January 23, 2012 (New York, NY) — Proskauer announced that it represented athenahealth, Inc. in receiving a favorable advisory opinion from the U.S. Department of Health and Human Services, Office of the Inspector General, allowing the company to provide an order transmission and coordination service to health care professionals using a transaction-based pricing model. To date, athenahealth, a leading provider of cloud-based practice management, electronic health record, and care coordination services to medical groups, is the only health care information technology company to have received a favorable OIG advisory opinion for transaction-based pricing as it relates to the transmission and receipt of orders or referrals.
For athenahealth and its physician and health system clients, this important advisory opinion clears the way for an open, sustainable and widespread backbone for the electronic exchange of health information, as well as appropriately structured transaction-based pricing models for services that may include fees paid by the recipients of referrals. Such a system had been previously held back by uncertainty stemming from the U.S. Anti-Kickback Statute that was enacted before the technology existed to support robust exchange, and when the value related to the transmission and coordination of information was far less clear. The OIG opinion kept the spirit of the law intact while also finding a number of factors that would reduce the risk that remuneration provided would be an improper payment to induce referrals.
The athenaCoordinator SM service will augment athenahealth's existing service offering of integrated revenue cycle management, electronic health records, and patient communication services to facilitate a streamlined order workflow between physicians and their partner hospitals, surgical centers, imaging centers and other physicians. Over time, athenahealth plans to expand this service to accommodate an even broader community of critical health care entities, such as independent labs and pharmacies. As it evolves, athenaCoordinator will be able to connect and manage a wider array of clinical information and documentation across disparate points of care and absorb more of the burdens for the providers using it to deliver care coordination. Currently, both senders and receivers of information do a significant amount of work—much of it in duplicate—to transmit orders and provide reports; however, the sender bears the greater share of costs related to moving and processing that information. The goal of athenaCoordinator is to address this inequity while creating a clean order with accurate data as well as an electronic means to receive reports and results. To achieve this, athenahealth is developing a per-transaction pricing model that will charge fees to the parties that benefit from its service, including both the sender and the receiver of information, depending upon the circumstance.
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