DEW Advisory LLC

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Real ID Act

The NY Times has a good article on the Real ID Act.  https://nyti.ms/2jb5Fqi

As noted in the NY Times article, it is always a good idea to have a passport at one’s disposal just in case.  Within the Northeast Region, here are some links and current statuses of respective state initiatives in meeting the standard.   As it stands now, many states have been granted an extension so such state’s issued licenses should be acceptable past the impending deadline.

 https://www.dhs.gov/real-id-public-faqs : Department of Homeland Security FAQ regarding Real ID

 Q: What do I need to do if I am visiting a federal facility or a military base?

Visitors seeking access to military bases and almost all Federal facilities using their state-issued driver’s licenses or identification cards must present proper identification issued by REAL ID compliant states or a state that has received an extension. When planning a visit to a Federal facility or military base, visitors should contact the facility to determine what identification will be accepted.

 Q: When will I need to change how I travel domestically?

Starting January 22, 2018, passengers who have driver’s licenses issued by a state that is not yet compliant with REAL ID and that has not received an extension will need to show an alternative form of acceptable identification for domestic air travel. Please see TSA’s website for a list of acceptable forms of identification. Passengers who have licenses issued by a state that is compliant or that has an extension to become compliant with REAL ID requirements may continue to use their licenses as usual. For a list of states already in compliance or with an extension visit DHS’s REAL ID webpage. DHS continually updates this list as more states come into compliance or obtain extensions. 

Starting October 1, 2020, every air traveler will need to present a REAL ID-compliant license or another acceptable form of identification for domestic air travel. A REAL ID compliant license is one that meets, and is issued by a state that complies with, the REAL ID Act’s security standards. 

Travelers can check DHS’s REAL ID webpage at any time to learn if your state is compliant and can check with your state’s agency that issues driver’s licenses about how to acquire a compliant license. The earlier your state becomes compliant, the more likely you will be able to acquire a compliant license as part of the normal renewal cycle.

 https://www.mass.gov/service-details/real-id-in-massachusetts: Massachusetts REAL ID Source Page

You do NOT need a REAL ID until October 2020 but the RMV will begin to issue REAL IDs on March 26, 2018. 

 https://www.dhs.gov/real-id/massachusetts

Massachusetts has an extension for REAL ID enforcement, allowing Federal agencies to accept driver's licenses and identification cards from Massachusetts at Federal facilities, nuclear power plants and federally regulated commercial aircraft until October 10, 2018.

 https://www.dhs.gov/real-id/maine

Maine has an extension for REAL ID enforcement, allowing Federal agencies to accept driver's licenses and identification cards from Maine at Federal facilities, nuclear power plants and federally regulated commercial aircraft until October 10, 2018.

 https://www.dhs.gov/real-id/new-hampshire

New Hampshire has an extension for REAL ID enforcement, allowing Federal agencies to accept driver's licenses and identification cards from New Hampshire at Federal facilities, nuclear power plants and federally regulated commercial aircraft until October 10, 2018.

 https://www.dhs.gov/real-id/new-jersey

New Jersey has an extension for REAL ID enforcement, allowing Federal agencies to accept driver's licenses and identification cards from New Jersey at Federal facilities, nuclear power plants and federally regulated commercial aircraft until October 10, 2018.

 https://www.dhs.gov/real-id/new-york

New York is currently under review for a renewed extension from REAL ID enforcement.

 https://www.dhs.gov/real-id/pennsylvania

Pennsylvania has an extension for REAL ID enforcement, allowing Federal agencies to accept driver's licenses and identification cards from Pennsylvania at Federal facilities, nuclear power plants and federally regulated commercial aircraft until October 10, 2018.

 https://www.dhs.gov/real-id/rhode-island

Rhode Island is currently under review for a renewed extension from REAL ID enforcement.

[dewadvisory-blog]

Flashback to 20+ year-old Graduate Level Exam on Healthcare Utilization (same old, same old – Part 2)

Found a graduate exam (closed book, limited time, and handwritten so grammatical errors abound).  Many of the same issues in healthcare utilization remain so decided to share…….

Adverse Selection occurs when an insurance company lacks full information and sets a premium according to the anticipated / expected average utilization but unknowingly has a disproportionate number of bad risks and high utilizers whose expected utilization is much higher than this average.

Adverse Selection may occur when a group of ten, for example, has one high utilizer with the remaining being incrementally less likely to utilize such services.  Premiums will be set to reflect the average of the group in terms of expected utilization. Those, however, falling below this expected utilization will not choose to insure as it would be cheaper to pay out of pocket.  This creates a disproportionate number of poor risks / heavy utilizers not being offset by the good.  The insurer will either incur a loss as premiums received are less than service paid for, or raise premiums to reflect the new level of expected utilization. The latter will lead to a death spiral in that additional people will drop out as premiums are increased beyond their marginal benefit until only the last remains.  This person will also drop out as the service provided / covered will exceed marginal benefits because of the load factor / amount paid to the insurer to handle such coverage.

The inefficiencies caused by adverse selection are the fact that people willing to pay a fair premium for the appropriate and expected level [of insurance] will be unable to do so.

Compulsory and mandatory insurance will in effect require everyone to remain in the pool (both bad and good risks) so the good risks offset the bad.  Providing full information to insurers would also allow them to price premiums to people fairly based on expected utilization and risk level.  Both these policies will help to reduce adverse selection by monitoring a relatively average utilization rate and/or establish fair premiums based on such utilization so as to encourage people to remain in the pool.

[dewadvisory-blog]

Flashback to 20+ year-old Graduate Level Exam on Healthcare Utilization (same old, same old)

Found a graduate exam (closed book, limited time, and handwritten so grammatical errors abound).  Many of the same issues in healthcare utilization remain so decided to share.......

This tax subsidy encourages the purchase of too much insurance as insurance is paid for through pre-tax income.  By not including insurance purchases within one’s disposable income, this subsidy encourages people to buy or over-insure than if these premiums / payments came from out of pocket.  The marginal costs of such premiums are subsidized by this tax exclusion so as to distort the equilibrium between MC [marginal costs] and MB [marginal benefits]. People are inclined to increase these MB’s [marginal benefits] as incremental MC’s [marginal costs] are reduced and the tax benefit increases as insurance coverage purchases increase.

               In subsidizing the cost of insurance, these tax exclusions are in effect lowering the cost of services due to increased insurance coverage.  This decrease in cost of these services than encourages people to increase utilization. Studies have shown that such a 1 % decrease in price causes approximately on average 0.5% increase in utilization.  This moral hazard of not minimizing insured losses combined with the tax subsidy effect of increasing / over-insuring one’s coverage and benefits results in high / rising health care costs.  Unfortunately, such events cause market failure as people pay more through premiums for services they would not have chosen if they were paid out of pocket.

               I would agree with arguments that such a tax-subsidy encourages over-insuring and thus leading to increased utilization. Certainly through decreasing ones MC [marginal cost] (cost of premium subsidized by tax break) while maintaining marginal benefits (services received because of insurance coverage) will encourage such over-insuring.  …however, other factors have played a role in rising health care costs. Recommendations of MSA’s, tax credits, and catastrophic insurance are valid in that they address current problems due to this subsidy and moral hazard.  People will be encouraged to retain such savings if MC’s (marginal costs) came directly out of their MSA’s for incurred benefits.

               Creating tax credits for such incurred and non-incurred medical services used by the MSA also eliminates problems due to the tax subsidy.  The catastrophic insurance, however, unless made mandatory will create a market failure as adverse selection will arise.  Low-risks may be unwilling to contribute / participate in this catastrophic insurance leaving the ‘bad-risks’ behind.  Unless this adverse selection could be resolved, market failure will continue to occur and people will either overpay for premiums not matching marginal benefits or not have insurance.  Therefore, …[a] solution [MSA’s, changing tax-subsidy conundrum of purchasing health services, etc.] will not work unless this is resolved.

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10/20/16 Mass Bar Event: Recent Privacy and Security Risks to the Health Care Industry

Attend via webinar or in person at Mass Bar Offices 20 West Street Boston, MA.  Thursday October 20, 2016. 12pm - 1:30pm.

Join our experts for an hour panel discussion on recent privacy and security risks happening in the health care industry. Learn how enterprise digital rights management technology is helping to mitigate challenges in data security, information governance and audit compliance.

The program will cover:

What types of information are considered "high risk data" in the health care industry and beyond

How bad actors are creating these security risks

What the federal government is doing to warn the health care industry about these risks

Best practices to avoid becoming a victim and how to mitigate risk

Recent malware and ransomware case studies

New Health and Human Services ("HHS") guidance on ransomware

The value of medical information on the black market today

Recent health care cyberattacks and their outcomes

How lawyers are protecting their own sensitive employee and client data

The benefits of using EDRM technology for data security, information governance and compliance challenges

Defining data classification policies

Implementation strategies for information governance procedures

Internal and external compliance benefits using audit tracking logs

Faculty:

Kathryn Rattigan, Esq., program chair Robinson & Cole LLP, Providence

Brian Podolsky Seclore

Lisa Popadic Seclore

URL: http://massbar.org/cle/cle-programs?k=4467&kp=4462

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Lessons to Learn from Criticism and Backlash over Planned Spending of UNH Alumnus & Dimond Library Employee $4 million gift to UNH

The University of New Hampshire has faced sharp criticism regarding its planned spending of a $4 million gift donated by an alumnus and longtime UNH librarian Robert Morin.  This gift only reserved $100K of this gift to be directed towards the UNH Dimond Library.  UNH announced that $2.5 million of the gift would be used to launch an expanded career center.  However, the controversy stems from the planned use of $1 million to buy a video scoreboard for the UNH football stadium.

Many critical of this plan have posted several articles and other notes in social media.  One of the initial posts reacting to this purchase was from another UNH alumnus Claire Cortese.  Her post can be found here.

Link:  https://www.theodysseyonline.com/how-the-university-of-new-hampshire-chose-to-waste-an-alumnis-4m-gift

Several news outlets have picked up this story and it has garnered national attention.  Examples of new coverage can be found within the following links:

USA Today: http://college.usatoday.com/2016/09/15/critics-blast-unh-plan-to-spend-librarians-gift-on-scoreboard/

TIME: http://time.com/4497472/university-of-new-hampshire-librarian-scoreboard/

Boston.com: https://www.boston.com/news/local-news/2016/09/16/unh-facing-criticism-after-1-million-of-late-librarians-gift-goes-to-football-scoreboard

The University of New Hampshire noted the importance of unrestricted gifts by stating “Unrestricted gifts give the university the ability to use the funds for our highest priorities and emerging opportunities”.  

Source: https://www.unh.edu/unhtoday/2016/08/librarians-gift

The question raised by many critical of this planned spending is how such a large purchase aligns with the interests of Mr. Morin given his dedication and service to the UNH library for almost 50 years.  As reported by the Boston Globe, while Mr. Morin’s financial adviser noted Mr. Morin’s “…whole life was the library”, his financial adviser also noted Mr. Morin’s reaction to possible other restrictions on the gift’s use.  His financial adviser suggested directing some of the money to fund a library science related scholarship, but Mr. Morin entrusted UNH to use the money for whatever purpose.  http://www.bostonglobe.com/metro/2016/09/01/longtime-unh-librarian-leaves-million-school/ww2ivoRweb8wmI0zKgJepI/story.html?s_campaign=8315

The question remains if this was an expenditure Mr. Morin would have envisioned upon leaving an unrestricted gift to UNH.  Perhaps he would have gladly seen his gift would offset an expensive purchase seen necessary by the UNH administration as a critical component in competing for the attention of possible college applicants in building a more vibrant experience.  Conversely, he may have been disappointed that UNH could not envision other ways to align investing this gift in areas more related to his personal interests.  Where within this spectrum Mr. Morin would have fallen, we will never know.

The generosity of the individual providing the gift is what should be remembered particularly in this case with Mr. Morin’s prior service to the school.  Perhaps an even greater legacy of Mr. Morin would be to serve as an example for future discussions with clients regarding potential estate gifts.  One should note that it appears Mr. Morin’s adviser provided advice in this area in discussing limiting the gift and yet the controversy remains.  This example of a potential issue could build upon this discussion regarding topics of estate giving and even extend to those surrounding end of life directives.  Such conversations possibly could stem any future backlash against recipients of such gifts or even those responsible for making difficult end of life choices.

[dewadvisory-blog]

Donald Whitmore of DEW Advisory, LLC named Chair for the Health Law Section of the Massachusetts Bar Association.  As Chair of this group, Don is looking forward to collaborating with various stakeholders within the Health Law and Health Care Industry.

To learn more about the work of the Health Law Section and the Massachusetts Bar Association follow this link http://www.massbar.org/events/calendar

[dewadvisory-blog]

Looking for folks with an interest in discussing or collaborating on the topic of the application of project management and six sigma concepts in the legal field. The outcome of this discussion or collaboration could potentially be a blog post, article submission or perhaps a training opportunity.

  For those not familiar with these terms here is a brief summary. 

  Project Management essentially is a framework for managing a temporary and unique deliverable from inception to completion.  The Project Management Institute is an organization that provides certification in this area and has published project management standards captured within the Project Management Book of Knowledge (PMBOK).  The PMBOK recognizes five distinct project management processes and ten distinct areas of knowledge.

The concept of Six Sigma grew out of the operational improvement methods championed by Motorola and has since evolved into an organizational improvement methodology using it own set of terms yet comparable to those used in the context of project management.

    Project Management Concepts

  Six Sigma Concepts

Project Management Processes

  Project Management Areas of Knowledge

    DMAIC

Initiating

  Integration

Scope

Time

  Define the Opportunity

Planning

  Cost

Quality

Procurement

  Measure Performance

Executing

  Human Resources

Communications

Risk Management

  Analyze Opportunity

Monitoring and Controlling

    Stakeholder Management

    Improve Performance

Closing

          Control Performance

  Sources http://www.pmi.org/en/About-Us/About-Us-What-is-Project-Management.aspx

http://www-935.ibm.com/services/us/gbs/bus/pdf/g510-6331-01-leansixsigma.pdf