determining its market value. Leases for
retail and healthcare/medical office spaces
have distinctly different values in a given
market. Which is appropriate? On one
hand, the services being offered within the
leased space are healthcare in nature. On
the other hand, the benefits realized by the
lessee include higher customer traffic and
increased exposure more often associated
with traditional retail leases. Additional factors to consider in these valuations include
the marketing opportunities and brand
credibility from being associated with a
well-known, trusted national retailer; the
square footage of the lease space; the local
real estate market; and the building class
where the lease space is located.
Provider-to-provider telemedicine consultations offer tremendous benefits to
individual practitioners and their patients.
Provider-to-provider consults are interactions between a specialist or expert and a
patient’s primary care physician (PCP) who
lacks access to a specialist or expert in a
specific field. The consultation is designed
to augment the PCP’s ability to treat
These services often are structured in
two ways: real time (synchronous) interactions or store-and-forward (asynchronous)
interactions. Real time consultations are
live audio-video streams in which the consulting physician interacts with the PCP.
Through this service, community physicians can interact with specialists or experts
to advise on appropriate care for the patient.
The consulting physician can assist with
establishing the most appropriate care
plan for the community physician’s patient
and is available to answer questions and
provide insight in a timely manner. With
store-and-forward interactions, the PCP
captures information from the patient and
transmits it to the specialist. The consulting
physician reviews the information sent by
the PCP and offers recommendations. The
PCP can review the specialist’s recommen-
dations and draw upon it to develop a care
plan for the patient.
Assessing FMV payments for these
services can often be simpler than other
telemedicine service arrangements, because
there are fewer variables and the burden
(from an on-demand availability standpoint) is less because these consultations
can easily be scheduled in advance. Key
factors to consider include the ability to
bill and collect from third-party payers,
the consulting physician’s specialty, and
the time it takes the consulting physician
to perform the consult. For these types of
arrangements, if the consulting provider is
not able to bill and collect for the services
provided, flat fee or hourly rate approach
may be considered.
There are an ever-increasing variety of
new, innovative ways to use technology to
deliver healthcare services. One constant,
however, is the importance of ensuring
that such arrangements are compliant with
healthcare fraud and abuse laws. Providers
should take reasonable steps to review their
arrangement to ensure the compensation
is consistent with FMV and the terms are
1. 42 CFR §411.351.
2. 26 CFR § 53.4958-4(b).
3. 70 FR 4858, 4866 (January 31, 2005).
4. Id. at 4863.
5. 69 FR 16054, 16093 (March 26, 2004).