In my work as an expert witness regarding the Patient Protection and Affordable Care Act (also known as the “ACA” or “Obamacare”), I find that more medical malpractice and personal industry cases as well as cases involving requirements for insurance coverage for self-insured employer’s employees encompass ACA in their scope. New entities called Accountable Care Organizations (ACOs) that blend the functions of a health care provider and a payor (insurance) into a new entity may be factors.
Therefore ACA may change the economics of healthcare as they apply to a legal matter involving damages, value of care, or insurance coverage and benefits.
The Affordable Care Act contains hundreds of pages on electronic, economic, patient engagement, and fiscal revisions that impact health plans, hospital systems, physician groups and healthcare IT firms. The Affordable Care Act must not be viewed in a vacuum; the HITECH Act, International Classification of Diseases version 10 (ICD-10) and other data, industry best practices and guidelines must be considered. Medicaid waivers before and after the Affordable Care Act, as well as whether the matter involves Medicaid expansion which is a state by state issue.
Just as it has taken time to educate health care providers and payors, parties to litigation and their counsel will evolve to an improved understanding of the Affordable Care Act as its many complexities and nuances are included in the facts tried in court. Expert witnesses must simplify the ACA so that the ‘trier of fact’ or jury can understand the issues that are relevant to the case. An expert witness must do this in a neutral, unbiased way.
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