Osteopathic Medical Oncology and Hematology, P.C. v. Commissioner ( 1999 )


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    113 T.C. No. 26
    UNITED STATES TAX COURT
    OSTEOPATHIC MEDICAL ONCOLOGY AND HEMATOLOGY, P.C., Petitioner v.
    COMMISSIONER OF INTERNAL REVENUE, Respondent
    Docket No. 11551-98.                     Filed November 22, 1999.
    P, a professional service corporation, specializes
    in the treatment of cancer through chemotherapy. P
    uses drugs and ancillary pharmaceuticals (collectively,
    the drugs) during its treatment. The chemotherapy
    treatments are prescribed by P’s professional staff,
    and patients do not select the type or quantity of
    drugs used during the treatments. P uses the cash
    method to expense the cost of the drugs. R determined
    that the drugs were "merchandise" under sec. 1.471-1,
    Income Tax Regs., and that P must use an accrual method
    to report all amounts attributable to the drugs.
    Held: The inherent nature of P's business is that
    of a service provider, P’s use of the drugs is
    subordinate to the provision of its services, and P
    uses the drugs as an indispensable and inseparable part
    of the rendering of its services; thus, the drugs are
    not "merchandise" under sec. 1.471-1, Income Tax Regs.,
    and P properly used the cash method to expense the
    drugs’ cost.
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    David C. May, for petitioner.
    Grant E. Gabriel, for respondent.
    OPINION
    LARO, Judge:    The parties submitted this case to the Court
    without trial.   See Rule 122.    Petitioner petitioned the Court to
    redetermine respondent's determination of a $50,515 deficiency in
    its 1995 Federal income tax.     The sole issue for decision is
    whether petitioner, a professional service corporation, may use
    the cash receipts and disbursements method (cash method) to
    expense the drugs and ancillary pharmaceuticals (collectively,
    chemotherapy drugs) used by it while providing chemotherapy
    treatments to its patients.    We hold it may.    Unless otherwise
    stated, section references are to the Internal Revenue Code as
    applicable to 1995, and Rule references are to the Tax Court
    Rules of Practice and Procedure.
    Background
    All facts are stipulated and are so found.      The stipulation
    of facts and exhibits submitted therewith are incorporated herein
    by this reference.   Petitioner's principal place of business was
    in Clinton Township, Michigan, when it petitioned the Court.
    Petitioner is a professional medical corporation that
    provides osteopathic services, with a speciality in oncology
    (mainly chemotherapy) and hematology.      Petitioner's staff
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    consists of physicians, nurses and nursing assistants, laboratory
    technicians, administrative personnel, and office workers.
    Petitioner has three offices in the Clinton Township area.   At
    each of these offices, petitioner stores chemotherapy drugs and
    has the staffing, equipment, and supplies necessary to administer
    chemotherapy treatments.
    Chemotherapy drugs are pharmaceutical drugs which under
    applicable State (Michigan) law must be prescribed by a doctor
    and may be sold only by a licensed pharmacist.   Petitioner is not
    a licensed pharmacist, and it is unlawful for petitioner to sell
    the drugs.   Petitioner may use the drugs during the performance
    of its chemotherapy services.
    Chemotherapy drugs come in ready-to-use form or as powders
    or liquids that require mixing.   Petitioner generally maintains
    about a 2-week supply of chemotherapy drugs, and it regularly
    purchases chemotherapy drugs from suppliers to insure that it has
    enough on hand to administer prescribed treatments.    Chemotherapy
    drugs, in an unmixed form, have shelf-lives varying from about 6
    months to 1 year.
    When an individual first becomes a patient of petitioner,
    one of petitioner's physicians examines him or her to prescribe
    necessary treatments, and that physician records the
    individualized chemotherapy treatment in the patient's file.
    After the patient is evaluated and the physician prescribes a
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    chemotherapy regime, the patient begins regular, periodic
    treatments.    The patient does not select the type or quantity of
    drugs used in the treatments; this selection is within the sole
    discretion of petitioner’s professional staff.    In accordance
    with standard oncology practice, patients are not examined by a
    physician at every chemotherapy treatment but are usually
    reexamined by a physician every 4 to 6 weeks during the ongoing
    course of treatments.   Any changes in the future course of
    treatments are documented in the patient's file at that time.
    Petitioner's personnel mix and otherwise prepare the
    chemotherapy drugs that petitioner administers to a patient; the
    chemotherapy drugs cannot be self-administered.    One of
    petitioner's oncology nurses generally performs the
    administration, and a physician is always on site to respond to
    emergencies.   The physician is not always in the room during the
    administration.
    Petitioner is a participating provider with Medicare1 and
    several other private insurance carriers.   Virtually all of
    petitioner's patients who receive chemotherapy treatments are
    covered by Medicare or private insurance, and those patients are
    billed only for the cost of the treatments to the extent of
    co-payments, deductibles, and other uncovered charges.      For each
    1
    See Health Insurance for Aged Act, Pub. L. 89-97, 
    79 Stat. 291
     (1965), currently codified at 42 U.S.C. secs. 1395 through
    1395ccc (1994).
    - 5 -
    patient visit, petitioner's staff prepares a physician's
    statement known as a "charge sheet", which is the document from
    which petitioner's billing department generates its bills.   The
    charge sheet specifically lists the type, amount, and cost of
    chemotherapy and other drugs administered, and the type and cost
    of all professional services rendered.   The charge sheets are
    specific as to the particulars of chemotherapy treatments so as
    to comply with the guidelines of Medicare and the private
    insurance industry.   Petitioner submits the charge sheets
    directly to Medicare or other responsible party, and petitioner
    bills its patients for the copayments or other charges not
    covered by insurance.
    Medicare and private insurers analyze on an item-by-item
    basis whether to reimburse the charges shown on the charge
    sheets.    The dollar amount reimbursed for a drug administered to
    a patient is ascertained by reference to the average wholesale
    price (AWP) of the units in which the drug is packaged and sold
    wholesale, which AWP is published annually with quarterly
    updates.   Generally, the reimbursement amount for drugs equals
    the AWP times the units used, with rounding up to the next whole
    unit of a drug when billing for administration of a partial unit.
    It is common industry practice to charge for all medical
    services provided even when the health care provider anticipates
    it will not be paid in full for all charges.   The standard charge
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    nationally for chemotherapy drugs is 1.5 times the AWP, and
    petitioner bills its patients for the drugs at this rate with the
    expectation that the patient will pay the excess over the amount
    reimbursed.   With all reimbursement payments from Medicare or
    private insurers, petitioner receives an "Explanation of
    Benefits" that details the amounts allowed and disallowed as to
    each specific charge, and the amounts for each charge which are
    due from secondary insurance and/or the patient.
    Petitioner has always used the cash method for purposes of
    both financial and tax accounting, and it has never maintained an
    inventory of any of the items used in its practice.    Petitioner
    expenses as supplies the cost of all chemotherapy drugs purchased
    during the year; the actual cost of chemotherapy drugs which it
    had on hand at the end of 1995 was $31,887.    Petitioner deducted
    on its 1995 tax return $772,522 in "medical supplies" for the
    actual cost of the chemotherapy drugs and $66,305 in "laboratory
    supplies" for the actual cost of miscellaneous nonpharmaceutical
    items.   Petitioner reported on its 1995 tax return $2,938,726 in
    gross receipts and no cost of goods sold.
    Respondent determined that petitioner had to inventory its
    chemotherapy drugs, and, thus, that petitioner's use of the cash
    method did not clearly reflect its income.    Respondent changed
    petitioner's method of accounting to a hybrid method, which
    hybrid method accounted for the chemotherapy drugs on an accrual
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    method and the balance of petitioner's business on the cash
    method.   Respondent's change to the hybrid method increased
    petitioner's income by:   (1) $31,887, the actual cost of the
    chemotherapy drugs on hand at the end of 1995, and (2) $148,557,
    the value of petitioner's accounts receivable relating to
    chemotherapy drugs conveyed to patients as of the end of 1995.
    Discussion
    We decide for the first time whether the furnishing of
    pharmaceuticals by a medical treatment facility as an integral,
    indispensable, and inseparable part of the rendering of medical
    services is the sale of "merchandise" for purposes of section
    1.471-1, Income Tax Regs.   In Hospital Corp. of Am. v.
    Commissioner, 
    107 T.C. 116
     (1996) (HCA), we held that medical
    supplies and pharmaceuticals used by hospitals are so vital to
    the furnishing of medical services that income earned therefrom
    constitutes income earned from the performance of services for
    purposes of the nonaccrual-experience method of section
    448(d)(5).   In HCA, we explicitly reserved for another day the
    question of whether those supplies and pharmaceuticals were
    merchandise that had to be inventoried under section 1.471-1,
    Income Tax Regs.   See 
    id.
     at 143-144 n.18.   That day is here in
    the factual setting of a physician’s outpatient chemotherapy
    treatment facility.
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    We decide this issue in the context of whether it was an
    abuse of respondent’s discretion to exercise his authority under
    section 446 and require petitioner to change from the cash method
    to a hybrid method.2    Presented is the question of whether
    petitioner should be required to keep inventories for tax
    purposes under section 471.    Respondent determined that
    petitioner’s chemotherapy drugs were merchandise that was an
    income-producing factor, that petitioner therefore was required
    2
    Sec. 446 provides in pertinent part:
    SEC. 446.    GENERAL RULE FOR METHODS OF ACCOUNTING.
    (a) General Rule.--Taxable income shall be
    computed under the method of accounting on the basis of
    which the taxpayer regularly computes his income in
    keeping his books.
    (b) Exceptions.--If no method of accounting has
    been regularly used by the taxpayer, or if the method
    used does not clearly reflect income, the computation
    of taxable income shall be made under such method as,
    in the opinion of the Secretary, does clearly reflect
    income.
    (c) Permissible Methods.--Subject to the
    provisions of subsections (a) and (b), a taxpayer may
    compute taxable income under any of the following
    methods of accounting--
    (1) the cash receipts and disbursements method;
    (2) an accrual method;
    (3) any other method permitted by this chapter; or
    (4) any combination of the foregoing
    methods permitted under regulations
    prescribed by the Secretary.
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    to inventory the drugs, and that petitioner was required to use
    an accrual method to account for this inventory in order to
    reflect its income clearly.    Petitioner asserts that it is not a
    merchandising business but a provider of services; to wit,
    chemotherapy treatments for patients stricken with cancer.
    Petitioner argues that it need not maintain inventories for the
    chemotherapy drugs used in the treatments.
    We agree with petitioner that it is not required to
    inventory its chemotherapy drugs.    We are mindful of the broad
    discretion accorded the Commissioner in applying sections 446 and
    471.    Taxpayers challenging the Commissioner’s authority must
    prove that the Commissioner’s determination is “clearly unlawful”
    or “plainly arbitrary”.    See Thor Power Tool Co. v. Commissioner,
    
    439 U.S. 522
     (1979); see also Wal-Mart Stores, Inc. & Subs. v.
    Commissioner, 
    T.C. Memo. 1997-1
    , affd. 
    153 F.3d 650
     (8th Cir.
    1998).    The fact that the Commissioner has broad authority under
    section 446(b), however, does not mean that the Commissioner may
    change a taxpayer’s method of accounting with impunity.        See,
    e.g., Prabel v. Commissioner, 
    91 T.C. 1101
    , 1112-1113 (1988),
    affd. 
    882 F.2d 820
     (3d Cir. 1989).      The Commissioner, for
    example, may not change a taxpayer's method of accounting from
    one that clearly reflects income to another one that the
    Commissioner believes more clearly reflects income.      See
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    Ansley-Sheppard-Burgess Co. v. Commissioner, 
    104 T.C. 367
     (1995);
    see also Wal-Mart Stores, Inc. & Subs. v. Commissioner, supra.
    We focus our inquiry on whether the chemotherapy drugs were
    supplies deductible under section 162, or merchandise that must
    be inventoried under section 471.   Section 162(a) allows a
    deduction for “all the ordinary and necessary expenses paid or
    incurred during the taxable year in carrying on any trade or
    business”.   The relevant regulations explain that
    Taxpayers carrying materials and supplies on hand
    should include in expenses the charges for materials
    and supplies only in the amount that they are actually
    consumed and used in operation during the taxable year
    for which the return is made, provided that the costs
    of such materials and supplies have not been deducted
    in determining the net income or loss or taxable income
    for any previous year. If a taxpayer carries
    incidental materials or supplies on hand for which no
    record of consumption is kept or of which physical
    inventories at the beginning and end of the year are
    not taken, it will be permissible for the taxpayer to
    include in his expenses and to deduct from gross income
    the total cost of such supplies and materials as were
    purchased during the taxable year for which the return
    is made, provided the taxable income is clearly
    reflected by this method. [Sec. 1.162-3, Income Tax
    Regs.]
    Section 471 provides in pertinent part:
    SEC. 471.   GENERAL RULE FOR INVENTORIES.
    (a) General Rule.--Whenever in the opinion of the
    Secretary the use of inventories is necessary in order
    clearly to determine the income of any taxpayer,
    inventories shall be taken by such taxpayer on such
    basis as the Secretary may prescribe as conforming as
    nearly as may be to the best accounting practice in the
    trade or business and as most clearly reflecting the
    income.
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    The relevant regulations explain that "inventories at the
    beginning and end of each taxable year are necessary in every
    case in which the production, purchase, or sale of merchandise is
    an income-producing factor."   Sec. 1.471-1, Income Tax Regs.
    Jurisprudence provides that a taxpayer with inventories must use
    an accrual method, unless the taxpayer shows that use of another
    method would produce a substantial identity of results and that
    the Commissioner’s determination requiring a change is an abuse
    of discretion.   See Knight-Ridder Newspapers, Inc. v. United
    States, 
    743 F.2d 781
    , 789, 791-793 (11th Cir. 1984);
    Wilkinson-Beane, Inc. v. Commissioner, 
    420 F.2d 352
     (1st Cir.
    1970), affg. 
    T.C. Memo. 1969-79
    ; Ansley-Sheppard-Burgess Co. v.
    Commissioner, 
    104 T.C. at 377
    ; see also sec. 1.446-1(c)(2)(i),
    Income Tax Regs.
    Under the facts at hand, respondent may require petitioner
    to utilize an inventory method of accounting only if we find each
    of the following as facts:   (1) Petitioner produced, purchased,
    or sold merchandise, and (2) petitioner's production, purchase,
    or sale of that merchandise was an income-producing factor.     See
    Honeywell Inc. v. Commissioner, 
    T.C. Memo. 1992-453
    , affd.
    without published opinion 
    27 F.3d 571
     (8th Cir. 1994).   We need
    not reach the second part of this inquiry; i.e., whether the
    production, purchase, or sale of merchandise is an
    income-producing factor, if we are unable to find first that the
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    chemotherapy drugs are merchandise.      See Wilkinson-Beane, Inc. v.
    Commissioner, supra; Honeywell Inc. v. Commissioner, supra; sec.
    1.471-1, Income Tax Regs.
    The statute and regulations do not define the words
    “merchandise” or “inventory”, nor do they clearly distinguish
    between "inventory" and “materials and supplies” that are not
    actually consumed and remain on hand.     We have held that
    “merchandise”, as used in section 1.471-1, Income Tax Regs., is
    an item acquired and held for sale.      See Wilkinson-Beane, Inc. v.
    Commissioner, 
    T.C. Memo. 1969-79
    .     Upon appeal, the Court of
    Appeals for the First Circuit agreed, stating:
    A canvassing of authorities in the accounting field
    yields several definitions, such as “goods purchased in
    condition for sale,” “goods awaiting sale,” “articles
    of commerce held for sale,” and “all classes of
    commodities held for sale.” Clearly, the meaning of
    the term must be gathered from the context and the
    subject. * * * The common denominator, however, seems
    to be that the items in question are merchandise if
    held for sale. [Wilkinson-Beane, Inc. v. Commissioner,
    
    420 F.2d at 354-355
    ; citations omitted.]
    Whether an item is acquired and held for sale is governed by
    the substance of the transaction and not its form.     See Honeywell
    Inc. v. Commissioner, supra.     We take into account the particular
    facts and circumstances of the taxpayer in each case and the
    manner and context in which the taxpayer operates the business at
    hand.     See Wilkinson-Beane, Inc. v. Commissioner, supra; Thompson
    Elec., Inc. v. Commissioner, 
    T.C. Memo. 1995-292
    ; Honeywell Inc.
    v. Commissioner, supra; J.P. Sheahan Associates, Inc. v.
    - 13 -
    Commissioner, 
    T.C. Memo. 1992-239
    .     We have previously examined
    service transactions in a variety of industries to determine
    whether the transactions in substance involved solely the sale of
    a service, or whether the transactions involved the sale of both
    a service and merchandise.   Those cases are not readily
    reconcilable and underscore the fact-intense nature of this
    inquiry.3   We have not, however, explored this issue in the
    context of the health care industry and have never had a
    situation where, as here, applicable laws would prohibit the
    taxpayer from selling the items in issue without provision of the
    attendant service.
    We find the instant setting distinguishable from the setting
    of those cases in which we have held that goods utilized by a
    service provider were merchandise for purposes of the inventory
    rules.   We give significance to the uniqueness of the industry in
    3
    See, e.g., Addison Distribution, Inc. v. Commissioner,
    
    T.C. Memo. 1998-289
     (electronic materials were merchandise);
    Thompson Elec., Inc. v. Commissioner, 
    T.C. Memo. 1995-292
    (electrical contractor’s wire, conduit, and electrical panels
    were merchandise); Honeywell Inc. v. Commissioner, 
    T.C. Memo. 1992-453
     (rotable spare parts used in maintenance service
    business were not merchandise; Court rejected argument that
    taxpayer’s “consideration” of the parts' cost to set its fixed
    fee established that the parts were acquired and held for sale),
    affd. without published opinion 
    27 F.3d 571
     (8th Cir. 1994); J.P.
    Sheahan Associates, Inc. v. Commissioner, 
    T.C. Memo. 1992-239
    (contractor’s roofing materials were merchandise); Surtronics,
    Inc. v. Commissioner, 
    T.C. Memo. 1985-277
     (electroplating metals
    were merchandise); Wilkinson-Beane, Inc. v. Commissioner, 
    T.C. Memo. 1969-79
     (funeral business’ caskets were merchandise), affd.
    
    420 F.2d 352
     (1st Cir. 1970).
    - 14 -
    which petitioner operates in relation to the other service
    industries we have addressed on this issue and bear in mind the
    recent case of Hospital Corp. of Am. v. Commissioner, 
    107 T.C. 116
    , 143-145 (1996).   There, as explained in more detail below,
    we held that the income attributable to the pharmaceuticals and
    various medical supplies frequently used by the personnel of the
    taxpayer/hospital while performing medical services was not
    income from the sale of goods for purposes of the nonaccrual-
    experience method of section 448(d)(5).4   We held that those
    items were "inseparably connected" to the taxpayer's services.
    See 
    id. at 143
    .
    Like the taxpayer in HCA, petitioner's business is a
    quintessential service business.   It is a health care provider
    that administers chemotherapy treatments to patients with cancer.
    Although it furnishes chemotherapy drugs to its patients as part
    of its service, a person cannot obtain the drugs but for the
    chemotherapy treatments, and the treatments require the extensive
    and specialized service of petitioner's professional staff.
    Petitioner's professional staff, as an integral and indispensable
    part of furnishing chemotherapy drugs to a patient, must examine
    the patient and prescribe a treatment regime, monitor the length,
    4
    The medical supplies included items such as radiological
    dyes, casts, crutches, canes, walkers, bandages, sutures,
    splints, skin staples, various implants such as joint
    replacements, pacemakers, heart valves, orthopedic devices, and
    physical and occupational therapy items.
    - 15 -
    kind, quantity, and frequency of the treatments, and reevaluate
    the patient on an ongoing basis.   That these services are
    critical and essential to the furnishing of the chemotherapy
    drugs by petitioner's staff cannot be denied.
    Petitioner is not a merchandiser.   Although it is true that
    petitioner transfers the tangible quality of the chemotherapy
    drugs to its patients when it administers the drugs to them,
    petitioner does so only as an integral and inseparable part of
    its service.   Petitioner is precluded by law from selling the
    chemotherapy drugs to any person without providing the medical
    service, and the drugs are not susceptible of self-
    administration.   In fact, the only way that a person may legally
    receive the chemotherapy drugs from petitioner is to agree to
    petitioner's overall chemotherapy service, and, when they do
    agree to this service, they have no say in the type or quantity
    of chemotherapy drugs which petitioner uses in their care.
    Usually, they are not even aware of the type or quantity of
    chemotherapy drugs used on them as part of their treatment.
    Where, as here, the service provider dispenses the drugs as an
    indispensable and inseparable part of the rendering of its
    services, the service provider is not selling “merchandise”.     The
    service provider is using the items as supplies which are
    essential to the provision of its services.   A medical practice
    such as petitioner’s is inherently a service business, and the
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    drugs administered in the practice are subordinate to the
    provision of the medical services.
    We disagree with respondent's contention that "The transfer
    of the drugs is clearly a commercial transaction" to the extent
    he implies a commercial transaction is the conveyance of
    merchandise.   Given the nature of the services petitioner
    provides and the substance of the service transactions, we are
    convinced petitioner is not selling merchandise when it
    administers chemotherapy drugs.   The case of Abbott Labs. v.
    Portland Retail Druggists Association, Inc., 
    425 U.S. 1
     (1976),
    parallels that conviction.   There, the Supreme Court decided
    whether drugs purchased by a nonprofit hospital at prices lower
    than those charged commercial pharmacists were exempt from the
    antiprice discrimination provisions of the Robinson-Patman
    Antidiscrimination Act, ch. 592, 
    49 Stat. 1526
     (1936), 15 U.S.C.
    sec. 13(a) (1994).   The exemption generally applies where the
    nonprofit institution is purchasing the drugs for its "own use"
    as opposed to for sale to patients.    In siding with the
    hospital's contention that it was exempt, the Court stated:
    it seems to us to be very clear that a hospital's
    purchase of pharmaceutical products that are dispensed
    to and consumed by a patient on the hospital premises,
    whether that patient is bedded, or is seen in the
    emergency facility, or is only an outpatient, is a
    purchase of supplies for the hospital's "own use," * *
    *. In our view, * * * this is so clear that it needs
    no further explication. [Abbot Labs. v. Portland
    Retail Druggists Association, supra at 10-11; emphasis
    added.]
    - 17 -
    This Court has also stated similarly.   See St. Luke's Hosp. v.
    Commissioner, 
    35 T.C. 236
    , 238 (1960), wherein the Court stated
    that the taxpayer hospital was "not a merchandising business, and
    * * * has no merchandise inventories which would require the use
    of an accrual method in keeping its books or reporting its
    income.   Its income is derived from providing hospital and
    professional care to the sick."
    Respondent's characterization of the chemotherapy drugs as
    merchandise offends the natural and ordinary meaning of the term
    "merchandise".   The word "merchandise" denotes commodities or
    goods that are bought and sold in business.   See Merriam
    Webster's Collegiate Dictionary 727 (10th ed. 1996).   Although
    pharmaceuticals could reasonably be construed to be merchandise
    in some contexts; e.g., when purchased at a grocery store for
    self-administration at home, it does not necessarily follow that
    pharmaceuticals are merchandise in all contexts.   The latter
    proposition is especially true under the facts at hand where
    petitioner's patients generally cannot be understood to consider
    themselves as purchasers of "merchandise" during the course of
    their medical treatment.   The chemotherapy drugs are administered
    by petitioner's trained, licensed, and specialized physicians and
    other health-related professionals during the rendition of a
    unique medical service, and, when administered, the drugs are not
    "goods [that were] purchased in condition for sale," or "articles
    - 18 -
    of commerce held for sale."    Simply put, petitioner is not
    peddling products.
    Respondent looks to the value of the chemotherapy drugs and
    asserts that petitioner's business is part service, part sale.
    We disagree.   The mere fact that the chemotherapy drugs are
    expensive is insufficient to transmute the transaction from the
    sale of a service to the sale of merchandise and a service.     The
    common denominator that the items be held for sale is lacking on
    these facts.   Petitioner's chemotherapy treatment business is a
    pure service business and not, as respondent asserts, a mixed
    service and merchandising business.     See, e.g., Hewlett-Packard
    Co. v. United States, 
    71 F.3d 398
     (Fed. Cir. 1995) (taxpayer's
    computer maintenance business was a service business, not mixed
    service and merchandise business, despite installation of parts);
    Honeywell, Inc. v. Commissioner, 
    T.C. Memo. 1992-453
     (taxpayer's
    computer maintenance business was a service business, not mixed
    service and merchandise business, despite installation of parts),
    affd. without published opinion 
    27 F.3d 571
     (8th Cir. 1994).
    We find no cases on this issue analogous, much less
    controlling.   The reported authorities, including those cases
    where the court found that the merchandise at issue there was
    sold either with or without a service, are all materially
    distinguishable from the facts herein given the uniqueness of the
    service provided.    Respondent relies on the seminal case of
    - 19 -
    Wilkinson-Beane, Inc. v. Commissioner, 
    420 F.2d 352
     (1st Cir.
    1970), affg. 
    T.C. Memo. 1969-79
    .   There, the taxpayer was an
    undertaker that sold caskets as part of its funeral service.    In
    finding that the caskets were merchandise for purposes of section
    471, the Court of Appeals for the First Circuit noted that the
    taxpayer normally kept an inventory of some 35 caskets, that the
    caskets were not necessarily used during the year but were
    purchased and occasionally carried for long periods of time, that
    the caskets were on display and played a central role in the
    "sale" of the taxpayer's service, and that there was a direct
    relationship between the magnificence of the caskets and the cost
    of the service.   See 
    id.
    Those factors are not present here.   Petitioner kept no more
    than a 2-week supply of chemotherapy drugs on hand and used
    virtually all the drugs during the taxable year.   The drugs also
    were not displayed to patients for selection, and patients played
    no role in determining the type or amount of drugs used on them.
    Furthermore, unlike the taxpayer’s business in Wilkinson-Beane,
    Inc., the type of chemotherapy drugs or the "magnificence"
    thereof played no role in whether patients chose to purchase
    petitioner's services.   The variable factor in the cost of a
    patient's treatment is a factor out of the patient's control;
    i.e., the type and severity of the patient's condition.   We also
    find it critical that a person is unable to obtain the
    - 20 -
    chemotherapy drugs without purchasing petitioner's service.    We
    find nothing in the case of Wilkinson-Beane, Inc. that would
    cause us to believe that the taxpayer's services there depended
    on the purchase of caskets from it.    Instead, the taxpayer in
    Wilkinson-Beane, Inc., by choice, sold the funeral services and
    caskets as a package.
    Respondent also relies on Knight-Ridder Newspapers, Inc. v.
    United States, 
    743 F.2d 781
     (11th Cir. 1984).    There, the Court
    of Appeals for the Eleventh Circuit considered whether the
    taxpayer, who produced and sold newspapers, was required to keep
    inventories.   The taxpayer argued that it was a service business
    in that it provided information for its readership and
    advertisement for its clients.   The court found that even though
    the taxpayer sold an extremely perishable commodity (a 2-day-old
    newspaper is stale) and had no inventory of finished goods, the
    taxpayer was required to account for inventories because the
    newspapers were merchandise and there was a significant
    fluctuation of newsprint and ink on hand.
    The facts of Knight-Ridder Newspapers, Inc. v. United
    States, supra, are materially distinguishable from the facts at
    hand.   In contrast to the instant case, the taxpayer in Knight-
    Ridder, Inc. clearly manufactured a product (newspapers) and used
    raw materials (paper and ink) in the manufacturing process.    We,
    like the Court of Appeals for the Eleventh Circuit, find
    - 21 -
    unconvincing the taxpayer's argument that the readership was
    purchasing a service.
    We also find the facts herein to be markedly different from
    the facts presented in the various cases on this issue involving
    contractors and subcontractors.   In all of those cases where we
    found the taxpayer was selling merchandise, the contractor's
    services involved installation of products and the customers came
    to the contractors to purchase the products as well as the
    installation services.   See, e.g., Thompson Elec., Inc. v.
    Commissioner, 
    T.C. Memo. 1995-292
     (taxpayer was selling
    merchandise in connection with a service when he installed
    wiring, conduits, electrical panels, and lighting fixtures); J.P.
    Sheahan Associates, Inc. v. Commissioner, 
    T.C. Memo. 1992-239
    (contractor's roofing materials were merchandise); Surtronics,
    Inc. v. Commissioner, 
    T.C. Memo. 1985-277
     (electroplating metals
    were merchandise).   The customers of the taxpayers also could
    have personally purchased the merchandise elsewhere and either
    installed the merchandise themselves, if they had the time and
    expertise to do so, or contracted with a third party to install
    the merchandise for them.   In the instant case, by contrast,
    persons seeking chemotherapy treatment may not buy the drugs
    elsewhere, and they may not apply the drugs themselves.
    Respondent unduly focuses on the fact that petitioner listed
    on the bills submitted to Medicare and private insurers the type
    - 22 -
    and amount of chemotherapy drugs used on its patients but did not
    itemize the less expensive supplies.    While we agree with
    respondent that the itemization of the drugs on the bills is a
    fact properly considered, see, e.g., Thompson Elec., Inc. v.
    Commissioner, supra, we disagree with respondent that it is
    dispositive of the issue.    The substance of the transactions at
    issue is that a service is provided by and purchased from
    petitioner.   Petitioner and other health care providers today
    must operate under a myriad of statutory, regulatory, and
    contractual mandates the purpose of which is aimed at management
    of care and cost containment in the health care industry.      See,
    e.g., 42 U.S.C. secs. 1395 through 1395ccc (1994); 42 C.F.R.
    secs. 405.201 through 405.2470 (1998); Health Care Finance
    Administration, Medicare Provider Reimbursement Manual (Pubs. 15-
    1 and 15-2) (Rev. 3-93).    Undoubtedly, as the costs of medical
    supplies increase, so do the regulatory and contractual
    directives for itemization and justification.    There is no
    evidence petitioner provided those itemizations for merchantable
    purposes or because it was selling merchandise.    Rather, the
    manner and form in which petitioner prepares its bills are
    dictated by applicable laws, contracts with private insurers, and
    the environment of the industry in which it operates.    We decline
    to attach further accounting or other significance thereto.
    - 23 -
    Our declining to attach accounting significance to the bills
    is supported by Federal Medicare statutes and regulations.     As
    stipulated by the parties, the chemotherapy treatments and drugs
    at issue are covered by Medicare.   Medicare covers only medical
    "services" and does not cover prescription drugs that can be
    self-administered.   See 42 C.F.R. sec. 410.29 (1998).5   In
    creating legislative coverage for medical services, Congress was
    astutely aware that health care providers may need to use
    supplies or administer drugs incident to and as an integral part
    of their services.   As pertinent, the Health Insurance for Aged
    Act, Pub. L. 89-97, sec. 1861, 
    79 Stat. 291
    , 321 (1965), 42
    U.S.C. sec. 1395x(s) (1994), provides as follows:
    The term "medical and other health services" means
    any of the following items or services:
    (1) physicians' services;
    (2)(A) services and supplies (including drugs
    and biologicals which cannot, as determined
    in accordance with regulations, be self-
    administered) furnished as an incident to a
    physician's professional service, of kinds
    which are commonly furnished in physicians'
    offices and are commonly either rendered
    without charge or included in the physicians'
    bills.
    5
    This is true for the fee-for-service statutory coverage
    under Medicare. The Secretary of Health and Human Services may
    contract with private insurers (health maintenance organizations)
    to provide benefits to beneficiaries under Medicare. See Health
    Insurance for Aged Act, Pub. L. 89-97, 
    79 Stat. 291
     (1965), 42
    U.S.C. sec. 1395mm (1994). The beneficiaries that opt for
    coverage under a health maintenance organization plan may have
    prescription drug coverage under their contract with the insurer.
    - 24 -
    The chemotherapy treatments administered by petitioner, including
    the chemotherapy drugs, are considered part of the medical
    service under Medicare and are within the scope of Medicare's
    coverage.   Congress explicitly provided that charging for the
    drugs on the bill does not change the nature of the transaction
    from the provision of a covered "service" to the sale of
    noncovered prescription drugs.    See 42 U.S.C. sec. 1395x(s)
    (1994); see also 42 C.F.R. secs. 410.10, 410.26, 410.27 (1998).
    Respondent is also unduly impressed by the fact that
    petitioner's physicians do not administer the treatments and are
    generally not present when treatments are administered by
    oncology nurses.   This is irrelevant to the inquiry of whether
    petitioner is selling a service or a service and merchandise, and
    we place no significance on it.    We disagree with respondent's
    likening the facts herein to "prescription drugs in a drug store
    -- drugs which are clearly merchandise requiring the use of
    inventories."   When a drug store sells drugs, there is little if
    any specialized and personalized service element attendant to the
    sale.   Respondent's analogy is flawed.
    Respondent argues the chemotherapy drugs comprised 26
    percent of petitioner's gross receipts, that the drugs are billed
    to responsible parties at 1.5 times the AWP, and that the cost of
    the chemotherapy drugs was dramatically higher than the cost of
    other supplies.    These factors go to whether the sale of the
    - 25 -
    "merchandise" is an income-producing factor.   Without addressing
    the merits of these arguments, we do not interpret section
    1.471-1, Income Tax Regs., to require that if a material is an
    income-producing factor it must, per se, be “merchandise”.    The
    section provides that “inventories * * * are necessary in every
    case in which the production, purchase, or sale of merchandise is
    an income-producing factor”.   See sec. 1.471-1, Income Tax Regs.
    Because we conclude that the chemotherapy drugs used in the
    administration of the chemotherapy treatments are not
    merchandise, we need not and do not reach the question of whether
    merchandise is an income-producing factor in petitioner’s
    business.
    As mentioned above, our conclusion parallels our holding in
    Hospital Corp. of Am. v. Commissioner, 
    107 T.C. 116
     (1996), where
    the hospital's professional staff frequently used pharmaceuticals
    and medical supplies to provide medical care to patients.
    Respondent argued in that case that the income attributable to
    the pharmaceuticals and supplies could not be reported using the
    nonaccrual-experience method of section 448(d)(5) because the
    income was attributable to the sale of “goods”.   
    Id. at 141
    .
    Under that method, an accrual method taxpayer need not accrue
    amounts to be received for the performance of services that, on
    the basis of experience, will not be collected.   See sec.
    448(d)(5).   The nonaccrual-experience method may not be used to
    - 26 -
    the extent amounts are attributable to a "taxpayer's activities
    with respect to * * * selling goods".    Sec. 1.448-2T(d),
    Temporary Income Tax Regs., 
    52 Fed. Reg. 22775
     (June 16, 1987).
    We held in HCA that the taxpayer's income attributable to
    the pharmaceuticals and medical supplies was service income
    because it was "inseparably connected" to the performance of
    services.    Hospital Corp. of Am. v. Commissioner, 
    107 T.C. at 143
    .    Consistent with that holding, the income that petitioner
    earned here from its use of the chemotherapy drugs must also be
    considered service income.    Service income, by definition, does
    not include income from the sale of goods.    See, e.g., sec.
    1.448-2T(d), Temporary Income Tax Regs., 
    52 Fed. Reg. 22775
     (June
    16, 1987).    The logical conclusion is that the underlying items
    giving rise to service income also are not "merchandise".      As we
    discussed above, the meaning of the word “merchandise” is no
    broader than the meaning of the word "goods", and, if anything,
    the word “merchandise” is a subset of the word “goods”.      As a
    matter of fact, not even respondent has argued that an item can
    be “merchandise” for one purpose of the Code but not a “good” for
    a different purpose.    Nor has respondent argued that an item the
    income from which may be reported on the nonaccrual-experience
    method may be inventory for purposes of section 471.
    The notice of deficiency is worded broadly as to the
    specific basis for respondent's determination that the cash
    - 27 -
    method does not clearly reflect petitioner’s income.    On brief,
    however, respondent’s argument as to why petitioner's use of the
    cash method does not clearly reflect income articulates that the
    chemotherapy drugs are merchandise that must be inventoried.
    Respondent does not dispute that petitioner's use of the cash
    method clearly reflects income to the extent that the
    chemotherapy drugs are not merchandise.   We need not and do not
    engage in further analysis of the clear reflection of income
    standard of section 446.6   See Concord Consumers Housing v.
    Commissioner, 
    89 T.C. 105
    , 106 n.3 (1987); Estate of Fusz v.
    Commissioner, 
    46 T.C. 214
    , 215 n.2 (1966).   Based on the
    foregoing, we hold that respondent abused his discretion in
    requiring petitioner to use the hybrid method and that petitioner
    may report all its income and expenses under the cash method.
    We have considered all arguments in this case for a contrary
    holding and, to the extent not discussed above, find those
    6
    We are mindful of Asphalt Prods. Co. v. Commissioner, 
    796 F.2d 843
     (6th Cir. 1986), affg. in part and revg. in part Akers
    v. Commissioner, 
    T.C. Memo. 1984-208
    , revd. on another issue 
    482 U.S. 117
     (1987), wherein the Court of Appeals for the Sixth
    Circuit held that the taxpayer’s method of accounting did not
    clearly reflect its income. The setting of Asphalt Prods. Co. is
    distinguishable from the setting at hand. The issue there was
    not the issue before us today; i.e., whether the furnishing of
    pharmaceuticals by a medical treatment facility as an integral,
    indispensable, and inseparable part of the rendering of medical
    services is the sale of "merchandise" for purposes of section
    1.471-1, Income Tax Regs. That case also involved primarily a
    significant accumulation of accounts receivable at yearend and
    neither involved nor addressed whether the disputed items of
    inventory (asphalt) were merchandise in the first place.
    - 28 -
    arguments to be without merit or irrelevant.   To reflect the
    foregoing,
    Decision will be entered
    for petitioner.
    Reviewed by the Court.
    CHABOT, PARR, WELLS, COLVIN, BEGHE, FOLEY, VASQUEZ, GALE,
    and THORNTON, JJ., agree with this majority opinion.
    MARVEL, J., concurs in the result only.
    RUWE, J., dissents.
    - 29 -
    PARR, J., concurring:   I agree with the majority's opinion,
    and write separately merely to emphasize that each case that
    comes before this Court presents a unique set of facts and is
    decided on its own merits.   Although we now find that the facts
    of this case are "markedly different" from the facts of some of
    the cases we have decided involving construction contractors, I
    believe that the principles enunciated here also apply to
    construction cases.   This is true, for example, when a building
    material is indispensable and inseparable from the service
    provided by the construction contractor.   See, e.g., Galedrige
    Constr., Inc. v. Commissioner, 
    T.C. Memo. 1997-240
    .
    BEGHE, J., agrees with this concurring opinion.
    - 30 -
    BEGHE, J., concurring:   I write separately to tie up or at
    least pick at a loose end left by respondent’s determination and
    arguments:   the proper tax treatment of the slightly more than 2-
    week supply of chemotherapy drugs costing $31,887 on hand at the
    end of the taxable year.1
    Respondent, having tried to put petitioner on the accrual
    method with respect to “sales” of chemotherapy drugs, determined
    that petitioner’s income should be increased not only by the cost
    of such drugs on hand at yearend in the amount of $31,887, but
    also by $148,557, the value of petitioner’s accounts receivable
    relating to such drugs transmitted to patients during the year.
    Rejecting respondent’s “sales” characterization in favor of
    treating petitioner’s operations as an overall service business,
    we have thereby rejected respondent’s determination putting
    petitioner on a hybrid method that would require accrual of its
    yearend receivables with respect to transmissions of such drugs.
    Respondent did not assert or argue, as an alternative fall-
    back position, that petitioner’s deduction of the cost of drugs
    on hand at yearend should be deferred to the following year.   The
    Court need not sua sponte make that adjustment, particularly
    where the proper result in this case is not clear, in part
    because respondent did not make a stand-alone clear-reflection-
    1
    $772,522 ÷ 26 = $29,712.384 (average cost of 2-week
    supply) ‹ $31,877 (actual on hand).
    - 31 -
    of-income determination (or even argument) with respect to such
    drugs.   But, because other cases under submission to the Court
    present similar or analogous issues, and because the issue seems
    to be a recurring one, a premonitory attempt to tidy up may not
    be amiss.
    The relevant authority is section 1.162-3, Income Tax Regs.,
    “Cost of materials”, which provides as follows:
    Taxpayers carrying materials and supplies on hand
    should include in expenses the charges for materials
    and supplies only in the amount that they are actually
    consumed and used in operation during the taxable year
    for which the return is made, provided that the costs
    of such materials and supplies have not been deducted
    in determining the net income or loss or taxable income
    for any previous year. If a taxpayer carries
    incidental materials or supplies on hand for which no
    record of consumption is kept or of which physical
    inventories at the beginning and end of the year are
    not taken, it will be permissible for the taxpayer to
    include in his expenses and to deduct from gross income
    the total cost of such supplies and materials as were
    purchased during the taxable year for which the return
    is made, provided the taxable income is clearly
    reflected by this method.
    The accounting authorities are in accord:    This regulation
    means that “Supplies in and of themselves are not considered
    inventory and, thus, will not cause the taxpayer to be required
    to use accrual accounting,” Bauernfeind, Income Taxation
    Accounting Methods and Periods 3-4 (1991), “supplies are deferred
    expenses under Reg. § 1.162-3 and not inventory under § 471”, id.
    3-14, n. 61, and “when the taxpayer’s inventories are of supplies
    only, use of the cash method is permitted.   These items are not
    - 32 -
    inventories under section 471.    They are not held for sale in the
    ordinary course of business.”    Gertzman, Federal Tax Accounting
    3-55 (2d ed. 1993) (Gertzman).
    The regulation says that materials and supplies cannot be
    currently expensed unless four tests are met:   (1) They are
    “incidental”; (2) no record of consumption is kept; (3) no
    physical inventories are taken at the beginning and end of the
    year; and (4) income is clearly reflected.   Petitioner in this
    case would appear to flunk the first three tests: (1)
    Chemotherapy drugs transmitted to patients in the course of
    petitioner’s rendering of medical services are a substantial
    portion of petitioner’s gross receipts and are a material income
    producing factor, as evidenced by the markups shown in
    petitioner’s billing records; and (2) and (3) records of
    consumption and of supplies on hand at yearend are kept; indeed
    such records seem to be required by Medicare.   However, as to
    (4), respondent has not made a stand-alone clear-reflection-of-
    income determination, having chosen to rely solely on the
    presence of merchandise requiring inventories as compelling
    automatic adoption of the accrual method of accounting, the
    position that we have rejected.
    In other cases of service providers, such as small
    contractors in the construction industry, an adjustment treating
    yearend supplies as deferred expense might very well be
    - 33 -
    appropriate, provided that respondent makes the necessary
    determinations.   Compare J.P. Sheahan Associates, Inc. v.
    Commissioner, 
    T.C. Memo. 1992-239
    , with Thompson Elec., Inc. v.
    Commissioner, 
    T.C. Memo. 1995-292
    , which present different
    findings of fact regarding yearend materials and supplies.
    As Gertzman states at 6-30:
    The rationale behind this provision [the sec. 162-
    3 regulation] seems clear. Many taxpayers do not
    maintain financial accounting records of consumption
    and do not take physical inventories of the supplies on
    hand at the beginning and end of the year for business
    purposes. In these cases, it would be inconsistent
    with the book conformity requirement of Section 446(a),
    impractical, and unduly burdensome to require that they
    undertake such record-keeping responsibilities or make
    such physical counts solely for tax purposes. However,
    to protect the Treasury against taxpayers who might
    avoid undertaking these activities solely for the
    purpose of obtaining a tax benefit, two protections are
    afforded. First, the supplies must be incidental and,
    second, the taxable income so computed must be
    reflected clearly * * * [citation omitted.]
    The regulation appears to be not much more than an
    illustration of the rule that expenditures that result in assets
    having a life beyond the end of the year must be capitalized.
    See sec. 263; INDOPCO, Inc. v. Commissioner, 
    503 U.S. 79
     (1992).
    Without attempting to predict the outcome of a hypothetical, see
    Gulf Oil Corp. v. Commissioner, 
    89 T.C. 1010
    , 1044 (1987)
    (Chabot, J., concurring), affd. on other grounds 
    914 F.2d 396
     (3d
    Cir. 1990), it suffices to note that the section 162 regulation
    authorizes the Commissioner in appropriate cases to treat
    supplies on hand at yearend as deferred expenses.
    - 34 -
    HALPERN, J., dissenting:
    I.   Introduction
    Respondent determined a deficiency in petitioner’s 1995
    Federal income tax liability.    That deficiency resulted from
    respondent’s rejection of the cash receipts and disbursements
    method of accounting (the cash method) used by petitioner to
    compute taxable income and his recomputation of petitioner’s 1995
    taxable income under a hybrid method of accounting.    Under that
    method (the hybrid method), petitioner was required to use an
    accrual method to account for purchases and sales of merchandise.
    Respondent recomputed petitioner’s taxable income pursuant to his
    authority to require a taxpayer to use a method of accounting
    that clearly reflects income, if the method used by the taxpayer
    does not clearly reflect income.    See sec. 446(b).
    Whether a particular method of accounting clearly reflects
    income is a question of fact, and the issue must be decided on a
    case-by-case basis.   See, e.g., Hamilton Indus., Inc. v.
    Commissioner, 
    97 T.C. 120
    , 128-129 (1991).    Generally, where
    respondent has determined that a taxpayer’s method of accounting
    does not clearly reflect income, the taxpayer must demonstrate
    either that his method of accounting clearly reflects income or
    that respondent’s method does not clearly reflect income.    See
    Asphalt Prods. Co. v. Commissioner, 
    796 F.2d 843
    , 847 (6th Cir.
    1986), affg. in part and revg. in part 
    T.C. Memo. 1984-208
    .
    - 35 -
    Petitioner has demonstrated neither that the cash method
    clearly reflected its income nor that the hybrid method does not.
    Petitioner has demonstrated to the majority’s satisfaction,
    however, that its business is a service business.   The majority
    holds:   “Service income, by definition, does not include income
    from the sale of goods.”   Majority op. p. 26.   Therefore, reasons
    the majority, petitioner is not engaged in the sale of
    merchandise (a word that the majority equates with the word
    “goods”).   
    Id.
       Since petitioner is not engaged in the sale of
    merchandise, the majority concludes that respondent may not
    require petitioner to use “an inventory method of accounting”.
    Majority op. p. 11; see sec. 1.471-1, Income Tax Regs.   Finally,
    limiting its consideration to the incompatibility of the cash
    method with an inventory method of accounting, see sec. 1.446-
    1(c)(2)(i), Income Tax Regs., the majority finds that respondent
    abused his discretion in requiring petitioner to use the hybrid
    method and that petitioner may continue to report all of its
    income and expenses under the cash method.
    I dissent from the conclusion that petitioner is not engaged
    in the sale of merchandise.   I also wish to caution against undue
    reliance on the majority’s conclusion that respondent abused his
    discretion in requiring petitioner to use the hybrid method.    As
    will be explained, by his answer to the petition, respondent has
    limited the issues before the Court.
    - 36 -
    II.   Facts
    The majority has set forth many of the facts stipulated by
    the parties, and, for the most part, I shall not repeat those
    facts.   The following facts relate to petitioner’s return,
    respondent’s determination of a deficiency, and the pleadings in
    this case.
    On its Form 1120, U.S. Corporation Income Tax Return, for
    1995, petitioner reported gross receipts of $2,938,726, no amount
    of cost of goods sold, and a gross profit equal to its gross
    receipts.     Among other items, petitioner deducted $772,522 for
    “medical supplies” (chemotherapy drugs), $600,328 for
    compensation paid to its three physician-shareholder-officers
    (officer compensation), and other salaries and wages of $630,381.
    Petitioner’s deduction for chemotherapy drugs equaled 26 percent
    of its reported gross receipts and gross profits and 129 percent
    of its officer compensation.
    For 1995, under the hybrid method, respondent disallowed the
    deduction for chemotherapy drugs claimed by petitioner and
    required petitioner to recompute its gross profit by subtracting
    from gross receipts (determined under an accrual method) the cost
    of the chemotherapy drugs “conveyed” (sold) by petitioner during
    that year.     The net adjustment to petitioner’s 1995 taxable
    income (the net adjustment) was an increase of $180,344,
    resulting from (1) an increase of $148,557 in gross receipts to
    - 37 -
    reflect accounts receivable with respect to chemotherapy drugs
    and (2) an increase in closing inventory for the actual cost,
    $31,887, of such drugs on hand at the end of 1995.
    In respondent’s notice of deficiency in tax (the notice),
    respondent explains the net adjustment as follows:
    It is determined that since the cash basis of
    accounting does not clearly reflect income as required
    by the Internal Revenue Code section 446(b), the
    Government is changing the taxpayer’s method of
    accounting from the overall cash receipts and
    disbursements method of accounting to a hybrid method
    by which purchases and sales of merchandise are
    accounted for on the accrual method of accounting, with
    maintenance of inventories.
    In the petition, petitioner avers, among other things, that
    it is a qualified personal service corporation within the meaning
    of section 448(d)(2), “thus allowing it the use of the cash
    method of accounting.”    See sec. 448(a) and (b).   In the answer,
    respondent denies petitioner’s averment that it is allowed to use
    the cash method and “[a]lleges that the petitioner is required to
    maintain inventories and, therefore, is required to use the
    accrual method for the purchase and sale of inventories.”
    III.    Pertinent Provisions of the Code and Regulations
    Gross income is defined in section 61(a), which includes, as
    an item of gross income, “[g]ross income derived from business”.
    Sec. 61(a)(2).    In pertinent part, section 1.61-3(a), Income Tax
    Regs., provides:    “In a manufacturing, merchandising, or mining
    business, ‘gross income’ means the total sales, less the cost of
    - 38 -
    goods sold, plus any income from investments and from incidental
    or outside operations or sources.”     The regulations thus
    recognize that a necessary step in the calculation of the gross
    income from sales (at least in a manufacturing, merchandising, or
    mining business) is a determination of the cost of goods sold.
    That recognition implies the use of inventories, to determine the
    cost of goods sold.1   Section 1.162-1(a), Income Tax Regs.,
    confirms the role that inventories play in the determination of
    1
    The determination of cost of goods sold and gross income
    from sales for a manufacturer involves the use of inventories
    pursuant to the basic accounting equation described below:
    Beginning inventory                        $    XXX
    Purchases of inventory                          XXX
    Production costs incurred                       XXX
    Total cost of goods
    available for sale                             XXX
    Less: Ending inventory                          XXX
    Cost of goods sold                         $    XXX
    Gross receipts from sales                  $    XXX
    Less: Cost of goods sold                        XXX
    Gross income from sales (sec. 61)          $    XXX
    It can be seen from the foregoing equation that the amount
    of a taxpayer’s ending inventory and cost of goods sold both have
    a very direct effect on the amount of the taxpayer’s gross income
    from sales; however, those effects are exerted in opposite
    directions. All other things being constant, as a taxpayer’s
    ending inventory increases in amount, its cost of goods sold
    decreases, and its gross income from sales increases. In
    contrast, as a taxpayer’s ending inventory decreases in amount,
    its cost of goods sold increases, and its gross income from sales
    decreases. The foregoing equation and comment appear in
    Schneider, Federal Income Taxation of Inventories, sec. 1.01,
    pp. 1:4-1:5 (1999).
    - 39 -
    gross income from sales:    “The cost of goods purchased for
    resale, with proper adjustment for opening and closing
    inventories, is deducted from gross sales in computing gross
    income.”
    Section 446(a) provides the general rule for methods of
    accounting:    “Taxable income shall be computed under the method
    of accounting on the basis of which the taxpayer regularly
    computes his income in keeping his books.”    In pertinent part,
    section 446(b) provides:    “[I]f the method used does not clearly
    reflect income, the computation of taxable income shall be made
    under such method as, in the opinion of the Secretary, does
    clearly reflect income.”
    Section 471(a) is specific with respect to the use of
    inventories:
    SEC. 471(a). General Rule.--Whenever in the
    opinion of the Secretary the use of inventories is
    necessary in order clearly to determine the income of
    any taxpayer, inventories shall be taken by such
    taxpayer on such basis as the Secretary may prescribe
    as conforming as nearly as may be to the best
    accounting practice in the trade or business and as
    most clearly reflecting the income.
    The Secretary has exercised the discretion conferred upon him by
    Congress in section 471 by requiring, pursuant to regulations,
    that, “[i]n order to reflect taxable income correctly,
    inventories at the beginning and end of each taxable year are
    necessary in every case in which the production, purchase, or
    - 40 -
    sale of merchandise is an income-producing factor.”    Sec. 1.471-
    1, Income Tax Regs.
    The determination that a taxpayer must maintain inventories
    has two important consequences for the computation of the
    taxpayer’s taxable income.   First, to the extent that costs
    incurred by the taxpayer are reflected in items of inventory
    that, at the end of the taxpayer’s taxable year, remain unsold,
    such costs will not contribute to the cost of goods sold for that
    year and, thus, will result in a correspondingly higher gross
    income from sales for the year.2    Second, if a taxpayer is
    required to use inventories, then, to reflect its income clearly,
    it must use an accrual method of accounting with respect to
    purchases and sales of inventory items.    See sec. 1.446-
    1(c)(2)(i), Income Tax Regs.3    The rationale behind this accrual
    requirement is explained in Knight-Ridder Newspapers, Inc. v.
    United States, 
    743 F.2d 781
    , 789 (11th Cir. 1984) (“According to
    accounting wisdom, the income realized from the sale of
    2
    But cf. sec. 1.471-4, Income Tax Regs. (“Inventories at
    cost or market, whichever is lower.”)
    3
    The taking of inventories does not of itself represent a
    separate and distinct method of accounting. As Professor
    Chirelstein states: “Rather, it is a component of the over-all
    accounting procedure whose essential purpose is to establish the
    cost of goods sold as a step towards determination of the
    taxpayer’s gross income from business operations.” Chirelstein,
    Federal Income Taxation, A Law Student’s Guide to the Leading
    Cases and Concepts, par. 12.03 at 269 (8th ed. rev. 1999).
    - 41 -
    merchandise is most clearly measured by matching the cost of that
    merchandise with the revenue derived from its sale.”)
    Even if a taxpayer need not maintain inventories, the
    recovery of costs associated with the production of income may
    not be governed by the taxpayer’s method of accounting.   That
    treatment is well known with respect to the recovery of certain
    capital expenditures by way of the deduction for depreciation.
    See sec. 167(a); sec. 1.446-1(a)(4)(ii), Income Tax Regs.
    (“Expenditures made during the year shall be properly classified
    as between capital and expense.”)   More pertinent to our case is
    section 1.162-3, Income Tax Regs., which addresses the cost of
    materials and supplies (without distinction, supplies) that do
    not constitute inventory.   Unless the purchase of such supplies
    constitutes a capital expenditure, section 1.162-3, Income Tax
    Regs., provides:
    Taxpayers carrying materials and supplies on hand
    should include in expenses the charges for materials
    and supplies only in the amount that they are actually
    consumed and used in operation during the taxable year
    for which the return is made, provided that the costs
    of such materials and supplies have not been deducted
    in determining the net income or loss or taxable income
    for any previous year. If a taxpayer carries
    incidental materials or supplies on hand, for which no
    record of consumption is kept or of which physical
    inventories at the beginning and end of the year are
    not taken, it will be permissible for the taxpayer to
    include in his expenses and to deduct from gross income
    the total cost of such supplies and materials as were
    purchased during the taxable year for which the return
    is made, provided the taxable income is clearly
    reflected by this method.
    - 42 -
    Section 1.162-3, Income Tax Regs., provides for the deferred
    expense treatment of nonincidental supplies without regard to the
    taxpayer’s overall method of accounting.
    IV.   Discussion
    A.   Purchases and Sales of Inventory
    1.   Respondent’s Pleading
    Petitioner expended $772,522 for chemotherapy drugs during
    1995 and treated that expenditure as an expenditure for
    incidental supplies.    That was plain error under section 1.162-3,
    Income Tax Regs.    See concurring opinion of Judge Beghe at 32.
    Respondent treated the expenditure as if it constituted the cost
    of goods purchased for resale.    On the facts of this case, in
    terms of accounting for the cost of the chemotherapy drugs, it
    makes no difference whether the $772,522 expended for
    chemotherapy drugs is treated as the cost of goods held for
    resale or as a deferred expense.4
    The only issue open to debate is whether respondent can
    compel petitioner to account for amounts billed to Medicare (and
    to patients) under an accrual method.    Although section 1.446-
    1(c)(2)(ii), Income Tax Regs., leaves no doubt that the Secretary
    can so compel petitioner if purchases and sales of inventory are
    involved, nothing in section 446(b) prohibits the Secretary from
    4
    The notice of deficiency shows a $0.00 sec. 481
    adjustment.
    - 43 -
    so compelling petitioner if purchases and sales of inventory are
    not involved.   Section 446(c) specifically permits a taxpayer to
    compute taxable income under the cash method; nevertheless, that
    permission is made subject to the Secretary’s section 446(b)
    authority to reject the taxpayer’s method of accounting.      See
    sec. 446(c).    By the pleadings, however, the parties have limited
    what petitioner must prove to stay on the cash method.
    Above, in section II., I have set forth both respondent’s
    explanation of the net adjustment and his allegation, in response
    to petitioner’s averment that it is entitled to use the cash
    method, that “petitioner is required to maintain inventories and,
    therefore, is required to use the accrual method for the purchase
    and sale of inventories.”    (Emphasis added.)   Correctly, the
    majority thinks that a fair reading of the issue for trial in
    this case, as framed by the pleadings, is whether petitioner is
    required to maintain inventories.    I agree with the limited scope
    of the majority’s inquiry, in this case.    I do not agree,
    however, that petitioner need not use inventories.
    2.    Inventories Are Required
    As set forth in section III., supra, regulations provide:
    (1) Inventories are necessary in every case in which the sale of
    merchandise is an income-producing factor, and (2) with limited
    exceptions, in any case in which it is necessary to use an
    inventory, an accrual method must be used with regard to purchase
    - 44 -
    and sales.   See secs. 1.446-1(c)(2), 1.471-1, Income Tax Regs.
    Thus, generally, if the purchase and sale of merchandise is an
    income-producing factor, an accrual method must be used with
    regard to such purchases and sales.
    The nominal focus of the majority’s inquiry is whether the
    chemotherapy drugs are merchandise:      “We focus our inquiry on
    whether the chemotherapy drugs were supplies deductible under
    section 162, or merchandise that must be inventoried under
    section 471.”   Majority op. p. 10.     The majority states:
    “Respondent’s characterization of the chemotherapy drugs as
    merchandise offends the natural and ordinary meaning of the term
    ‘merchandise’”.   Id. at 17.   The majority concedes, however:
    “Although pharmaceuticals could reasonably be construed to be
    merchandise in some contexts; * * * it does not necessarily
    follow that pharmaceuticals are merchandise in all contexts.”
    Id.   The majority reaches the conclusion that the chemotherapy
    drugs are not merchandise on the basis that petitioner “is not a
    merchandiser”, id. at 15, its business “is inherently a service
    business”, id. at 16, or “[s]imply put, petitioner is not
    peddling products.”   Id. at 18.      The majority’s conclusions seem
    to be informed by its view:    “A medical practice such as
    petitioner’s is inherently a service business, and the drugs
    administered in the practice are subordinate to the provision of
    the medical services.”   Id. at 16.
    - 45 -
    3.   Conclusion of Law
    The majority’s conclusion that the chemotherapy drugs are
    not merchandise is not a finding of fact.     The majority’s
    conclusion that the chemotherapy drugs are not merchandise
    appears to rely on a number of propositions that, when taken
    together, amount to a rule of law (i.e., a rule of general
    application).    The majority’s view that a medical practice such
    as petitioner’s is inherently a service business is dependent on
    a number of factors (some of which are conclusory):     “the
    uniqueness of the industry in which petitioner operates”, the
    fact that petitioner’s business is a “quintessential service
    business”, the “inseparable connection” of the chemotherapy drugs
    to the performance of services, and, finally “[s]ervice income,
    by definition, does not include income from the sale of goods”.
    From those factors, the majority composes the following rule of
    law:    Doctors (medical and osteopathic) are not in trade.    The
    dictionary gives as one definition of trade:     “the business of
    buying and selling commodities; commerce.”     The American Heritage
    Dictionary of the English Language 1897 (3d ed. 1992).     The
    majority believes that doctors are not in trade because they are
    members of a learned profession, whose stock in trade is
    knowledge, not goods or merchandise.     See majority op. p. 16.
    The majority relies on Abbott Labs. v. Portland Retail
    Druggists Association, Inc., 
    425 U.S. 1
     (1976), to support its
    - 46 -
    conviction that doctors are not in trade (i.e., are not
    merchants).   Abbott Labs., however, is an antitrust case, in
    which the Supreme Court addressed purchases by nonprofit
    hospitals of pharmaceutical products at favored prices from the
    manufacturers of those products.    The issue was the proper
    construction of the phrase “purchases of their supplies for their
    own use,” as it appears in 
    52 Stat. 446
    , 15 U.S.C. sec. 13c
    (1994) (referred to by the Supreme Court as the “Nonprofit
    Institutions Act”).    The precise question was whether the
    nonprofit hospitals’ purchases in question were exempt from the
    proscription of the Robinson-Patman Antidiscrimination Act, ch.
    592, 
    49 Stat. 1526
     (1936), 15 U.S.C. secs. 13, 13a, 13b, and 21a
    (1994) because they were for the hospitals’ own use, within the
    meaning of the Nonprofit Institutions Act.    Abbott Labs. v.
    Portland Retail Druggists Association, Inc., supra at 4.       The
    majority states:    “The exemption generally applies where the
    nonprofit institution is purchasing the drugs for its ‘own use’
    as opposed to for sale to patients.”    Majority op. p. 16
    (emphasis added).    Apparently, since, in Abbott Labs., the
    Supreme Court found that at least some of the drugs in question
    were purchased by the hospitals for their own use (within the
    meaning of 15 U.S.C. sec. 13c), the majority concludes that those
    drugs were not purchased for resale (which, I assume, leads to
    the conclusion that doctors, like the hospitals, are not
    - 47 -
    merchants).    The majority mischaracterizes a provision of the
    Nonprofit Institutions Act, 15 U.S.C. sec. 13(c) (1994).    That
    provision provides as follows:    “Nothing in the * * * Robinson-
    Patman Antidiscrimination Act, shall apply to purchases of their
    supplies for their own use by schools, colleges, universities,
    public libraries, churches, hospitals, and charitable
    institutions not operated for profit.”    The provision does not
    establish a dichotomy between use and sale, as suggested by the
    majority.5    See, e.g., De Modena v. Kaiser Found. Health Plan,
    Inc., 
    743 F.2d 1388
    , 1393 (9th Cir. 1983) (referring to Abbott
    5
    In Abbott Labs. v. Portland Retail Druggists Association,
    Inc., 
    425 U.S. 1
     (1976), each of the hospitals in question
    operated a pharmacy, which was a separate department of the
    hospital, and whose operations produced revenue in excess of
    cost. The pharmacies dispensed the pharmaceutical products in
    question. The Supreme Court used the terms “sales” and
    “dispensations” with reference to those products, and without any
    clear distinction between the two terms. The Supreme Court
    categorized the following dispensations as for the hospitals’
    “own use”:
    1. To the inpatient, or to the emergency facility patient,
    upon his discharge and for his personal use away from the
    premises.
    2. To the outpatient for personal use away from the
    premises.
    3. To the hospital’s physicians, employees, or students,
    for their personal use or for the use of their dependents.
    Clearly the third category, if not all three, constitutes
    sales of merchandise by the pharmacies, notwithstanding that such
    merchandise was acquired for the hospitals’ own use. Nothing in
    the opinion indicates that the pharmacies failed to inventory
    their pharmaceuticals.
    - 48 -
    Labs. v. Portland Retail Druggists Association, Inc., 
    425 U.S. 1
    (1976), and holding:   “[D]rugs purchased by an HMO * * * for
    resale to its members are purchased for the HMO’s ‘own use’
    within the meaning of the Nonprofit Institutions Act and thus
    qualify for protection under the Act.”).    Abbott Labs. is no
    support for the proposition that, as a matter of law, petitioner
    is not selling merchandise.
    The majority also cites St. Luke’s Hosp., Inc. v.
    Commissioner, 
    35 T.C. 236
    , 238 (1960), for the proposition that
    petitioner is not selling merchandise when it administers
    chemotherapy drugs.    The principal issue in St. Luke’s Hosp.,
    Inc. was whether the taxpayer, having requested and received
    permission from the Commissioner to change from an accrual method
    to the cash method of accounting for 1953 and thereafter,
    properly reported income on the cash method when it continued to
    employ primarily an accrual method in keeping its books and
    records.   We concluded that it did properly report income on the
    cash method since, notwithstanding the taxpayer’s retention of an
    accrual method, its cash-basis income could readily be
    ascertained from its books and records.    Our findings of fact
    included the following:
    Petitioner owns and operates a hospital in Bluefield.
    Its business is the customary hospital service
    business. It is not a merchandising business, and
    petitioner has no merchandise inventories which would
    require the use of an accrual method in keeping its
    books or reporting its income. Its income is derived
    - 49 -
    from providing hospital and professional care to the
    sick. [Id. at 238.]
    Those are not statements of law but findings of fact.   The
    findings that the Bluefield hospital is in the customary service
    business of hospitals and has no merchandise is not necessarily
    applicable to petitioner.   Petitioner is not a hospital, but runs
    a chemotherapy clinic, where chemotherapy drugs constitute both a
    significant cost and a substantial source of revenue.   There is
    no finding as to how significant drugs and similar items were to
    the overall cost of treatment at the Bluefield hospital.    In St.
    Luke’s Hospital, Inc. v. Commissioner, supra, which dealt with
    medicine as it was practiced over more than 40 years ago, the
    Commissioner did not even suggest that inventories were required.6
    It is no authority for any conclusion of law.
    Nor can the majority rely on any rule of law that service
    providers need never use inventories:   “We have previously
    examined service transactions in a variety of industries to
    determine whether the transactions in substance involved solely
    the sale of a service, or whether the transactions involved the
    sale of both a service and merchandise.”   Majority op. p. 13.
    6
    In Abbott Labs. v. Portland Retail Druggists Association,
    Inc., supra at 11, decided in 1976, the Supreme Court stated with
    respect to nonprofit hospitals: “we recognize * * * that the
    concept of the nonprofit hospital and its appropriate and
    necessary activity has vastly changed and developed since the
    enactment of the Nonprofit Institutions Act in 1938.” Needless
    to say, much more has changed in the last 23 years.
    - 50 -
    Finally, the majority’s reliance on Hospital Corp. of Am. v.
    Commissioner, 
    107 T.C. 116
     (1996), to support its proposition
    that petitioner’s income is attributable solely to services and
    not to some combination of services and merchandise is puzzling.
    In Hospital Corp. of Am., we did indeed find that, for purposes
    of section 448(d)(5), the use of medical supplies is part of the
    medical services furnished patients by the hospitals in question.
    See 
    id. at 144
    .   In the same breath, however, we found “the cost
    of those supplies is an incidental cost of the health care
    services provided by the hospitals.”      
    Id.
       Given that finding,
    the fact that Hospital Corp. of Am. involves a different section
    of the statute, and our specific reservation in Hospital Corp. of
    Am. that we were not deciding the question of whether the
    furnishing of medical supplies by the hospitals as a part of the
    rendering of services to their patients could be considered to be
    a sale of inventory, I do not consider that case as persuasive
    with respect to the issue before us today.
    The majority cannot escape an examination of the particular
    facts of this case in light of the relevant provisions of law.
    4.   Finding of Fact
    We find the instant setting distinguishable from
    the setting of those cases in which we have held that
    goods utilized by a service provider were merchandise
    for purposes for the inventory rules. We give
    significance to the uniqueness of the industry in which
    petitioner operates in relation to the other service
    industries we have addressed on this issue and bear in
    - 51 -
    mind the recent case of Hospital Corp. of Am. v.
    Commissioner, 
    107 T.C. 116
    , 143-145 (1996).* * *
    Majority op. p. 14.
    What facts distinguish this case from those cases in which
    we have held that goods utilized by a service provider were
    merchandise for purposes of section 1.471-1, Income Tax Regs.?      I
    agree with the majority’s observations that medicine is unique,
    and that it is inherently a service business.   So what!   Contrary
    to the majority’s impression, health care providers do sell
    goods.   See, e.g., De Modena v. Kaiser Found. Health Plan, Inc.,
    supra (drugs purchased by an HMO for resale to its members are
    purchased for the HMO’s own use).   The relevant distinction is
    between supplies, for which inventories need not be taken, and
    merchandise held for sale (merchandise), for which inventories
    must be taken.   Compare section 1.162-3, Income Tax Regs., with
    section 1.471-1, Income Tax Regs.   I agree with the majority when
    it states:   “The statute and regulations do not define the words
    ‘merchandise’ or ‘inventory’, nor do they clearly distinguish
    between ‘inventory’ and ‘materials and supplies’ that are not
    actually consumed and remain on hand.”   Majority op. p. 12.   As
    previously discussed, supra section IV.A.1, it was plain error
    for petitioner to treat the expenditure for the chemotherapy
    drugs as an expenditure for incidental supplies, and, in terms of
    properly accounting for that expenditure, it makes no difference
    whether the expenditure is treated as being for merchandise or
    - 52 -
    for supplies.   The relevant difference is with respect to the
    application of section 1.446-1(c)(2)(i), Income Tax Regs., which,
    with an exception not here relevant, and taking into account
    section 1.471-1, Income Tax Regs., requires an accrual method
    with regard to purchases and sales of merchandise.     The majority
    agrees that the distinction between supplies and merchandise does
    not turn on the nature of the underlying commodity:
    “pharmaceuticals could reasonably be construed to be merchandise
    in some contexts”.   Majority op. p. 17.     In Wilkinson-Beane, Inc.
    v. Commissioner, 
    420 F.2d 352
    , 354 (1st Cir. 1970), affg. 
    T.C. Memo. 1969-79
    , the Court of Appeals for the First Circuit
    determined that the meaning of the term “merchandise”, as used in
    section 1.471-1, Income Tax Regs., “must be gathered from the
    context and the subject.”   The context and the subject are the
    explicit requirement that a taxpayer’s method of accounting
    clearly reflect income.   See sec. 446(b).    Income realized from
    the sale of merchandise is most clearly measured by matching the
    cost of that merchandise with the revenue derived from its sale.
    Knight-Ridder Newspapers, Inc. v. United States, 
    743 F.2d at 789
    .
    Given the lack of any clearly pertinent distinction between the
    term “supplies” and the term “merchandise”, where the facts raise
    some question (as they do here), we should inquire which
    classification results in a clearer reflection of the taxpayer’s
    income.
    - 53 -
    The majority describes as seminal the opinion of the Court
    of Appeals for the First Circuit in Wilkinson-Beane, Inc. v.
    Commissioner, supra.    The taxpayer in Wilkinson-Beane, Inc. was
    an undertaking establishment, which argued the primacy of the
    services that it provided to its customers.   The Court of Appeals
    affirmed the finding of the Tax Court that the taxpayer was
    selling merchandise.   The Court of Appeals stated:
    We fully recognize that petitioner was in the business
    or providing valuable services. But we think it would
    be anomalous to hold that a taxpayer in a service
    business can have no merchandise even though he derives
    a substantial portion of his income from the regular
    purchase and sale of tangible personal property. We
    certainly have no basis for so restricting the
    application of the word 'merchandise’. * * * Since the
    caskets play a central role in the 'sale' of taxpayer's
    service, to use its term, we see no error in the
    determination that the caskets were merchandise.
    Id. at 355.   The Court of Appeals’ inquiry into the centrality of
    the property to the sale and the substantiality of the income
    attributable to the property has been followed in subsequent
    cases.   For example, in J.P. Sheahan Associates, Inc. v.
    Commissioner, 
    T.C. Memo. 1992-239
    , we determined whether roofing
    materials constituted merchandise, and we looked to whether the
    materials were shown separately on the customer’s bill, they
    represented a substantial amount of the total bill, and they were
    marked up.    In Thompson Elec., Inc. v. Commissioner, 
    T.C. Memo. 1995-292
    , which involved an electrical contractor, we said:    “If
    the cost of material a taxpayer uses to provide a service is
    - 54 -
    substantial compared to its receipts, the material is a
    substantial income-producing factor even if the taxpayer does not
    markup the prices charged to its customers for the material.”
    What I distill from the Wilkinson-Beane, Inc. line of cases is
    that, where the question is whether a provider of services is
    using supplies or selling merchandise, the answer turns on
    whether the commodity in question is a substantial and
    identifiable source of revenue.   If so, and if the merchandise is
    an income-producing factor, than such merchandise must be
    inventoried and an accrual method is appropriate (and may be
    required) to match costs and revenue.   On the facts before us, I
    would require inventories because petitioner is selling
    merchandise that is an income-producing factor.
    The majority’s finding that the chemotherapy drugs are
    subordinate to the services rendered ignores the substantiality
    and centrality of the income attributable to the chemotherapy
    drugs and involves conclusions that have no basis in the record.
    The only facts stipulated with respect to the medical aspects of
    petitioner’s business are set forth in the margin.7   Petitioner is
    7
    When an individual first becomes a patient of petitioner,
    one of petitioner’s physicians examines the patient in order to
    determine the proper chemotherapy treatment for that patient.
    When a patient has been evaluated and a chemotherapy regime
    has been prescribed, the patient begins regular, periodic
    treatments.
    (continued...)
    - 55 -
    a corporation, operating clinics and employing physicians,
    nurses, nursing assistants, laboratory technicians,
    administrative personnel, and office workers.   The parties have
    not stipulated how individuals came to be petitioner’s patients.
    Given petitioner’s apparent specialization, it is likely that
    patients were referred for chemotherapy drug treatment.   Nothing
    in the record establishes the majority’s findings that “patients
    played no role in determining the type or amount of drugs used on
    them”, majority op. p. 19, or that patients must “agree to
    petitioner’s overall chemotherapy service, and, when they do
    agree to this service, they have no say in the type or quantity
    7
    (...continued)
    Petitioner’s physicians prescribed the chemotherapy regime
    but, with rare exception, did not actually administer the
    chemotherapy drugs to patients during taxable year 1995 to
    present.
    Chemotherapy drugs were administered by oncology nurses
    during taxable year 1995.
    Prior to the initiation of each course of chemotherapy, the
    patients were seen and evaluated by the attending physician.
    The patients were not examined at the time of every
    chemotherapy administration pursuant to the standard practice of
    medical oncology.
    Once a patient has begun a chemotherapy regime, that patient
    will see one of petitioner’s physicians approximately every 4- to
    6-weeks, between treatments.
    While a physician must be available to respond to
    emergencies, a physician is not required to be in every room with
    a patient while chemotherapy treatment is being administered.
    - 56 -
    of chemotherapy drugs which petitioner uses in their care.”
    Majority op. p. 15.    Nor does anything in the record establish:
    “Usually, they [patients] are not even aware of the type or
    quantity of chemotherapy drugs used on them as part of their
    treatment.”   
    Id.
        Contrary to the inference in the majority’s
    opinion, petitioner’s physician-employees do not choose or decide
    that a patient shall receive chemotherapy drugs.     Common
    experience tells us that, although petitioner’s physician-
    employees may recommend such treatment, the patients are the ones
    who must make the decision to receive the drugs.     Moreover, if
    those patients decide to receive chemotherapy drugs, they want
    the drugs and nothing in the record (or in common sense) leads me
    to believe that the drugs are necessarily subordinate to the
    physician’s services.     I cannot agree with the majority’s
    conclusion that, with respect to petitioner’s business, the
    provision of chemotherapy drugs was subordinate to the provision
    of medical services.
    B.   Clear Reflection of Income
    If a taxpayer’s method of accounting does not clearly
    reflect income, section 446(b) accords the Secretary the
    authority to require the taxpayer to compute taxable income under
    such method as, in the opinion of the Secretary, does clearly
    reflect income.     We have interpreted respondent’s position in
    this case as requiring petitioner to use an accrual method (the
    - 57 -
    hybrid method) only because purchases and sales of inventory were
    involved.   Having concluded that petitioner did not purchase and
    sell inventory, the majority has determined that respondent
    abused his discretion in requiring petitioner to use the hybrid
    method.   Taxpayers should not read too much into that
    determination.
    As stated, although section 1.446-1(c)(2)(ii), Income Tax
    Regs., leaves no doubt that respondent can so compel petitioner
    if purchases and sales of inventory are involved, nothing in
    section 446(b) prohibits the Secretary from so compelling
    petitioner if purchases and sales of inventory are not involved.
    Moreover, although section 446(c) specifically permits a taxpayer
    to compute taxable income under the cash method, that permission
    is made subject to the Secretary’s section 446(b) authority to
    reject the taxpayer’s method of accounting.   See sec. 446(c).
    The legislative endorsement of the cash method undoubtedly means
    that wages and salaries can be reported on the cash method.    The
    taxpayer in this case, however, is not a wage earner.    Petitioner
    is a corporation, with three physician-shareholder-employees,
    three other physician-employees, numerous other employees, and,
    for 1995, just shy of $3 million in receipts.   For that year, it
    paid officer compensation of $600,328 and other salaries and
    wages of $630,381, for a total of just over $1.2 million.   If the
    value of the services provided by all six physicians employed by
    - 58 -
    petitioner is measured by their compensation, then that value is
    somewhere in the neighborhood of $1 million (given that there
    were numerous employees other than physician employees).
    Petitioner, thus, had receipts of about $2 million attributable
    to something other than the negotiated value (to the corporation)
    of physician’s services, including chemotherapy drugs costing
    $772,522.    Petitioner’s receivables at the end of 1995 were
    $148,557.    I know of no rule of law that forecloses an inquiry
    into whether, to reflect clearly petitioner’s income, the
    receivables attributable to the chemotherapy drugs used during
    the year should not be reported on an accrual method, as would be
    the case under the hybrid method.    Recently, in Oakcross
    Vineyards, Ltd. v. Commissioner, 
    T.C. Memo. 1996-433
    , affd. 
    142 F.3d 444
     (9th Cir. 1998), we sustained the Commissioner’s
    determinations that (1) the cash method did not clearly reflect a
    farmer’s receipts from the sale of grapes and (2) an accrual
    method was required.    We surveyed many of the cases dealing with
    a challenge by the Commissioner to the cash method, including
    cases involving the Commissioner’s rejection of the cash method
    for reporting receipts.    Among the cases we surveyed were the
    following:    American Fletcher Corp. v. United States, 
    832 F.2d 436
     (7th Cir. 1987) (credit card charge account service required
    to change from cash method to an accrual method); Applied
    Communications, Inc. v. Commissioner, 
    T.C. Memo. 1989-469
    - 59 -
    (concerning sales of computer software by the developer of the
    software and taking into account that “cash method of accounting
    is not appropriate for petitioner because it generates
    substantial amounts of receivables or deferrals of revenue as
    evidenced by the difference between its software income for tax
    and financial purposes.”); Silberman v. Commissioner, 
    T.C. Memo. 1983-782
     (cash receipts and disbursements method of accounting
    could not be used by a movie production partnership because the
    predicted delay between expenditures and receipts created a
    mismatching of funds and a distortion of income), affd. without
    published opinions sub nom. Appeal of David Whin, Inc., Appeal of
    Giordano, Appeal of Malanka, Stamato v. Commissioner, 
    770 F.2d 1068
    , 1069, 1072, 1075 (3d Cir. 1985).    In Oakcross Vineyards
    Ltd., we also pointed out that the question of whether a
    taxpayer’s method of accounting materially distorts or clearly
    reflects income is one of fact and is to be resolved on a
    case-by-case basis.
    As previously stated, where the Commissioner has determined
    that a taxpayer’s method of accounting does not clearly reflect
    income, the taxpayer must demonstrate either that his method of
    accounting clearly reflects income or that the Commissioner’s
    method does not clearly reflect income.   Respondent’s explanation
    of the net adjustment in the notice is broader than the ground he
    relies on in the answer.   That narrowing of his ground in the
    - 60 -
    answer may not have been intended.    Taxpayers similarly situated
    to petitioner should be prepared to demonstrate that the cash
    method clearly reflects their income or that the hybrid method
    does not.8
    V.   Conclusion
    For the foregoing reasons, I dissent from the majority’s
    opinion.
    COHEN, WHALEN, and CHIECHI, JJ., agree with this dissent.
    8
    Taxpayers may have difficulty in proving that a method of
    accounting such as the hybrid method does not clearly reflect
    income. In Hospital Corp. of Am. v. Commissioner, 
    T.C. Memo. 1996-105
    , we concluded that certain hospitals’ use of a hybrid
    method of accounting that reported on an accrual method revenue
    allocable to charges for supplies and pharmaceuticals clearly
    reflected the hospitals’ income