OIG Changes Position On HIE Fees
By Katie Wike, contributing writer
OIG’s 2011 decision which allowed $1 fees for in and out of network transactions has now been reversed; athenahealth says this is a huge setback for HIE adoption
In 2011, The Office of the Inspector General at HHS issued a statement at the request of atenahealth which said that it “would not impose administrative sanctions” against its proposed electronic care-coordination and referral service. On April 8, 2014, however, the OIG reversed that decision according to Modern Healthcare.
"We no longer find that the factors to which we cite in (the 2011 opinion) are sufficient to mitigate against the risk that the discount could be an improper payment to induce referrals of federal healthcare program business, particularly in the context of high-volume services, such as laboratory tests," said the OIG statement.
The OIG has now determined that the formerly approved fee structure, which allowed atenahealth to charge both parties a referral transaction via the service, “could potentially influence the referring physicians' referral decisions in a material way” and “potentially generates prohibited remuneration” in violation of anti-kickback laws.
"We are disappointed with the OIG’s decision to reverse course and terminate its Advisory Opinion No. 11-18," blogged athenahealth COO Ed Park. "The OIG’s walk-back closes one promising path forward to a functioning, sustainable economic model for health information exchange. It represents a setback for any patient who has ever been turned away from a doctor’s office because their referral paperwork hasn’t been received, or handed a clipboard to provide information that a practice should already have had. And it’s a setback for one of the few bipartisan objectives of health reform: care coordination.
“While the OIG reversal eliminates one clear path to a functional model for health information exchange, we are confident there are other ways to get where we need to go. We will continue to work by every lawful means with innovative officials, providers, and industry colleagues to advance health care toward a fully modern data economy where a sustainable and fair economic model enables data to flow freely to improve outcomes and lower costs,” resolved Park.