate way to stay hydrated (or caffeinated) all day long at trade shows. Custom drinkware is also an eco-friendly way to generate brand awareness too since it cuts back on plastic bottle consumption! Check out some of the custom drinkware options available from brands other than the expensive brands you’ve heard about. There is no reason to pay more for a brand name when other products work just as well.

Custom PopSockets & Phone Wallets

Phone accessories are all the rage when it comes to promotional items. Seriously, if your goal is to make the most impressions possible on your prospective clients, customers, or colleagues, a PopSocket or phone wallet with your company logo is the way to go. Just think, how many times do you look at your phone a day?

 

 

 

 

 

 

 

Personalized Tote Bags

It’s no surprise to see the tote bag on this list, as custom totes have been the go-to option for promotional bags for years. That’s because totes can easily hold all your trade show swag and they’re perfect for an embroidered company logo or custom design.

 

 

 

 

 

 

 

Custom Printed Bottle & Can Koozies

If you want to affordably maximize impressions then personalized koozies are the way to go. These wholesale bottle and can coolers by Koozie are a cheap and easy way to get your corporate logo into as many hands as possible! Plus, we can all agree that warm beer and soda stinks.

 

 

 

 

 

 

 

Custom Audio Devices

Company branded audio devices like custom Bluetooth speakers and wireless headphones are always a hit when it comes to premium promotional products. Part of this is simply because people just love getting new tech and gadgets, especially when it’s free. The other reason is that a speaker or a pair of headphones comes in handy on these business trips whether you’re jamming out in your hotel room or just blocking out the noise on your flight home.

 

 

 

 

 

 

Company Branded Lip Balm

Trade show season is also chapped lip season. There’s very little humidity in the air in the winter, causing lips to get chapped, and even if your convention is in Las Vegas, there’s little reprieve from the dry air. That’s what makes lip balm and chap stick tubes with your custom printed company logo so fitting as trade show giveaways. An added benefit is the fact that your clients will probably use these for months on end and see your logo every time.

 

 

 

 

 

 

Reusable Straws

This is a very recent development and is turning out to be a great promotional idea. They tie into the move away from single-use plastic items. They are a bit witty and unusual and have some serious staying power.

With the state and local governments bringing awareness to using less plastic, straws and plastic bags are being targeted.

More and more restaurants have opted to “no straw” or a “metal straw” unless a plastic straw is requested. Plastic straws take up to 200 years to degrade and even then don’t fully return to the soil. They end up affecting wildlife, the ocean, and the air we breathe. It’s no wonder many restaurants are banning disposable straws altogether!

But, if you have ever gone out for a drink with friends and received one of those paper straws that taste funny and stick to your lip, you will get why people are carrying their own straws.

Straws are the promo product to use if you are trying to bring awareness to an eco-friendly brand or campaign. Silicone or stainless steel straws are the trendiest promo product. They have small little cleaning brushes and carrying cases.

A new addition to this listing…Hand sanitizer.

Corona virus has made a mark on the psyche of most people. The “wash your hands” message we see on nightly news has made us acutely aware

From the CDC website:

Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

 

  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

 

The CDC has dedicated an entire page with instructions on how best to wash your hands and how hand sanitizer when and how to use it.

https://www.cdc.gov/handwashing/when-how-handwashing.html

We also hear that hand sanitizer is unavailable or in low supply. That’s not the case with branded versions. There is huge variety of styles and sizes with various price points. This promo product is a win all around. 6 months ago hand sanitizer was just another inexpensive promo product. Obviously it’s grown in popularity for obvious reasons.

 

 

 

 

 

 

 

***Since this article was written, branded hand sanitizer’s availability is now maxed out! Most suppliers are no longer accepting orders for them, and if they are, the minimum quantities are in the thousands.***

Submitted by Sheila Fox-Lovell

Shandy Creative Solutions

770.951.0305

sales@shandycreative.com

Tech heavyweights, others call on HHS to release info blocking rules

Categories: Articles

Many Healthcare executives say the biggest change and pressure point for interoperability in 2020 and beyond will be around the rules allowing application programming interface (APIs) to access patient records. This could open the door for third party software to help patients access their own health information. This just might be the one of the main defining changes within the health IT space for the next five to 10 years.

However, many people are voicing concerns about patient privacy implications and the potential of enabling more open data sharing with third-party apps. Additionally, many EHRs are against the idea.

See more about this article by Nathan Eddy      ARTICLE

 

Article supplied by

Bill Steuer

GSG Compliance, LLC

Kari’s Law Compliance

Categories: Articles

On February 16, 2018 Kari’s Law was signed into federal law. Named for Kari Hunt Dunn, the law was championed by her family after she was killed and her 9 year old daughter was unable to reach emergency services because she didn’t know she had to dial “9” to reach an outside line before calling 911 at the hotel where they were staying.

Kari’s Law requires direct dialing of  “911” be enabled in enterprise environments and directs the FCC to develop necessary 911 calling regulations for the multi-line telephone systems (MLTS) that are commonly used for communications services in buildings, like hotels, hospitals, and most office campuses.

Bringing your business into compliance with new laws and regulations can sound daunting, but having the right partner to help guide your efforts can make the February 16, 2020 Kari’s Law compliance date far less intimidating.

No More “9” For Outside Line

Tragically, the adoption of Kari’s Law was a response to an emergency event in which a child was unable to reach emergency assistance because she did not know she had to dial “9” to reach an outside line to make a 911 call at a hotel. Kari’s law will require that any MLTS will allow callers to reach emergency services (911) without the need to dial a prefix for an outside number first. Thus, among other things, all enterprises utilizing MLTS will need to update their phone configurations accordingly.

Locations & Notifications

In addition to disallowing prefixes when calling 911, the new rules also aim to ensure help is sent precisely where it’s needed while also notifying designated personnel of the emergency.

Location Information

When you call 911 from your home, your registered street address is typically passed along to the Public Safety Answering Point (PSAP), who in turn gives that information to emergency responders. But what about at your office? If there’s a medical emergency in a 4th floor conference room and you call 911 from that office (without having to dial a prefix!), how will they know where to go if they only have the street address?

In addition to the direct dialing and notification requirements of Kari’s Law, pursuant to another federal law called Ray Baum’s Act, the FCC is also creating rules to improve the dispatchable location information that is associated with emergency calls from MLTS. Specifically, the objectives of the new rules are for campuses that use MLTS to be able to pass along location information that would be more specific than a front desk or the administrative office and add such information as building, floor, suite, and even specific conference rooms potentially.

Notifications

In addition to removing the need to dial a prefix for an outside line when calling 911, Kari’s Law requires businesses using MLTS to also implement notifications to designated personnel when a 911 call has been made. These notifications can take the form of a phone call, email, SMS/text message, or conspicuous on-screen message.

Notifications will allow for designated personnel to know that there’s an emergency and even provide first aid if necessary. Most importantly, it allows them to quickly escort emergency personnel to where they’re needed, helping them through the front doors, elevators, and into keycarded areas depending on the particulars of any enterprise environment.

Don’t Go It Alone

We know this all sounds like a lot (and in some ways it is), so how can your business manage its legal obligations most effectively?

Well for one, you don’t have to do it alone — reach out to our 911 experts to find out how we can support your business’s 911 calling needs. For example, Clear Choice Telephones 911 solutions are well positioned to provide your business with the location and notification functionality you need.

Get Started Soon + Understand Vulnerabilities

Kari’s Law requires compliance by February 16, 2020. Getting started sooner will ensure that you’re not racing to find effective solutions at the last minute.

Create a checklist to understand what your business needs to do. Making sure that your entire team is on the same page will help make sure everyone is working towards the same goal (and that you’re not forgetting a crucial piece).

 

Article submitted by Paul Mancini, contact him to learn more.

678-387-3200 or paul@clearchoiceinc.com

 

Categories: Articles

If you’re thinking about changing your software you’re not alone. According to the Medical Economics 2017 EHR Report Card, 62 percent of physician respondents indicated that they had already switched EHR systems at some point.  High level physicians and admins almost always begin the transition process by asking “What are the best practices for switching EHRs?”

The marketplace has partially answered where to start with an EHR switch, practices are demanding more user-friendly EHRs that offer better interoperability. In other instances, practices are searching for specific functionality to help them thrive. Often, the need to switch EHRs is driven by frustration that your current software impedes rather than speeds your workflow.

Undertaking an EHR switch can feel daunting—after all, it’s a big investment. You may be wondering:

  • How do I identify the need for an EHR switch?
  • What steps should I take to find the right vendor for my practice?
  • How can I best prepare my practice to make this change?

To help you on your journey, the following are our best practices for switching to a new EHR.

Focus on your functional requirements

Consider your daily workflow. What types of capabilities does your practice need from an EHR? Of course, physicians want mobile capabilities, e-prescribing and integration with billing systems but it’s also important to look at the functional needs of your specific practice. List each functionality you want and create a scorecard to rate how well each vendor’s solution can meet your needs. Be sure to ask for input from people in a variety of roles at your practice.

Keep emerging needs in mind

Identify EHR software that helps you use data analytics to benefit both your patients and your practice. From population health management to merit-based incentive payment system (MIPS) reporting that helps practices receive reimbursement for value-based care, your EHR’s capabilities should offer both the tools and the interfaces that allow you to leverage the power of data. Your practice will also want an EHR with strong internal reporting functionality that allows you to create custom queries and leverage your data in the real world.

Be sure you’re in a position to Promote Interoperability

When evaluating new EHR software, ask how the candidate system operates with regard to interfaces with labs and hospitals in your area, how well it handles referral management, and does it support the newer initiatives evolving for on demand data requests such as Commonwell, Carequality, and Surescripts National Record Locator and Exchange.  This is important with regard to the CMS Promoting Interoperability, a component of MIPS, compliance guidelines.  You can read more about how we help our practices with MACRA/MIPS here.

Seek a vendor with a proven track record of success

Identify potential EHR vendors by reviewing published ranking lists and awards from third parties such as KLAS Research.  Insight from your peers is also valuable and can be attained by attending industry conferences, or talking to other physicians in your specialty.

Verify ease-of-use

An EHR that checks all the boxes on paper may not necessarily perform to your expectations in practice. When you demo the system, make sure it fits into YOUR workflow versus changing how you practice to accommodate the software. A great EHR is designed with the user in mind, helping you work the way you want to and reducing the time you spend on routine tasks.

Enlist a variety of power users to give the EHR a test drive

A system that works well for a physician may have shortcomings that only the administrative or billing staff can detect. Conversely, the same EHR that your office manager loves, may also be the EHR the physician loathes. After you’ve developed a shortlist of EHR products to test, gather people from different areas of your practice to test the EHR for issues. Be sure everyone is on board with the same EHR before making your final decision. Keep in mind that not everyone may get exactly what they want, a little give and take may be necessary in choosing the best solution overall for the organization.

Confirm the availability of responsive customer support

When you have questions concerning your EHR, you want answers as quickly as possible. Ask EHR vendors whether they have a U.S.-based support team available during regular office hours and, again, look at published lists and rankings that detail the vendor’s approach to support.

Don’t skimp on training

Proper training is essential for every EHR user. Not only can it help reduce the frustration of adapting to a new system, it can help users become proficient more quickly—lessening the impact on your practice and patients. The vendor you choose should offer robust training options to help you experience a smooth implementation. Although everyone who uses the system must attend training, it is also valuable to select a person or persons depending on the size of your practice to be a “super-user” who will cross train on clinical, billing, and admin capabilities.

Invest in long-term gain

Although switching your practice’s EHR system is a major undertaking, the gains achieved by increased interoperability, more easily sharing patient data and reducing administrative workload can reap long-term benefits. Find the EHR that’s the right fit for your practice and focus on the future. Also be sure to consider the experience of the potential vendors in assisting practices in making a change. The path to successful change can be bumpy, but experience and proven processes can avoid many of the potholes along the way.

Your next step is to add Aprima to your shortlist.  Our track record of industry praise, long-term client retention (98% of practices have remained customers after 10 years!), and expertise in helping practices switch EHRs make Aprima an EHR you should know!

Bart Segal is the CEO of Tri-Med Solutions, an award winning Gold Certified Value Added Reseller of Aprima EHR. He has over 20 years of experience in the EHR industry and loves talking about EHR’s. He can be reached at bsegal@trimedsolutions.net.

It’s In! SECURE Act Included in 2020 Spending Package

Categories: Articles

Landmark retirement reform bill tacked onto “must-pass” FY 2020 spending package by Congress; will be voted on this week by House and Senate

by Brian Anderson-December 16, 2019

in 401k Fiduciary, Regulation, Your 401k News

Talk about your nail-biters! After months of collecting dust in the Senate, the SECURE Act, the most significant retirement saving reform legislation since the Pension Protection Act of 2006, is finally on its way to becoming law after being tacked on to a larger mandatory spending bill introduced into the House of Representatives on Monday afternoon.

The Setting Every Community Up for Retirement Enhancement (SECURE) Act, passed by an unheard of 417-3 vote in the House back in May, became stalled in the Senate after a handful of Senators placed “holds” on the bill over various concerns, preventing the bill from being fast-tracked to President Trump’s desk by unanimous consent.

Both chambers of Congress worked through last weekend, frantically negotiating the details of this final wide-ranging, must-pass $1.4 trillion spending package for fiscal year 2020. Down to its last chance of the year at moving forward, the SECURE Act, with strong bipartisan and retirement industry support, made the cut to be included in the package.

“Including the SECURE Act in the FY 2020 funding bill is a big victory that will help ensure that all hard-working Americans have a chance to build a nest egg for their retirement,” said U.S. Senator Rob Portman (R-OH), a key backer of the bill. “Many of the provisions in the SECURE Act have been under consideration by the Senate for multiple years and multiple sessions of Congress, dating all the way back to the Senate Finance Committee markup in 2016. I’m particularly pleased that this legislation includes legislation I’ve introduced to help protect the retirement security of hundreds of thousands of dedicated older Americans who are at risk of losing future retirement benefits this year.”

Portman noted it also includes two provisions he’s championed to help expand access to 401ks and allow individuals choosing to work later in life to keep saving for retirement. “I look forward to the president signing this legislation into law quickly to strengthen the retirement security of the American people,” he said.

The SECURE Act includes Portman’s Retirement Security Preservation Act, which would reform pension nondiscrimination laws to prevent more than 400,000 Americans from having their pensions frozen through no fault of their own. Several components of Portman’s bipartisan Retirement Security & Savings Act, which he introduced with Senator Ben Cardin (D-MD), are also included in the SECURE Act.

In a statement released Monday afternoon, American Council of Life Insurers (ACLI) President and CEO Susan Neely lauded congressional leaders for including SECURE Act in the 2020 spending package.

“The SECURE Act is the most sweeping retirement security legislation to move through Congress in more than a decade. It would mark a significant step toward modernizing America’s retirement system for workers.

“Each day, 10,000 Americans turn age 65 and many can expect to live 20 years or longer in retirement. Yet, research shows that one-third of Americans approaching retirement have between nothing and $25,000 in savings to supplement Social Security income,” Neely said. “The SECURE Act makes important changes that will go a long way toward addressing the nation’s looming retirement crisis. One provision alone will get more than 700,000 small business employees nationwide to start saving for retirement. Another will make it easier for employers to offer retirement plans with lifetime income options through annuities.”

Wayne Chopus, president and CEO, Insured Retirement Institute, said in a statement Monday, “We have a first down and goal on the 1-yard line. Congress and the President are about to deliver a meaningful, positive benefit to millions of American workers by expanding opportunities to save for and achieve a dignified retirement.”

The spending bill is expected to be voted on sometime Tuesday in the House, and then sent on to the Senate, where it would also be expected to pass without snags due to the looming Dec. 20 deadline to approve the spending bill and prevent a government shutdown, not to mention the fast-approaching Congressional holiday recess. It could be signed by President Trump by the end of this week.

Big changes coming

Provisions of the SECURE Act will have a wide-ranging impact on retirement savings plans, and 401k plans in particular. Among the biggies:

  • The SECURE Act’s Section 204 gives fiduciary safe harbor to 401k plan sponsors who include annuities among offerings to plan participants, something long craved by insurers who offer annuity products. Many defined contribution plan sponsors have been reluctant to offer annuities in their plans due to the concern about fiduciary liability if the annuity provider becomes insolvent. Under Section 204, if an annuity provider chosen for a 401k plan were to go out of business or defraud plan participants, employees would not be able to sue the employer afterward.

MetLife released the following statement Monday from Graham Cox, executive vice president and head of MetLife’s Retirement & Income Solutions group, regarding Section 204:

“This legislation removes the long-standing regulatory barriers that prevent companies from including lifetime-income options in their employees’ retirement plans.

“MetLife is a strong supporter of these provisions and committed to ensuring that employees enjoy a secure retirement by having access to guaranteed income for life. Through the requirement that lifetime income estimates be included on annual defined contribution (DC) plan benefit statements, employees will gain a better understanding of how their savings translate into retirement income. The safe harbor provision, provided under the SECURE Act, increases workers’ access to solutions that will protect against the risk of outliving their savings. Both of these provisions provide valuable tools that will strengthen retirement security for millions of Americans.”

  • The SECURE Act will increase the tax credit for employers introducing new retirement plans from $500 to $5,000, and small employers that implement an automatic enrollment feature in the plan design will be eligible for an additional $500 credit.
  • The SECURE Act’s Open MEP provision will make it easier and more economical for smaller employers to offer retirement plans by allowing for the creation of pooled retirement plan providers. It removes the common nexus requirements and allows Open MEPs for employers that don’t share common traits to be administered by the pooled plan provider.

The provision also protects small employers in Open MEPs from penalties if other members violate fiduciary rules, also known as the “one bad apple” liability risk that a non-conforming member can pose to an entire plan. That issue has long been a stumbling block for MEPs.

  • Many part-time workers will be eligible to participate in an employer retirement plan under the SECURE Act.
  • The SECURE Act also pushes back the age at which retirement plan participants need to take required minimum distributions (RMDs), from 70½ to 72.

To pay for the estimated $389 million the SECURE Act would add to the federal budget over the next 10 years, the bill—in perhaps its most controversial provision—will effectively put an end to the popular estate planning tool known as the “Stretch IRA.”

As James Lange wrote in an article about Stretch IRAs on 401k Specialist earlier this year, under existing law, non-spouse heirs of an IRA owner can “stretch” or extend the taxable distributions of an inherited IRA over their lifetime. The benefit of protracting the distributions of an inherited $1 million IRA could mean as much as a million dollars to the heirs of the IRA owner over their lifetime. It’s all about how quickly taxes are or are not collected.

Under the SECURE Act, the entire IRA or retirement plan would have to be distributed within 10 years of the death of the IRA owner.

American Benefits Council applauds pension fix

“Among the many valuable elements of the SECURE Act is a measure that would address a glitch in the nondiscrimination rules affecting participants in frozen pension plans. The Council has determined that hundreds of thousands of participants could lose future pension benefits as of January 1, 2020, without a legislative fix,” said Lynn Dudley, senior vice president, global retirement and compensation policy. “We applaud the leaders of the committees of jurisdiction for their support and, in particular, Senators Rob Portman and Ben Cardin, for their bipartisan commitment to employer-sponsored retirement plans.”

“The bipartisan deal struck by congressional leaders is a victory for millions of Americans who receive health and financial security through employer-sponsored benefit plans,” American Benefits Council President James A. Klein added.

Article submitted by Joshua C. Harper, CFP®, ChFC®, CLU®, RICP®

3 Reasons to Explore Continuous Insulation

Categories: Articles

An article presented by Scott Zanardo, AIA, President of Zanardo Architects, PC, as originally printed in Architect, Posted on August 16, 2019

It’s time this under-loved energy-saving wonder received the credit it deserves.

Is it a silver bullet in cutting home energy costs? It comes close if it isn’t. Just consider all the ways this sometimes shunned and overlooked building component is changing home design and construction. For example:

  • Chapter 4 of the 2018 International Building Code (2018 IBC R402.1.2) makes clear the code community’s ringing endorsement.
  • Two vast and remarkably different homebuilding markets—California and Canada—have codified it by law into all future building practice.
  • It’s revitalized 2×4 framing by making it once again relevant and practical in a world of net-zero energy standards.
  • Much smaller, far less costly HVAC systems are now routinely spec’d.
  • Alternative energy sources like solar are finally viable because of the R-value punch of exterior wall assemblies.

We’re talking about continuous insulation. Today, continuous insulation is helping differentiate home energy performance across homes of all sizes, types, and budgets. Yet some architects resist the growing weight of evidence. They argue the incremental cost of continuous insulation outweighs all other considerations, including the environment, to which veteran residential energy conservation expert Charlie Devine replies: “Don’t drop a dollar to pick up a dime.”

48% Savings

Devine is the national accounts and energy adviser to OX Engineered Products, a leading U.S. building product manufacturer. Devine believes continuous insulation’s clear advantages are shortchanged by misleading short-term thinking.

“People talk about programmable thermostats, high-efficiency HVAC systems, and LED light bulbs,” Devine says. “Where can we really squeeze energy demand out of a house? Continuous insulation is the answer. In my state of Minnesota, homes built with a single inch of continuous insulation have reduced heating costs by as much as 48 percent.”

2×4 vs. 2×6

That’s just the beginning. Take 2×4 framing. Not so long ago, the framing standard looked like it might fade away with the rise of 2×6 framing. Not so fast, Devine says.

“It’s true the deeper 2×6 cavity and fewer studs helps improve energy performance. CI levels the playing field for 2×4 builders. If it’s cheaper to add an inch of CI than to spec 2×6 framing, you can bet homebuilders are going to do it,” he says.

West Coast Foreshadowing

In California, the net-zero energy focus of Title 24, with its mandated solar photovoltaic panels, is making headlines. Why should that bother architects in Minnesota, Missouri, or Maryland? “California foreshadows things to come everywhere,” Devine says.

“Building a Title 24 house doesn’t make sense without CI. It’s the only affordable way to meet code,” he says. Adding R-6 structural sheathing like OX-IS to the exterior wall still makes standard cladding standard possible, he says.

Why Wait?

Residential designers in the Midwest aren’t. Devine says top builders in Nebraska and Iowa are all-in on CI. They understand the true cost of OSB isn’t the panel. It’s labor, housewrap, and trips around the house. Structural insulated sheathing like OX-IS simplifies in ways no OSB panel can.

Devine believes we’ll soon look back on CI and wonder: “What took them so long?”

To learn more about all the ways CI can help with performance, economy, and quality, visit https://www.oxengineeredproducts.com/product/ox-is/.

 

Business Owners Need Help in Communicating 401k Advantages

Categories: Articles

New research from Nationwide finds employers understand the value of offering 401k plans, but need help to better communicate their benefits to employees

by Brian AndersonNovember 13, 2019

in 401k Client AcquisitionEducation and EnrollmentRetentionYour 401k News

Advisors can help business owners communicate 401k benefits to employees

 

It won’t come as a surprise that business owners view 401ks as advantageous both for their business and their employees. Yet, despite business owners seeing the advantages and value of 401ks, a gap exists in understanding how to effectively communicate 401k benefits to employees, according to a new survey from Nationwide.

And with the Bureau of Labor Statistics reporting 71% of all U.S. workers have access to retirement benefits (which include defined benefit and defined contribution plans), offering a 401k to employees has become necessary in order to competitively attract and retain talent in today’s strong, steady labor market.

Nationwide’s latest research, which surveyed 400 U.S. business owners with 11-500 employees that offer 401ks, finds business owners agree 401ks offer key benefits including attracting and recruiting top talent (88%); tax advantages for both one’s business and employees (88%); improving employee retention (86%); and employees viewing a 401k as a necessary benefit (84%).

The survey data also found that although nearly nine in 10 business owners report their retirement plan provider offers tools and resources to them to help encourage employees to participate, over half of business owners (53%) still struggle with communicating the benefits and encouraging participation among their employees.

This number increases to 60% when looking at female business owners and 65% for younger business owners (aged 18-34 years old). What’s more, 68% of business owners acknowledge it’s their role/responsibility to encourage employees to participate in a 401k offering.

“Our latest survey shows employers are struggling to communicate the benefits of a 401k and encourage participation among their employees, ultimately putting their business and their employees at a disadvantage,” said Eric Stevenson, president of Nationwide Retirement Plans. “This data illustrates that the industry has an opportunity to help business owners bridge this gap and make a meaningful difference in the retirement security of their employees.”

Business owners agree 401k benefits outweigh challenges

While 401k plans have become a standard of sorts as a retirement benefit, business owners still report the following challenges in offering a 401k to employees:

  • Financial cost: 45%
  • Encouraging and managing employee participation: 41%
  • Administrative headaches (i.e. paperwork for plan administration): 37%
  • Lack of knowledge around starting or maintaining a plan: 27%

Even with the challenges associated with offering a 401k, an overwhelming majority of business owners (92%) agree that the benefits of offering a 401k plan to employees outweigh the challenges. Business owners ages 35-54 years-old are most likely to agree with this perspective, with nearly all in this age group (99%) agreeing. Interestingly, over three in 10 business owners aged 55+ years-old say they don’t believe there are any challenges in offering a 401k plan.

Helping business owners encourage participation

Nationwide’s data shows nearly two-thirds (64%) of business owners feel it is their role/responsibility to provide details on the benefits of participating in a plan with employees, as well as share information on how to enroll (62%).

In order to cut through the jargon and effectively communicate the benefits of participating in a 401k with employees, business owners can look to their plan provider and advisor for additional guidance.

“A workplace retirement plan, such as a 401k, is among the most valuable employment benefits and a top gauge of retirement preparedness,” Stevenson said. “As such, it’s integral that employers feel equipped to effectively have these conversations with their employees. Talking to a financial advisor is a good first step to not only discuss the resources and benefits available to business owners from plan providers, but to also gain insight into how to thoughtfully distribute this information and material to employees.”

More from the research

Beyond details about helping employers communicate the benefits of a 401k to employees, the Nationwide survey of 400 business owners (with 11-500 employees and who offer a 401k plan) contained some additional noteworthy data regarding the SECURE Act and 401k matching contribution rates. From the study:

  • 59% of business owners surveyed believe the SECURE Act would make it easier to offer a 401k plan to employees
  • 77% of business owners think passage of the SECURE Act would allow them to offer a 401k plan that rivals those offered at large corporations

401k Contribution Matching:

  • 8% of business owners don’t match employee contributions at all
  • 31% match 1-3% of contributions
  • 43% match 4-6% of contributions
  • 19% match 7% or more of contributions

Article submitted by Joshua C. Harper, CFP®, ChFC®, CLU®, RICP®

Why Are Healthcare Organizations are Struggling with Infrastructure?

Categories: Articles

Healthcare organizations are starting to hop on the technology train moving into the 21st century, which is excellent! Information technology and the healthcare industry have been growing more intertwined over the past 20 years. Advances that include Electronic Health Records (EHRs), Electronic Medical Records (EMRs), Cloud Storage, and Telemedicine have are widely adopted for helping to enhance the quality of care for many patients. This increase in quality of care has also provided more funding for healthcare organizations through the MACRA and MIPS programs. All of this sounds great, but “What’s the catch?” you may ask. The answer is infrastructure.

A loose definition of information technology infrastructure in the healthcare industry is the hardware, software, networks, and facilities used to support, monitor, service, and support information technologies. You may think that your Managed Service Provider (MSP) should be able to handle the security, support, and growth of these systems. For the most part, you would be correct, but with the acceptance and integration of mobile devices as viable platforms to use for healthcare services support and security of these devices becomes more difficult for even the largest of MSPs. According to a set of two surveys done by Spok, one in 2011 the other in 2019, mobile device use for nurses grew from 53% to 79%.  Today in 2019, 90% of doctors use mobile devices to perform health-related activities. Most of these activities involve communicating with care team members, receiving actionable information, and delivering real-time clinical data.

We can see that mobile devices are not just used for casual phone calls in the healthcare atmosphere. More and more, these devices are being used to communicate critical time-sensitive information that can have a significant impact on the quality of care of patients. That being said, mobile devices are notorious for their lack of security protection, and the fact that they use wifi makes them more vulnerable. Pair this with a lack of importance put on mobile device policies, and you have a perfect storm that cybercriminals will exploit when given a chance.

So, what can you do? The use of mobile devices is inevitably going to grow. So the best thing you can do for your practice is to ensure you have a robust and secure infrastructure in place to help support these devices.

Here at Medicus IT, we specialize in creating IT solutions for healthcare organizations and understand the stringent security standards that are required for HIPAA compliance.  If you have concerns about the infrastructure of your healthcare organization, contact us today. We can perform a free network assessment to determine any security and compliance gaps your practice may have.

You Treat Patients. We Treat You.

By: Mike Jann
Medicus IT
www.MedicusIT.com
678-495-5908

MJann@medicusit.com

 

 

 

Meet Your Customer’s Changing Payment Needs

Categories: Articles

The true measure of success for a thriving business is their customers.  Therefore, it’s important to be in tune with your customers to offer the right products, services, location, and yes, payment options.  Customers may want your product, but they are more apt to buy it on their terms.  Meeting them at this point increases the likelihood of the sale and increases the sale amount.

Physical Terminal:

Do you have a physical terminal with the latest technology?  The traditional consumer has their credit card ready to pull out to swipe or ‘dip the chip’.  Younger generations are more likely to pay using their mobile wallet.  The physical terminal should have the capability for EMV chip processing as well as NFC (near field communication) such as Apple Pay, Android Pay, or Google Wallet. These features not only allow convenience but also speed and PCI (payment card industry) compliance to limit fraud.

Recurring and/or Installment Payments:

Larger purchases require more flexible payment solutions.  Today’s consumers want to buy now and pay later.  By allowing the customer the instant gratification they desire, merchants meet their customer’s desire and make the sale.  Setting up recurring or installment payments through a virtual terminal is a simple process to capture the sale.  Virtual terminals offer flexible options to collect payments weekly, bi-weekly, monthly, quarterly, and more.  So, payments can be captured after customers are paid or in-between other bill periods.

Through recurring processing or installment payments, merchants can also extend their relationship. Customers don’t visit just once, they return and build loyalty. Using a subscription model for services, such as monthly lawn service or unlimited treatments for a monthly fee, merchants can collect payment before providing their services.  It creates a predictable cash flow and higher customer retention. Additionally, merchants reduce late payments or chasing down outstanding balances.

Electronic Invoicing and Web Payments:

Electronic invoicing is a hassle free way for merchants to collect outstanding payments.  Sending an invoice via email or text where the customer can simply click, enter their card information on a secure server, and payment complete.  It’s convenience for your customers and faster payments for the merchant.  No more sending paper statements every 30 days waiting for the customer to send in their payment.  Customers can click and pay when they first see the invoice, whether that be 9am or 2am.  The merchant can receive an email when payment complete or review reports.

Similar to electronic invoicing, the merchant can have a ‘Make Payment’ button on their website to collect payments from customers.  The button brings the customer to a secure payment server hosted by the processor gateway to ensure proper encryption.  The customer enters their payment amount, invoice number or other custom fields, and card information to complete the payment.

Mobile Processing:

If your business takes you away from the office, you can collect payments on your smart phone or tablet.  An app from the payment processor provides easy to use and secure payment collection on the go.  Bluetooth devices can be added to utilize EMV, swipe, and/or NFC payments similar to the physical terminal. Being ready to take payments when away from the office help to secure the sale as well as meet the customer where they are.

By utilizing a suite of payment options, your business will be ready for the various types of customers.

 

Jennifer Autian is the founder of TCA Business Solutions and an independent representative of merchant services.  To learn more about expanding your payment processing options, connect with her at 678-523-8760 or by email at Jennifer@tcabiz.com.

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