Cloud-based physician software and billing services vendor athenahealth Inc. is expressing disappointment and frustration with a policy reversal by the Department of Health and Human Services' Office of Inspector General. The OIG terminated its own 2011 advisory opinion regarding the company's online service that facilitates the exchange of information between healthcare providers and suppliers.

In 2011, athenahealth asked the OIG whether it could apply an “in-network/out-of-network” model to healthcare transactions at a cost of $1.00 per transaction to "accelerate the rate of adoption of electronic information exchange." However, three years later, OIG has changed its previous conclusion that athenahealth's fee structure "would be unlikely to influence an ordering health professional’s referral decisions in a material way." 

According to OIG, under athenahealth's arrangement, ordering health professionals who purchased the "coordination service package" received a discount on their monthly EHR service subscription fees. Moreover, each time an ordering health professional used the coordination service to make a referral to a non-trading partner, the discount was reduced by an amount equal to or less than $1.00, until it disappeared entirely.

OIG Chief Counsel Gregory Demske stated in a final notice of termination issued April 1 and posted April 8 that it now concludes that "the financial incentive provided to ordering health professionals under the arrangement could induce the ordering health professionals to select trading partners rather than non-trading partners, particularly with respect to services the ordering health professionals order with a high degree of frequency, such as laboratory tests."

Nevertheless, in an April 8 blog, athenahealth COO Ed Park challenged OIG's new thinking on the issue. "Here at athenahealth, we’ve always held the view that the exchange of information is a two-way street and that the cost of information exchange should be shouldered by both sides," Park wrote, an approach common in many other industries including banking where "you don’t pay an ATM fee for in-network ATMs, but you pay a fee for out-of-network ATMs." 

"We are disappointed with the OIG’s decision to reverse course and terminate its Advisory Opinion No. 11-18," he said. "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."

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