Tag Archives: doi

The Sad State of Continuing Education

About 25 years ago, I attended an education committee meeting at the Southern Agents Conference in Atlanta. Continuing education (CE) had really just gotten started in some states. At this meeting, legendary insurance educator Bob Ross, of the Florida Big I, literally stood on his chair at the conference table and declared that mandatory CE would be the death of quality education. Has his prediction come true?

Four years ago, I posted the following on a LinkedIn discussion:

“A colleague related a recent experience to me last week. He went to one of the best known online insurance CE web sites and signed up for a course titled “Consumer Insurance.” He registered as a new user in the system, perused the course catalog, signed up for the course, skipped the course material, took the test, and earned 3 hours of CE credits. All in 16 minutes.

“He was also able to save the exam and email it to me (and, of course, anyone else taking the course). The test was loaded with vaguely worded questions and misspelled words and insurance terms (like “vessals” and “ordinance IN law” coverage). For some test questions, no right answer was listed or more than one answer was correct.

“In the spirit of one-upmanship, I told him about my experience 11 years ago when online CE was just getting started. I registered at a vendor’s web site and, like him, went straight to the test. I forget the exact total time required to register and take the 50-question test, but it was around a half hour I think and definitely less than an hour. The CE credit for this personal auto course? 25 HOURS. To quote the late Jack Paar, ‘I kid you not.’

“Afterward, I browsed the material, and it was full of general consumer-type information taken directly from the Insurance Information Institute. The hours of CE credit granted by the state DOI were based on a word count with complete disregard to the difficulty level.

“One thing I remember about this vendor was that it used what it called “Split Screen Technology.” What that meant was, while you were taking the test on one side of the screen, you could view the course content that went with that test question topic on the right side and browse for the answer to the question. Browsing for the answer was easy, given that the relevant information was highlighted.

“So where are we 11 years later? Apparently in the same boat, except that online insurance education is much more pervasive than it was then. You can get two years of CE credit for as little as $39.95. A great bargain if your interest is in regulatory compliance and not actually learning something that will benefit you, your agency and the consumers and businesses you serve….”

“Is there no accountability? Is there no desire to truly educate ourselves? Does anyone care? Is anyone listening?”

Flash forward to 2015….

An agent and friend I know – good agent, CE course instructor, upstanding guy – waited until the last minute to complete his biannual CE requirement last year. So he went online, found the course he wanted, signed up, went straight to the exam, and in 23 minutes had completed three hours of CE credits. As they say, the more things change, the more they stay the same. And, did I mention that the course was to comply with his state’s three-hour ETHICS requirement?

There is an online insurance forum with a discussion called, “Any Suggestions on Best Online CE Site?” It has comments such as:

“I use XXXXX.com. About $35 for 21 hours of credit. Takes a few hours (maybe two) to finish and is open book.”

My tongue-in-cheek response (recalling my agent friend’s experience a few months earlier) was, “I hope it wasn’t an ethics course!” The poster’s response:

“Huh? I guess you think each hour of CE should take an hour? Unless it’s a LIVE CE class… CE courses don’t take that long. I get unlimited CE from [provider’s name] for $39.95 per year… including a 16-hour Ethics CE course… that takes me about 15 minutes to complete. And, yes, they are open-book courses, too.”

On another discussion board, someone was touting a “Fast, Easy, and Affordable Continuing Education” website. No mention of the quality or relevance of the course material or whether there is any actual learning involved. The site proudly proclaims a passing ratio of “over 98%.” What would regulators do if the passing ratio of their licensing exams were more than 98%? I suspect they’d insist that the exams be made a little tougher. Is any exam a legitimate test of learning if the passing ratio approaches 100%? Then why do regulators allow online CE programs that take a half-hour to get 20 hours or more of CE credit and include exams with passing ratios near 100%? The web site in question has 91 reviews…NONE of them mention whether the reviewer actually learned anything.

(If you’re actually looking to learn, the best place to start looking is your own agent association, which has a vested interest in providing you with the best education possible.)

So what do you think? Am I just a grumpy old man? Should anything be done about the diploma mills that have proliferated? If so, what? If not, why not?

How to Optimize Nurse Case Management in Workers' Comp

Traditionally, in workers’ comp, nurse case management (NCM) services have been widely espoused yet misunderstood and underutilized. The reasons for underutilization are many. Tension between NCM and claims adjusters is one. Even though overburdened, adjusters often overlook the opportunity to refer to NCM.

Also to blame is the NCM process itself. In spite of professional certification for NCM, the process is poorly defined for those outside the nursing profession. More importantly, NCM has difficulty measuring and reporting proof of value.

Underlying issues

Continuing to do business as usual is not acceptable. NCM needs to address several issues to qualify as legitimate contributors. First, NCM needs to articulate its value. To do that, NCM must computerize and standardize its process and measure and report outcomes, just like any other business in today’s world.

Too often, computerization for NCM is relegated to adding nurses’ notes to the claim system. However, such notes cannot be analyzed to measure outcomes based on specific nursing initiatives. 

In most situations, an individual NCM interprets an issue, decides on an action and delivers the response. The organization’s medical management is thereby a subjective interpretation rather than a definable, quantifiable product. 

Granted, the NCM is a trained professional. But when the product is unstructured, variables in delivery cannot be measured or appreciated. A process that is different every time can never be adequately defined.

It's crucial to establish organizational standards about what conditions in claims require referral to NCM—without exception. This will remove the myriad decisions made or not made by claims adjusters to involve the NCM. The referral can be automated through electronic claims monitoring and notification. NCM takes action on the issue according to organizational protocol, and the claims adjustor is notified.


When the conditions in claims that lead to intervention by NCM are computerized and standardized, the effects can be measured. Apples can legitimately be compared with apples, not to oranges and tennis balls. Similar conditions in claims are noted and approached the same way every time, so the results can be validly measured.

Results in claims such as indemnity costs, time from DOI to claim closure or overall claim cost can be compared before and after NCM standardization. Comparisons can be made across different date ranges for similar injuries going forward to measure continued effectiveness and hone the process.

Measuring outcomes is the most essential aspect of the process. Value is disregarded unless it is defined, measured and reported.

For non-NCMs, the dots in medical management must be connected to see the picture. Describe what was done, why it was done and how it was done the same way for similar situations and in context with the organization's standards. Then report the outcome value. Establish a continuing value communication process.

NCM constituencies should be informed in advance of the process and outcome measurements. Define in advance how problems and issues are identified and handled and how results will be measured. Then proceed consistently.

Recognized NCM value

Even as things now stand, NCM's value is being recognized. American Airlines recently reported it is adding NCM to their staff and will refer all lost time claims. The company cited a pilot project where nurse interventions were documented and measured, proving their value in getting injured workers back to work. 

Christopher Flatt, workers’ compensation Center of Excellence leader for Marsh Inc., wrote in WorkCompWire (http://www.workcompwire.com/), “One option that employers should consider as part of an integrated approach to controlling workers’ compensation costs is formalized nurse case management. Taking actions to drive down medical expenses is an essential component to controlling workers’ compensation costs.”1

Industry research and corporate or professional wisdom regarding risky situations can supply the standardized indicators for referral to NCM. American Airlines uses the standard that all lost time claims should be referred to NCM. But there are many, sometimes more subtle, indicators of risk and cost in claims that can be identified early through computerized monitoring and referred for NCM intervention.

Another example of developing standard indicators for referral is based on industry research that shows certain comorbidities, such as diabetes, can increase claim duration and cost. These claims should also be referred to NCM. Yet another example is steering away from inappropriate medical providers who can profoundly increase costs. 

As a long-ago nurse and a longer-time medical systems designer and developer, I believe the solution lies in appropriate computerized system design. The elements need to be simple to implement, easy to use and consistently applied. Only then can NCM offer proof of value.

1 Christopher Flatt: The Case for Formalized Nurse Case Management