Archive for the ‘Accountable Care’ Category

Expert Witness for Future Medical Costs : Personal Injury, Medical Malpractice, Product Liablity, under ACA

Thursday, July 7th, 2016

In my work as an Expert Witness, attorneys in personal injury, product liability, and medical malpractice cases sometimes retain our services to opine on the cost of future care under the Patient Protection and Affordable Care Act (ACA).

Several factors must be evaluated including age, life expectancy, and potential eligibility for Medicaid Expansion in those states that elected to expand.  Different levels of care, out of pocket expenses and maximum out of pocket assumptions must be considered.  Some types of care are also treated differently under the Affordable Care Act. Disability and waivers may come into play.

As an expert witness in personal injury cases, depending on whether past or future costs are a factor, we may ask for medical records and other data.   Life care plans or supplemental data from a different medical expert or life care planner expert may also be considered. The same holds true of expert witness work in this context for medical malpractice cases.


This proposed rule would update the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) programs based on the changes to Medicaid and the Children’s Health Insurance Program (CHIP) eligibility under the Patient Protection and Affordable Care Act. This proposed rule would also implement various other improvements to the PERM program. Source: Federal Register / CMS

An expert witness may be required to opine regarding diagnostic imaging, evaluation and management (E&M) primary care doctor visits, and visits to specialists for pain management, orthopedic surgery, physical therapy, home health care, cardiology or other episodic or ongoing modalities of care.

In our experience, one strategy is to work within the Superior Court or State Court and then appeal to a higher court. Some courts have elected not to hear testimony regarding future care costs under the Affordable Care Act, only to potentially find that it is the law of the land and now has an impact.  This is being tested now in several states.

There are also unintended consequences in product liability cases. Third party liability and subrogation may also be affected in motor vehicle / automobile accidents where auto insurance and health insurance are factors, depending on the State.

An expert witness may also be needed to opine on regional variances in the cost of care.  The cost of medical care in San Francisco will likely be far higher than the cost of care for the same medical procedure in Akron Ohio.   To provide a valid market study, national rates compared to both charges and possibly net reimbursement may also be relevant in testimony and affect the expert witness opinion regarding the Affordable Care Act and regional medical costs.

Building on the foundation of the ACA, Meaningful Use of Electronic Health Records, and PQRS quality measures we have a new 900 page regulation which will again re-factor calculations for healthcare costs: the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  Expert witness work will, I predict require re-factoring to allow for MACRA and the Affordable Care Act in the future. More on this new regulation which was posted for public comment in May 2016 in future posts.

Michael Arrigo  serves as an expert witness regarding the Affordable Care Act for personal injury, medical malpractice, and product liability cases.  He has given opinions in Superior, State, and Federal Court for cases in several venues across the U.S.  You may reach him for his Expert Witness CV, Case List, fee schedule and retainer agreement by clicking this link.


Mobile, Analytics, Cloud, Value-Based Care, Social Dominate News at HIMSS15

Tuesday, April 21st, 2015
HIMSS 2015

HIMSS 2015 featured The Internet of Things for Health™, the Intelligent Hospital, the Intelligent Medical Home (i-Home™) as well as mobile, cloud, social, analytics, population health and value based care.

Record attendance at HIMSS 2015 in Chicago – over 43,000 people.  Now that HIMSS15 is over, take a look at some of the trends that dominated the headlines, the social buzz and the chatter at after show cocktail parties.

Of course, there were the overarching themes of interoperability, and population health, but there were some key themes that received the most attention. Here are the five areas that stood out:

  1. Value based care and population health mergers and acquisitions
  2. mHealth – HIMSS 2015 mobile health survey and ROI issues as well as HIPAA Privacy and Security.
  3. Emerging technologies focused on referrals, eligibility and personal health engagement / patient engagement.
  4. SMAC – Social Mobile Analytics and Cloud, including ICD-10
  5. While there is work being done to break down the data and process silos in healthcare, much more work needs to be accomplished to realize the promise of these solutions.

The health care industry continues to rely on X12 EDI claims data because it is standardized.  Though clinical data is increasingly structured (‘discrete data’ per Meaningful Use of EHR regulations) it is not standardized as to specific content such as blood pressure (systole and diastole can be expressed as 120 / 80, “blood pressure in normal range” etc). Therefore, it can still be difficult at times to query and manage populations using clinical data.  It’s needed though if we are going to deliver on the promise of value based care and  population health.

Read the full story here in GovHealthIT.

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