Is there a regulation that requires a hospital to pay pathologists for administrative duties, such as oversight of the laboratory and other traditional duties typically performed by a hospital pathologist? This is not a simple question, and the answer is often specific to the relationship between the parties. Complications are imposed by the reimbursement policies of government payers for the professional and technical components of services provided by pathologists, part of which are, by regulation, paid to the hospital. To further complicate things, opinions vary about how these arrangements should be structured. Pathologists perform duties on the hospital’s behalf, and the hospital provides items such as space, equipment, and other services for the pathologists, who often operate private businesses and bill for their own professional component work. One regulation of concern is singled out in the Health and Human Services Office of Inspector General’s Supplemental Compliance Guidance for Hospitals, published in the Jan. 31, 2005, Federal Register. That guidance implies that anti-kickback regulations may affect the arrangements between pathologists and hospitals in cases where the pathologist is not an employee of the hospital. Some experts point out that because the hospital may be receiving some compensation in various bundled payments […]
Is there a regulation that requires a hospital to pay pathologists for administrative duties, such as oversight of the laboratory and other traditional duties typically performed by a hospital pathologist?
This is not a simple question, and the answer is often specific to the relationship between the parties. Complications are imposed by the reimbursement policies of government payers for the professional and technical components of services provided by pathologists, part of which are, by regulation, paid to the hospital. To further complicate things, opinions vary about how these arrangements should be structured.
Pathologists perform duties on the hospital’s behalf, and the hospital provides items such as space, equipment, and other services for the pathologists, who often operate private businesses and bill for their own professional component work. One regulation of concern is singled out in the Health and Human Services Office of Inspector General’s Supplemental Compliance Guidance for Hospitals, published in the Jan. 31, 2005, Federal Register. That guidance implies that anti-kickback regulations may affect the arrangements between pathologists and hospitals in cases where the pathologist is not an employee of the hospital.
Some experts point out that because the hospital may be receiving some compensation in various bundled payments for services the pathologists perform on the hospital’s behalf, not compensating pathologists at fair
market value for such services may be an anti-kickback issue, particularly if the hospital is directing referrals for testing to the pathologist.
The reverse also may exist. In this case, pathologists receive the benefit of referrals of hospital patients for which they receive professional service reimbursements and, as a result, do not charge the hospital for oversight and management duties they provide for the hospital laboratory.
There are also concerns related to the different compensation methods based on the kind of hospital involved in the arrangement, who the patient’s payer is, and any state laws that might govern the relationship. In the absence of a specific regulation that governs these relationships, it is important that both parties retain the services of experts and obtain legal advice when negotiating a contract for these arrangements.
