Monday, October 30, 2017

No Safe Harbor: Congress Threatens Free Speech Online



In Reno v. American Civil Liberties Union (1997), Justice John Paul Stevens extolled the virtues of the Internet as a medium for speech. In this "vast democratic forum," he wrote, anyone "with a computer connected to the Internet can 'publish' information ... [A]ny person with a phone line can become a town crier with a voice that resonates farther than it could from any soapbox."


Two decades later, Justice Stevens' words ring even more true. The explosion of Internet access--from 1.3 percent of the world's population in 1997 to 51 percent in 2017--has expanded this democratic forum to include billions. Thanks to broadband, voices now resonate across six of Earth's seven continents without the use of a phone line.


Since the 1990s, hundreds of innovative Internet intermediary services--website hosts and operators, email and domain name providers, search engines, social media networks, and more--have popped up to provide or facilitate virtual soapboxes for town criers to engage in worldwide discourse.


Yet, thanks to ill-advised efforts by Congress, the Internet's days as the bullhorn of democracy may be numbered. In August, Senators Rob Portman (R-Ohio) and Claire McCaskill (D-Mo.) introduced the Stop Enabling Sex Traffickers Act of 2017 (SESTA) (S. 1693), a bill that would amend Section 230 of the Communications Decency Act. A similar bill was introduced in the House (H.R. 1835).


Though the intentions are laudable, these legislative efforts to fight sex trafficking would undermine key protections that enable free expression online.


The Internet's First Amendment


In 1996, Congress passed the Communications Decency Act (CDA) in an attempt to regulate speech online. Following a public campaign against the CDA by free speech advocates, a panel of federal judges blocked part of the legislation, writing that "as the most participatory form of mass speech yet developed, the Internet deserves the highest protection from government intrusion."


A year later, in Reno v. ACLU, the Supreme Court stripped the law of its more constitutionally problematic provisions, leaving Section 230 intact. Called "the cornerstone for free speech online," Section 230 protects online speech by granting "interactive computer services"--the intermediary services discussed above--limited immunity from third-party speech liability.


Section 230 does not grant intermediaries full immunity. Courts have differed on the breadth of circumstances under which the safe harbor provision applies. Moreover, the provision explicitly does not extend to criminal liability under federal law, including federal sex-trafficking statutes.


SESTA would dramatically narrow the safe harbor by subjecting Internet services to state criminal prosecution as well, and to civil actions targeting user content that violates federal sex-trafficking laws. This narrow exception for sex trafficking is the camel's nose under the tent, and It is difficult to overstate the significance of the Section 230 protections that SESTA threatens to erode.


Without Section 230, intermediary services that host third-party speech would be subject to publisher liability under a patchwork of complex and potentially conflicting state laws. Online platforms could potentially face state criminal prosecution or civil liability for every single comment, image, and video their users post.


With service providers as diverse as Facebook, Google, Pinterest, Wikipedia, and Reddit hosting and transmitting often millions of pages of user-generated content per day, the legal risk becomes astronomical--and the incentive to censor proportionally so.


Absent Section 230, the services that make online speech possible would not only face a slew of defamation suits and other costly litigation; they would also come under enormous pressure to filter, moderate, or otherwise censor their users' speech. Many intermediaries may opt not to host or transmit any user content at all.


At the same time, little would be gained in the efforts to stop sex trafficking. Even sympathetic experts have questioned whether SESTA would be effective and many say it could be counterproductive by driving the activity farther underground, where law enforcement would have a harder time reaching it.


A Catch-22 for Online Intermediaries


Paradoxically, even though SESTA's state-law preemption exception would encourage further policing of user content, its linking of liability to a broad knowledge standard - SESTA speaks of "knowingly" benefiting from sex trafficking - could actually discourage intermediaries from monitoring content for misconduct.


As Matt Schruers, vice president of law and policy at the Computer & Communications Industry Association notes, "[m]issed calls happen, and if a missed call about one posting could provide the requisite knowledge for a trafficking charge, many intermediaries might be directed by lawyers to stop policing at all."


Consider that Silicon Valley giants are not the only ones SESTA's provisions would target. According to Eric Goldman, director of Santa Clara University's High Tech Law Institute, SESTA's vague language "potentially implicates every online service that deals with user-generated content." SESTA would thus force even smaller entities, like independent bloggers and social media entrepreneurs, to err on the side of caution by screening or censoring their users' content.


Section 230 is the law that made today's Internet possible. Without a robust safe harbor, the vast democratic forum that Justice Stevens praised would cease to exist as we know it. While fighting sex trafficking is certainly a goal worthy of pursuing, damaging that engine and sacrificing our freedom of speech is too high a price to pay.

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Sunday, October 29, 2017

The Perils of Patient Leakage

When you hear “patient leakage,” what comes to mind? No, it’s not a medical condition. For practices experiencing patient leakage it means you’re losing current patients to other facilities or services. With the emergence of urgent care centers and access to on-demand telemedicine services, some patients are opting-out of seeing their primary care physician for what they see as more “convenient” options.




Urgent care facilities appeal to patients seeking immediate care - often when their primary care physician’s office is closed or they can't get a timely appointment. In some circumstances, urgent care can be less expensive and have a quicker turnaround time. On-demand telemedicine services, not associated with a primary care physician or a designated specialist, are on the rise - with new websites popping up more frequently and employers offering video-based options to employees. Although sometimes beneficial, these services are another factor pulling patients away from seeing their chosen provider or specialist.


Let's go over the serious impact patient leakage can have on a practice, and some solutions for providers to combat this issue:

Clinical Impact of Patient Leakage - Uncoordinated Care


While these convenient options to care are appealing to patients, there are often unintended clinical consequences that can’t be ignored. Uncoordinated, fragmented care can result in unnecessary testing and conflicting treatments. Furthermore, without access to a patient’s medical records and history, urgent care centers and on-demand telemedicine providers risk misdiagnosis and dangerous medication interactions.


“If care isn’t coordinated in a way that improves outcomes, patient satisfaction, decreases costs and even provides provider satisfaction, everybody suffers.”


- Reid Blackwelder, MD, President of the American Academy of Family Physicians (AAFP)

Financial Impact - Revenue Suffers


When easy, less complex and less time consuming cases are lost to urgent care facilities and on-demand telemedicine providers, the overall economics of a practice suffers. Practices simply can’t survive on complex cases alone. More often than not, less complex cases comprise the bread and butter for most primary care physicians.


Practices can’t survive on complex cases alone. Less complex cases are the bread and butter for most practices. 


In our on-the-go era of immediate gratification, here's a snapshot of options patients have other than primary care services: Retail clinics see 10.5 million visits annually, according to a 2015 report, due to their convenience, accessible hours and low cost. There are more than 9,000 urgent care centers in the U.S, with approximately 300 more opening up each year (Advisory Board). More than a third of large companies are offering services at nearby clinics, often at discounted rates. 
Solution - Offer Convenience and Increased Communication


Adding convenience and improving communication with patients can be a winning combination for stemming patient leakage. 


Bring Video Visits to Outpatient Clinics: Because patients are seeking convenient access and improved continuity of care, most believe video visits with their primary care physician or specialist are a great idea. Besides increasing patient satisfaction and retention, video visits can also improve clinical outcomes. Because the provider has full access to the patient’s medical history, this reduces the risk of misdiagnosis, unnecessary testing, and adverse events.


Increase Patient Engagement with Better Communication: Are you leveraging software that offers secure and easy to use communication with patients? Technology options includingmobile EHRs, secure two-way text and email messaging, and accessible patient portals help create a personal connection with your patients, building loyalty and staying power. The provider-patient relationship always ranks high of any list about what patients are looking for in their healthcare. 


Overall, patient demand for access and convenience, combined with employers’ desire to reduce benefits costs is rapidly changing the healthcare delivery landscape. Urgent care centers and on-demand telemedicine options are quickly filling a void that PCPs are able to fill themselves in many cases. By offering video visits (whether it be in time blocks or after-hours) and convenient communication options, primary care physicians and specialists can ensure that their patients are healthy, happy and loyal.



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Thursday, October 26, 2017

Discrimination Via Public Utility Monopoly in LaGrange

Discrimination Via Public Utility Monopoly in LaGrange



It’s hard to believe that in the twenty-first century there are still households that face the risk of going without electricity or running water because of who they are and where they come from. But in Georgia, that’s still the case. In LaGrange, a town about an hour southwest of Atlanta, the City is the sole utility service provider and will not provide these basic services to any applicant who cannot provide specific identity documents that are unavailable to many immigrants, including those who are undocumented - and many who are lawfully present.

While the City’s identity document requirements disproportionately hurt Latinos, the City also limits and denies basic utility services to people with unrelated court debt owed to the City, a policy that predominantly harms African-Americans. To deny utility services to people because they cannot provide certain identity documents, or owe the City debt, is both inhumane and in violation of federal law—which is why we went to court.

In May, the Southern Center for Human Rights, the National Immigration Law Center, and the law firm of Relman, Dane and Colfax PLLC filed a lawsuit [complaint, PDF] on behalf of the Georgia NAACP, the Troup County Branch of the NAACP, Project South, and several impacted individuals, challenging two local policies [PDF] that make it incredibly hard, and even impossible, for many residents to keep the lights on and maintain running water in their homes. We are asking the court to permanently block these discriminatory policies.

Both local policies unlawfully restrict access to utility services that are vital to people’s ability to live in LaGrange—including gas, water and electricity—and the overwhelming majority of residents impacted are Black and Latino. Both of these policies put low-income residents of color in an impossible situation—either leave their homes and families in LaGrange or live without basic utilities.

Many of the individuals affected by this first policy are undocumented Latino immigrants who, in order to get water or electricity, must either rent from a landlord who provides the utilities, which seriously limits available housing options, or find a third party willing to open an account for them. The latter practice is criminalized under a current municipal ordinance and could subject the utility user (and the third party) to jail time and fines. Both options make families vulnerable to exploitation.

The policy applies to renters and homeowners alike. But for the kindness of a friend willing to risk prosecution, for example, a Project South member and his wife, and their two young children, would be unable to obtain water or electricity in their home in LaGrange, which they own.

Another resident impacted by this policy is an undocumented man who has lived in LaGrange for more than fifteen years. He lives with his four children in a home that he rents. He can’t obtain utilities from LaGrange in his own name because he does not have a social security number and separate U.S. or state-government-issued photo ID.

Another man lives in LaGrange with his wife and their two young children in a home that they own. He, too, is unable to obtain utilities from the City of LaGrange in his own name because he lacks a social security number and other U.S.- or state government-issued photo ID. His wife is similarly unable to meet the requirements of the discriminatory LaGrange policy.

The second policy we’re challenging adds individuals’ unpaid fines and fees from the LaGrange Municipal Court to their utility bills, and then threatens utility service disconnections if the court debt is not paid. LaGrange residents are often threatened with utility disconnection because of unpaid fines for things like traffic offenses, loitering and petty theft. Some of those convictions are more than ten years old. Most of the individuals affected by this policy are African-American - even though only half of the town’s residents are African-American, more than 90 percent threatened with utility disconnection because of court debt in recent years are African-American.

Many of the individuals affected by these discriminatory policies are on a fixed income, and some rely on electricity for medical treatment. One of the plaintiffs in the lawsuit, for example, is an African-American man with disabilities who relies on an oxygen machine to breathe. Yet the City of LaGrange has continually threatened to disconnect his electricity and other utilities, in part, because of court fines stemming from a traffic ticket.

These policies prey upon LaGrange’s most vulnerable residents. They are not only inhumane - they are illegal, too. We are confident the courts will agree.

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How To Attract New Patients to Your Practice Using Local SEO Strategies

Attracting New Patients to Your Practice Using Local SEO Strategies


SEO (search engine optimization) is the process of making a website readable to search engines like Google, Yahoo and Bing. It’s true that SEO can get quite complex, but let’s remember that most private practices compete for business within a 15 mile radius of their location. That means we don’t need to get too fancy or overly technical – taking care of some of the SEO basics will get most medical businesses the new patients they need in time.


First, let’s take a look at what SEO is so that we can better understand it. If you think of a billboard that you see on the highway they are basically saying who, what and where they are located. This is similar to how SEO works for local searches. It's simply telling the search engines who you are, what you do, how they can contact you and where your practice is located.

While you may want to increase overall traffic to your practice’s website, your most important visitors will be ones in your local area. These are the patients who will actually come into your office.


4 in 5 consumers use search engines to find local information. They search for store address, business hours, product/service availability and directions.

-- According to Understanding Consumers' Local Search Behavior, Google

This means that you want to design your website to increase local searches and attract local business. You want to reach and engage your community to grow your practice—not reach people 3,000 miles away!


Make Sure You're Found By Local Patients


Since local optimization can help you get found in searches in your area (i.e., Pediatrician, Iowa City), make sure that you cover these additional SEO tasks when setting up your site:

  • Include your city name along with top keywords in website content (i.e., We are pediatricians in Iowa City).
  • Include your full address on every page of your website (not just the contact us page) and make sure it is exactly the same everywhere (same words, punctuation, etc.). It needs to be consistent.
  • Link your Google Maps listing to your website.
  • Make sure your NAP (name, address, phone number) is consistent across all channels. This includes your website, social media profiles, review sites and directory listings.
  • Use local keywords in your URLs, heading tags, title tags and content, where appropriate.

Also include your hours of operation, driving directions and pages devoted to the services you offer. 
This ensures that search engines can easily find your site and that patients see what they want to see the moment they click through.

People Trust Online Reviews


More and more patients are turning to Google for reviews of the medical practices in their area before making a decision to visit the doctor. You should be aware of the power of positive online reviews when optimizing for local traffic. Today, most people trust online reviews as much as personal recommendations (see more consumer review sentiments below), making them powerful tools to bring in new patients to your practice. In healthcare, nearly 85% of patients said they consult a reviews website to view or post comments and ratings of healthcare staff, according to a Software Advice survey. And when using review sites, 77% of patients surveyed said they use them prior to choosing a physician.

Some of the top review sites include:
Yelp
Google+ Local
Yahoo! Local

You can go through these and other medical practice review sites to make sure you're listed and that the information about your practice is accurate. Here are some things to keep in mind about online reviews, according to a survey by BrightLocal:


84% of people trust online reviews as much as a personal recommendation
54% of people will visit the website after reading positive reviews
73% of consumers think that reviews older than 3 months are no longer relevant
58% of consumers say that the star rating of a business is most important

If you have a practice marketing software vendor, you should be able to access tools and feature to manage and promote your online presence across all important online review sites and directories.

The importance of ranking in local search is undeniable. As we’ve already seen, local searches lead to more visits. This means high local search rankings equals increased traffic and revenue for your practice.

With these benefits in mind, ensure your website and content are optimized for local searches, and get your practice listed on local review sites. Include contact info in a prominent location on your website and social media profiles, and make sure your site is optimized for viewing on mobile browsers. Search engine optimization doesn’t happen overnight, but it’s an important piece of a successful online reputation. So it’s worth the effort and time.



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Tuesday, October 24, 2017

Marketing Tips to Grow Your Medical Practice


Grow Your Medical Practice Using These New and Old School Marketing Techniques



One of the most important keys to a financially healthy practice is marketing. Not just any marketing. It has to be what's working right now to attract your target patients. It's true that to succeed in private practice today, you must leverage modern tools and techniques. And there are also some tried and true “Old School” marketing practices that still keep patients coming through your door.


Let’s take a look at some new and the old school techniques you should be using in your practice.
Modern Medical Practice Marketing Techniques That Work

#1 - Social Media



Although using social media can be one of the toughest marketing challenges for medical practices—with looming patient privacy issues—if done right, it can also have big payoffs in terms of patient engagement. Think of social media as free advertising, where you can get your name out in front of a much wider audience than any billboard or print ad. But one of the social contracts you must adhere to is to not be overtly self-promotional. Otherwise, you will quickly lose your connections. Instead, your posts should be useful, helpful, creative and even entertaining to your target patient populations.


For example, you could create a Fitness Challenge to engage your Facebook followers and ask them to post a picture to show their progress and completion. Or, you could post a weekly question on your Facebook page and choose the winner randomly from the correct answers. Here's a quick primer on using social media to build your practice.

#2 - Blogging



According to Pew Research Center, 72% of U.S. adults have searched for health information online. This makes becoming a source of commonly searched health information for your patients a vital part of any marketing strategy, and the best place to do this is through a blog on your website.


Many practices ignore the opportunity regular blog posts present to connect to patients, provide valuable information and become an expert source. Yet, if you post regularly — at least twice a month — with information your patients are searching for, you position yourself as a health authority who they will seek out.

#3 - Ebook or Guide



Consider creating ebooks or guides that provide information around a recurring topic that's of interest to your patients. For example, an endocrinologist could offer an ebook on living with diabetes or a thyroid condition that stresses the importance of regular medical management along with nutrition and exercise.


You can enlist creative staff members to help with graphic design or hire a freelancer to lay out the information for visual engagement. The end product will usually be a free pdf that patients can either print out or read online or on a mobile device. You can insert a link to the pdf in your blog and on your website. For bonus marketing points, find out how you can add a short form that will pop up when someone tries to download your ebook or guide, asking them to fill in an email address and maybe some other bit of information that would be helpful for you to know about them, such as their age or their topics of interest.

#4 - Website



There are a few things you need to remember to get the most from your practice website.


First, it needs to be mobile-friendly—this means that when people land on your website from their phones, the font and images are resized for easy viewing. Second, you might consider ditching the stock photography and instead capture your team, office, and the “creature comforts” you offer patients to give them a real feeling of what being part of your practice means.


For example, this practice website uses an excellent mobile-friendly design. It’s clean and answers all the questions a patient could have. To make it even better, they could use pictures of their team so that patients can see the friendly faces they will get to know in the practice. Also, although they do have a blog, it is not as current as it should be and could be better utilized.


Here is another site that is very mobile friendly and the design is beautiful. The pictures, although some are stock, add a feeling of warmth to the site which really works.


What they could do better is to use a blog to connect to patients and provide that ever important content as well as pictures of the staff, especially on the meet our team section.

#5 – SEO



Search engines are constantly evolving, and in order to get a favorable spot in search results, you need to follow the best practices of search engine optimization (SEO). There are no shortcuts to get to the top of search results. The key is to create high quality content and focus on local listings.]


Here's a recent article where I go into more detail about Attracting New Patients to Your Practice Using Local SEO Strategies.

#6 – Practice Marketing Software



Arguably the most important aspect of practice marketing is managing your online reputation. This involves monitoring and improving patient satisfaction, increasing provider-patient communications, as well as managing ratings and reviews on the ever growing number of review sites that patients consult before making a decision about a healthcare provider. Do your research to see which practice marketing software has the features and services you need to shine online.


Old School Marketing Techniques That Still Work


#1 - Reminder Calls and Emails



Patients are busy just like you. Many times all it takes to get them back in your office is to simply remind them you’re there.


Set up calls about upcoming and missed appointments and try a “We miss you” mailing or phone call. Attracting patients to a practice is sometimes less about persuading new ones to come in but more about reminding established ones to return.

#2 – Ask Patients and Colleagues for Referrals



Referrals are a great way to get the word out about your practice. Connect with colleagues in different specialties to learn more about what they do and how you might be able to refer patients to one another. And, don’t neglect to ask your happy patients for referrals.


One way to make it clear that you accept referrals is by posting an “Open to new patients” sign. To encourage patients to spread the word, you might have a sign in the waiting room saying, “Your referrals are the highest form of flattery” or “We are accepting referrals at this time. We appreciate recommendations to your friends, family and co-workers."

#3 - Generate Media Exposure



Generating media exposure is an often overlooked or underutilized tool in medical marketing.


Consider approaching your local newspapers and television stations with a press release or feature story regarding an initiative you’ve begun that helps the local community, new medical research you could be interviewed about or a human interest story.

#4 - Direct Mail



Direct mail is a form of advertising that allows your practice to directly communicate with patients through a mailing of flyers, postcards, brochures or letters. The key is that there is some sort of “call to action,” such as a discounted service or a free service with the purchase of another.


Since direct mail can get expensive, be sure to narrow down your target audience. Don’t buy a list of all of the people living in your area. Instead, mail to patients who have visited your practice in the past and you’ll see a much higher ROI.

#5 – Staying Active in the Local Community



Sponsoring a children’s baseball team, joining your local Chamber of Commerce and offering to be a speaker for community organizations are all opportunities to get the word out about your practice and build goodwill.

#6 – Office Open House



Depending on the type of practice, an open house could show established patients that they are appreciated and introduce the office to potential patients. The open house may include an educational component, such as a brief presentation by a physician, or minor health screenings, such as blood pressure checks by other office staff. Or it may be a chance for patients to sit down casually with a physician to discuss philosophy of care. An open house also may be an opportunity for a practice to show off an office redesign or new equipment.


Patients are becoming very savvy consumers of healthcare. Having regular open houses offers potential new patients an opportunity to meet you in person and can definitely put you above the competition in online provider searches.

#7 – Newsletters



Healthcare newsletter marketing programs provide a cost-effective way to reach out and keep in touch with both patients and referring providers on a regular basis.


Newsletter marketing programs can help your practice in the following areas:
Keeping your name and practice in front of patients and referral sources.
Reinforcing your authority in your field of practice.
Encouraging more word-of-mouth marketing.
Building relationships with referral sources.

#8 - Attracting Patients From Local Companies



Local companies with large numbers of employees can be a great source of new patients. You can offer to present a talk on a popular health topic, participate in a health fair or write an informative article for the corporate newsletter.


Now that you know what marketing techniques can work for your practice — both new and old school — it’s time to implement them to see both a wave of new patients into your office as well as a reactivation of established patients.