US Accountable Care Organizations Aim to Achieve Higher Quality Care at Lower Cost by Influencing Physician Referrals Ethically

by Dr. Trupti Shirole on January 15, 2015 at 4:22 PM

 US Accountable Care Organizations Aim to Achieve Higher Quality Care at Lower Cost by Influencing Physician Referrals Ethically
Growing number of accountable care organizations (ACOs) in the United States are aiming to achieve higher quality care at lower cost, partly by influencing where patients receive care. Experts from Johns Hopkins Berman Institute of Bioethics and Division of General Internal Medicine said, "ACOs can influence referrals in an ethical manner that simultaneously enhances choice and improves patient outcomes if they consider three basic issues: transparency, appropriate metrics, and the right incentives."

Co-author of the study Matthew DeCamp said, "In ACOs, physicians and other providers assume responsibility for patients' health outcomes and expenditures, and can earn financial bonuses by meeting specific quality measures while spending less than a benchmark. This is meant to encourage reducing unnecessary tests or increasing high value ones. For example, a traditional fee-for-service payment system may not discourage repeating diagnostic tests, such as X-rays, at both the primary care office and the specialist's office; under the ACO model however, an incentive exists to communicate, coordinate, and not repeat such tests. Influence over referrals must be done in ways that preserve physicians' primary duties to their patients' well-being and the inherent value of choice"

Another study co-author Lisa Lehmann said that we should learn from the mistakes of the managed care model of the 1990s, including the ethically problematic 'gag rule' contracts, some of which prevented physicians from referring specialists outside the organization. Having a transparency about why and how referrals are being influenced is the most fundamental ethical consideration.

The authors emphasized that the process of creating preferred referral lists is important, as there may be tension between choice and the ACO's quality and cost goals. DeCamp said, "As a physician, I want to be sure my patient sees a cardiologist who prescribes the right medicines and doesn't do unnecessary tests, but I also want to be sensitive to other values of interest to my patient, such as scheduling convenience, racial or cultural concordance, or communication style."

Lehmann said, "Providing physicians and patients with referral lists based on appropriate metrics could be incentive enough to achieve patients, physicians, and ACOs shared goal of high value care." The researchers were of the opinion that financial incentives are not inherently unethical, but should be employed only after nonfinancial options like information sharing and organizational recognition are tried, and patients must be informed.

DeCamp said, "In the existing system it is unclear how much choice patients really have and whether referral practices are truly in their best interest. ACOs have an opportunity to develop referral systems based on transparency, appropriately chosen metrics, and carefully employed incentives. This could make health care not just more effective, but more ethical."

The study appears in 'The New England Journal of Medicine'.

Source: Medindia

News A-Z
News Category
What's New on Medindia
'Hybrid Immunity' may Help Elude COVID-19 Pandemic
Stroop Effect
Plant-Based Diet may Reduce the Risk of COVID-19
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Laser Vision Correction Surgery 

Recommended Reading
Bioethics Experts Say Patient Consent Not Always Necessary in Health Research
Bioethics experts argue that full informed consent is not ethically required for some health ......
Literacy on Bioethics Matters Here
The ability of people to identify key issues, articulate their values and concerns, and to find the ...
To Fight Obesity, Bioethics Leader Calls for Bold Approach
Daniel Callahan, co-founder and President Emeritus of The Hastings Center, proposes a bold and ......
Medical Students Concerned About Desensitization to Dying Patients: Loyola Bioethics Study
In the fast-paced scene of hospital life, the imminent death of a patient is riddled with emotions ....
Laser Vision Correction Surgery
Techniques using laser allow faster recovery rates when compared to the older modalities. LASIK is t...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use