As reimbursement continues to move from fee-for-service toward fee-for-value, independent physicians will increasingly require access to advanced information technology to track reasons for patient admissions to hospitals, services received by patients while admitted and other general data affecting patient health. Given the significant cost of these systems and the generally limited spending power of small physician practices, a high likelihood exists that hospitals (and health systems) will be the ones to incur the significant capital expenditures for these new and evolving technologies to meet their own needs as well as the needs of the physicians in the communities they serve.
Within the Advisory Opinion, the OIG specifically noted that it had “distinguished between items and services that are integrally related to the offering provider’s or supplier’s services and those that are not.” Implied in this statement is the fact that in supplying some items or services to physicians which may not be integrally related to their services, hospitals may add additional value and, therefore, may implicate the Anti-Kickback Statute. In this light, we recommend consideration of the following:
(a) Community physicians will need data from new technology to support value-based reimbursement from governmental and third-party payors;
(b) Physicians do not necessarily have the capital to purchase the technology to support the reporting requirements of both payors;
(c) Hospitals providing access to technology is a cost-effective means of working with community physicians to provide the highest quality of care; and
(d) Physicians may ultimately earn additional compensation through the use of reporting from the technology.
In the event that these types of arrangements are developed without a waiver under the Patient Protection and Affordable Care Act, the providing hospital will likely have to assess the fair market value of the physicians’ ability to access to the technology through some form of subscription or license paid by the physicians.
Curtis H. Bernstein, CPA/ABV, ASA, CVA, MBA, is the managing director of transaction and valuation services at Sinaiko Healthcare Consulting. Stuart J. Schaff is a senior consultant of transaction and valuation services at Sinaiko Healthcare Consulting.
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