Do you read Terms of Service?
Posted by on July 2, 2020
What are Terms of Service?
Terms of Service agreements are contracts between a service provider and user that govern the use of a product. They establish rules, requirements, and prohibitions for use of the platform or website. They state copyright and trademark law, outline when a user can be terminated, proscribe billing and subscription rates and timelines, and explain content moderation policies, among other topics. These are just the issues that should be of interest to a consumer. Additional items may include how information is collected and shared, how many users are authorized, device specifications, advertising policies, and arbitration requirements.
Why do Terms of Service exist?
A Terms of Service agreement is not required by law, but nearly every online entity requires agreement with their policies for use of the service. This is to protect the company from liability, preserve proprietary information, establish immunity under Section 230 of Communications Decency Act, have the ability to collect user data, and establish legal procedures in the event of a dispute. This list is not exhaustive.
Are Terms of Service enforceable?
Yes. But there are two sides to this enforcement just as there are two sides to the agreement. Terms of Service are generally enforceable under the Computer Fraud and Abuse Act, which holds individuals who violate a contract limiting the uses of a computer, such as a Terms of Service agreement, criminally liable if they act without authorization or in excess of authorization. That means that if a consumer uses a service or product in a manner that is not part of the Terms of Service agreement, the user may be violating federal law.
Alternatively, an online service provider, such as a social media platform, website, or application owner, may be subject to enforcement under the Federal Trade Commission’s prohibition on “unfair or deceptive acts or practices.” Companies that make misrepresentations to consumers by not adhering to a Terms of Service agreement or posted policy may be held accountable. It is often consumers who identify this behavior and alert that something is amiss.
Why you don’t read Terms of Service…
According to several studies, and personal experience, most users to do not read Terms of Service.
Terms of Service are lengthy, boring, often require navigating to a new page, and are full of complicated legalese that the average consumer does not have the time or desire to decipher. Because we want access, we click the box agreeing to the Terms of Service without ever having read them, trusting that nothing too nefarious awaits us should we run afoul of whatever it is to which we’ve just agreed.
This blind trust is what leads many to misinterpret their rights on social media platforms while missing opportunities to hold the same companies accountable.
…and why you should.
Without knowing and understanding Terms of Service and privacy policies, you have limited control over how your data is collected and used, when you can be held liable for actions you might take, or how you can hold the service accountable for violations.
Some companies have taken steps to make Terms of Service more accessible to consumers by using plainer language and shortening the length of agreements. It is up to users to take a few minutes to access and read them.
Without reading the Terms of Service a consumer limits the liability of the company providing the service while simultaneously increasing their liability as a user. We must be proactive consumers by reading Terms of Service before we click Agree.
MDedge: Lawmakers Questions Mental Health Disclosure Rules
Posted by on July 2, 2020
by Kerry Dooley Young
Several federal lawmakers on June 30 questioned state policies that require disclosure of mental health treatment as part of medical licensing applications and renewals, citing concerns about creating barriers to psychiatric care for clinicians.
Mental health–related questions on state medical boards’ licensing applications are especially worrisome with many clinicians, including ED staff, immersed in the physical and emotional challenges involved in treating waves of people with COVID-19, lawmakers said during a hearing of the House Energy and Commerce Committee’s health panel.
“We must consider the mental health of the providers on the front lines of the pandemic,” said Rep. Morgan Griffith, a Virginia Republican.
The issue of state medical boards’ disclosure rules was not on the official agenda for the House Energy and Commerce health subcommittee’s hearing. And there was no discussion of any specific state medical board’s regulations. The Energy and Commerce health subcommittee is working on more than 20 bills related to mental health, including measures intended to aid first responders, such as firemen and emergency medical personnel, and students.
This hearing marked an early stage in the process for a planned package of mental health legislation, said Rep. Michael C. Burgess, MD, of Texas, who is the top Republican on the Energy and Commerce health subcommittee. There may be opportunities as this legislation advances to add provisions intended to aid physicians, said Dr. Burgess, who practiced for many years as an ob.gyn. before being elected to Congress.
“We knew that suicide was a problem among our colleagues prior to the onset of this coronavirus epidemic and I know it is more pronounced now,” he said.
Dr. Burgess then solicited specific recommendations from the hearing’s witnesses on steps needed to help clinicians’ mental health.
The first suggestion offered in reply by Jeffrey L. Geller, MD, MPH, appearing in his role as president of the American Psychiatric Association, was that Congress should look for ways to encourage states to alter their licensing procedures.
The hearing comes on the heels of the APA, the American Academy of Family Physicians, and more than 40 other groups having jointly signed a statement calling for changes to disclosure rules about mental health.
“Licensing and credentialing applications by covered entities should only employ narrowly focused questions that address current functional impairment,” the statement said. “Additionally, we strongly support The Joint Commission (TJC) statement on Removing Barriers to Mental Health Care for Clinicians and Health Care Staff. TJC ‘supports the removal of any barriers that inhibit clinicians and health care staff from accessing mental health care services.’ ”
Physicians and other clinicians must be able to safely secure treatment for mental or other health issues, just as any other individual,” the groups wrote. “A provider’s history of mental illness or substance use disorder should not be used as any indication of their current or future ability to practice competently and without impairment.”
Also among the signers to this statement was the Federation of State Medical Boards, which has been leading an effort for years to change licensing.
In 2018, the FSMB recommended state medical boards reconsider whether it is necessary to include probing questions about a physician applicant’s mental health, addiction, or substance use on applications for medical licensure or their renewal. While the intent of these questions may be to protect patients, these queries can discourage physicians from getting needed help, the FSMB said.
Several states have since revised or considered revising their license applications and renewals. In May 2020, The Joint Commission urged broader adoption of recommendations from the FSMB and the American Medical Association to limit queries about clinicians’ mental health to “conditions that currently impair the clinicians’ ability to perform their job.”
“We strongly encourage organizations to not ask about past history of mental health conditions or treatment,” said The Joint Commission, which accredits hospitals, in a statement. “It is critical that we ensure health care workers can feel free to access mental health resources.”
Rep. Susan Brooks, an Indiana Republican who is an attorney, suggested there may need to be a broader look at how state officials pose questions about past mental health treatment to people in many professions, including her own.
“It does build on the stigma on accessing services” to know a state or licensing authority may question a professional about receiving treatment for mental health, she said.
Also at the hearing, Rep. Nanette Diaz Barragán, a California Democrat, spoke of her own reaction to seeing a question about mental health treatment while applying for a White House internship. During her college years, Rep. Barragán had to cope with her father’s terminal illness.
“I remember thinking to myself: ‘Jeez, if I end up seeing a mental health expert maybe one day I couldn’t work in government,’ ” she said.
MedPage Today: Psychologists' Practice Scope an Issue at House Hearing
Posted by on July 1, 2020
by Joyce Frieden
WASHINGTON -- The House Energy & Commerce Health Subcommittee hearing Tuesday on bills to address the mental healthcare crisis was generally very collegial except for a turf war that broke out between the psychiatrist and the psychologist who testified before the subcommittee.
The discord came over H.R. 884, known as the Medicare Mental Health Access Act -- a bill sponsored by Reps. Jan Schakowsky (D-Ill.), Judy Chu (D-Calif.) and Markwayne Mullin (R-Okla.) that would treat clinical psychologists as physicians when it came to providing clinical psychology services to Medicare beneficiaries. Currently, psychologist must have a physician's order if they want to treat and be reimbursed for treating a Medicare patient; the bill would remove that requirement.
"Requiring psychologists to have to go through psychiatrists to provide services is just unconscionable at a time when our seniors are isolated, they're experiencing anxiety, they need direct services," said Arthur Evans Jr., PhD, CEO of the American Psychological Association. He added that he heard about one psychologist who was waiting to get a physician's order for his services "and the psychiatrist said to his face that 'I don't believe in psychotherapy; I'm not going to provide that order.' We cannot allow those barriers in 2020 to continue to exist."
But Jeffrey Geller, MD, MPH, president of the American Psychiatric Association, argued that the bill went too far. "The goal of H.R. 884 is unclear since Medicare already recognizes and allows psychologists to provide the services they're trained to perform and to practice independently in Medicare in appropriate settings," Geller said in his opening testimony. "But psychologists are not physicians. Psychologists do not have medical training. Psychiatrists treat patients with mental illness and co-morbid medical illnesses in inpatient and partial hospital settings. Psychiatrists have to recognize medical disorders masquerading as psychiatric disorders. You cannot be equipped to do this without a medical school background."
"High-quality care is best provided by a team working together to provide coordinated services, but this legislation would do the opposite -- further fragment and create unnecessary and dangerous silos," said Geller. "Administrative hurdles can be addressed without going to extremes like inappropriately defining psychologists as physicians under Medicare."
Evans disagreed. "The legislation doesn't try to redefine psychologists as physicians ... What psychologists are interested in is being able to practice to the full extent of their training and their licensure without administrative barriers. I find it ironic that at this hearing where we've talked about needless administrative burdens and requiring people to jump through hoops to get services, that we would have this as an issue. The reality is the Medicare program is the only payer that does this -- not Medicaid, not Tricare, not the VA, not any private payer."
Rep. Michael Burgess, MD (R-Texas), the subcommittee's ranking member, noted that none of the bills being considered addressed the mental illnesses suffered by frontline healthcare workers; he asked Geller for recommendations on how to help them. "A major problem for physicians and nurses and other licensed personnel is the fear they'll lose their license to practice if they report they've had treatment for a mental illness," Geller said. "I apply for license renewal every few years, and generally I'm asked a question in almost every state, 'Have I sought psychiatric treatment, and am I mentally impaired or do I believe I'm mentally impaired?' If Congress would address that problem, I think it would make frontline healthcare workers more willing to seek treatment."
If there is to be a question on the license renewal application relating to impairment, "it should be a broad question about impairment," he added. "I could be impaired because I have a medical disorder. The fact that I saw a psychiatrist should not preclude me from being a doctor, an attorney, a school janitor, or anything else."
Witnesses and subcommittee members also expressed concern that despite Congress's passing the Mental Health Parity and Addiction Equity Act in 2008, payment for treatment of mental illness is still not on a par with payment for treatment of physical illness. "We all know growing up in families where there is alcoholism, addiction and mental illness, that we don't like to talk about these things," said former Rep. Patrick Kennedy (D-R.I.), a mental health advocate, in his opening statement as a witness. "We're still in deep denial about these illnesses and their pervasiveness ... Exhibit A is that Congress never really appropriated the necessary resources for this crisis, and they never enforced the parity Act. Until there's that same urgency toward enforcing and same money backing up our words that these are equal illnesses, we're really still in denial as a nation."
Kennedy noted that currently, the Department of Labor, which oversees compliance with the parity act, has one inspector for every 2,500 health plans. "How are we going to have any accountability if there's no oversight?" he asked. The committee is considering a bill called the Mental Health Parity Compliance Act that would require plans to provide more information to the government about how they were enforcing parity.
Using telemedicine -- including telephone calls -- for psychiatric visits was a recurring theme during the hearing. Geller said that the increased ability to get psychiatry services via telephone has made a "tremendous difference" for people who don't have broadband access. He noted that one of this patients, who "hasn't bought any new equipment since the Johnson Administration," only talks to him by phone, "and if he didn't have that ability, he would be without services and probably be hospitalized." One bill the committee is considering, the Telemental Health Expansion Act, would allow for continued reimbursement of mental health services furnished through telemedicine, and would allow the patient's home to be an originating site.
Houston Chronicle: Thousands of hotels facing foreclosure as pandemic persists
Posted by on July 1, 2020
by R.A. Schuetz
Houston hotels are not expected to return to pre-pandemic revenue levels until 2024, according to commercial real estate firm CBRE. Some may not make it that long.
The American Hotel and Lodging Association predicts the industry is facing "massive foreclosures of thousands of hotel properties" across the nation, according to a press release sent out Wednesday.
"With a sharp decline in travel demand, nine times worse than September 11 and with lower room occupancy than during the Great Depression, our small business owners are struggling to survive," Chip Rogers, the association's chief executive, said in the release.
At special risk are hotels that were funded with mortgages that were bundled into securities, known as commercial mortgage-backed securities, or CMBS.
Commercial real estate investors are confronting issues similar to those faced by investors in residential real estate mortgages in the years leading up to the housing bust of more than a decade ago. As with homes, most commercial properties are purchased with mortgages, which are then bundled into securities and sold to investors, whose returns depend on property owners making their monthly payments.
One fifth of securitized hotel mortgages were delinquent in May, data from securities data company Trepp show. But hotels owners who are struggling to make monthly payments are finding much less flexibility if their mortgages have been securitized, according to a survey by the hotel association.
Only 20 percent of hotel owners whose mortgages had been bundled into securities have received any relief on their loans, compared to 91 percent of hotel owners who had borrowed from banks, making it more likely for such mortgages to foreclose, Rogers said. "Without action to shore up commercial debt especially CMBS loans, the hotel industry will experience mass foreclosures and permanent job losses which will snowball into a larger commercial real estate crisis impacting other segments of the economy."
Several Houston hotels with securitized mortgages, including Hilton Houston Post Oak and Crowne Plaza Houston on Katy Freeway, began trying in May to receive payment relief due to the effects of the pandemic. If they do not find a solution, they could be foreclosed on in November.
In a letter to the Department of Treasury and Federal Reserve, a group of U.S. representatives called for relief for CMBS loans.
"We request the Federal Reserve devise a relief plan for these borrowers, who through no fault of their own, have experienced a significant drop in revenue on account of the COVID-19 pandemic and related governmental orders," they wrote, saying that a wave of CMBS loan foreclosures would destroy jobs and cause property values to fall, dealing a blow to state and local tax revenues.
Those calling for the change included six of the 35 U.S. representatives from Texas: Republicans Van Taylor, Lance Gooden, Will Hurd, Michael Burgess and Roger Williams and Democrat Vicente Gonzlez.
Burgess to Health Subcommittee: Mental Health is not a Partisan Issue
Posted by on June 30, 2020
Washington, D.C. – Congressman Michael C. Burgess, M.D. (R-TX), a member of the House Rules Committee and Republican Leader of the House Energy and Commerce Subcommittee on Health, stressed the importance of addressing mental health in his opening remarks.
Thank you, Madam Chair. I appreciate your willingness to work on a productive, bipartisan agenda for this subcommittee and respect of my request for a hearing on mental health and coronavirus. This was a topic that we were slated to address prior to the outbreak but has become even more serious. The human loss, job loss, and isolation that Americans have faced due to this pandemic makes this an even more critical topic.
A Doctor's note on Mental Health
Posted by on June 30, 2020
The Ripon Advance: Burgess introduces cable competition bill to increase consumer choice
Posted by on June 30, 2020
by Ripon Advance News Service
U.S. Rep. Michael Burgess (R-TX) on June 25 proposed legislation that would prohibit franchising authorities from requiring approval for the sale of cable systems.
“In 2020, Americans should not be limited by franchise restrictions when choosing broadband services,” Rep. Burgess said. “This legislation will increase competition by getting rid of regulations that are not keeping up with how consumers access cable and Internet services.”
Rep. Burgess sponsored the Consumer Access to Broadband for Local Economies and Competition Act, also known as the CABLE Competition Act, H.R. 7336, which would amend the Communications Act of 1934 to prohibit a franchise authority from precluding cable operators from transferring a franchise, or requiring cable operators to receive approval from a franchise authority for the transfer of such franchise, according to a bill summary provided by the congressman’s office.
Additionally, H.R. 7336 would permit franchise authorities to require a cable operator transferring a franchise to notify the franchise authority within 15 days of the transfer, according to the bill summary.
“The expansion of telehealth and increased number of Americans working from home during this pandemic has revealed the necessity of being able to maintain reliable Internet services,” said Rep. Burgess. “I hope my fellow members will join me in quickly passing this vital legislation.”
Burgess: The Affordable Care Act has Proven to be Unaffordable
Posted by on June 29, 2020
Washington, D.C. – Congressman Michael C. Burgess, M.D. (R-TX), a member of the House Rules Committee and Republican Leader of the House Energy and Commerce Subcommittee on Health, delivered the following remarks from the House floor on H.R. 1425, the Patient Protection and Affordable Care Enhancement Act.
As Prepared for Delivery:I rise to speak against H.R. 1425, the Patient Protection and Affordable Care Enhancement Act. This is a partisan bill that serves no purpose other than a tenth birthday present to the Affordable Care Act. Since the passage of this law, I have heard from my constituents about the burdensome costs and lackluster quality of these exchange plans. This bill injects an enormous amount of funding into the Affordable Care Act as an attempt to superglue it back together.
H.R. 1425 establishes a new reinsurance program that would cost $10 billion per year for eternity. This reinsurance program does not include longstanding protections that ensure that federal funding cannot be used to pay for abortions. If we want to pass a bipartisan reinsurance policy, I have a bill, H.R. 1510, which includes reinsurance coupled with structural reform of the Affordable Care Act. It gives states more choice on how to repair their markets that have been damaged by the Affordable Care Act, and it’s offset by stopping bad actors from gaming the system. Importantly, it includes Hyde protections and therefore protects life.
H.R. 1425 also punishes states that chose not to expand Medicaid by cutting their federal share of Medicaid funding. States are already struggling to keep up with rising Medicaid costs, and this bill will only hurt them more.
The Supreme Court case, National Federation of Independent Business v. Sebelius, which ruled that threatening states’ Medicaid funding for not expanding is unconstitutional. Sections 204 and 205 of this bill would violate the same principles and coerce states rather than incentivize them to expand Medicaid. This bill will actively damage state Medicaid programs in states like Texas.
Lastly, this bill uses offsets that would actively harm our nation’s coronavirus response by using offsets from H.R. 3 that would require the government to set drug prices. The Congressional Budget Office analysis found that such policies would lead to substantially fewer new drugs coming to market. What if one of those drugs had been remdesivir? A vote for this bill is a vote against a vaccine or a cure for coronavirus.
There are policies we could pass today that would help Americans. We could reauthorize community health centers and newborn screening, we could reauthorize the Money Follows the Person program, which allows Medicaid beneficiaries to move out of nursing homes and back into their own homes. Unfortunately, we are wasting our time on a partisan birthday present for the Affordable Care Act. I urge my fellow Members to vote against H.R. 1425.
Burgess: A Vote for H.R. 1425 is a Vote Against a Cure for COVID-19
Posted by on June 29, 2020
Fox Business: Rep. Burgess joins Neil Cavuto Coast to Coast
Posted by on June 29, 2020
Rep. Burgess joins Neil Cavuto to discuss Houston hospitals' ICU nearing capacity.
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