Favorable OIG Advisory Opinion Enables Transaction-Based Pricing for the Exchange of Health Information

Opinion Supports athenahealth’s Effort to Create Win-Win Marketplace for Senders and Receivers of Health Information

WATERTOWN, Mass.–(BUSINESS WIRE)– athenahealth, Inc. (NASDAQ:ATHN), a leading provider of cloud-based practice management, electronic health record (EHR), and care coordination services to medical groups, today announced that it proactively sought and subsequently received a favorable Advisory Opinion from the U.S. Department of Health and Human Services, Office of Inspector General (OIG) relating to its athenaCoordinator SM service offering, in which it would provide an order transmission and coordination service to health care professionals using a transaction-based pricing model. The Opinion paves the way for the creation of a sustainable market for the exchange of health care information where the appropriate value for health care transactions will be paid by those parties who realize value from the successful exchange of data, taking costs out of the system and improving patient satisfaction and care. To date, athenahealth 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 of orders.

A market that incents participants to share information electronically across the health care supply chain has been held back in part by uncertainty stemming from the Anti-Kickback Statute that was enacted before there was the technology backbone available to support fair value exchange, and when the value related to the transmission and coordination of information was far less clear. For athenahealth and its physician and health system clients, the Opinion clears the way for an open, sustainable, and widespread backbone for the exchange of health information.

Announced in August of last year following the acquisition of Proxsys, Inc. by athenahealth, athenaCoordinator augments athenahealth’s existing service offering of integrated revenue cycle management, EHR, and patient communication services to facilitate a streamlined order workflow between physicians and their partner hospitals, surgical centers, and imaging centers. 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. To achieve this, athenahealth is developing a per-transaction pricing model that will charge fees to the parties that benefit from its service.

Jonathan Bush, Chairman and CEO of athenahealth, said, “The OIG opinion keeps the spirit of the Anti-Kickback Statutes and Stark Law intact but acknowledges that policy has perhaps unintentionally stymied free market innovation in health care IT that can provide benefits to all sides. athenahealth already had the technology and services to facilitate the meaningful exchange of health information on a broad scale. We now have the clearance to build in true win-win free market economics to athenaCoordinatorthat will enable providers both upstream and downstream to fully participate in the successful transmission of that data.”

About athenahealth

athenahealth, Inc. is a leading provider of cloud-based business services for physician practices. athenahealth’s service offerings are based on proprietary web-native practice management and electronic health record (EHR) software, a continuously updated payer knowledge-base, integrated back-office service operations, and care coordination services. For more information, please visit http://www.athenahealth.com/ or call 888-652-8200.