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Guidance Offered for Ethical Referrals Within ACOs

Influencing referrals should be transparent, with appropriate metrics and the right incentives

WEDNESDAY, Jan. 14, 2015 (HealthDay News) — For accountable care organizations (ACOs), referrals within the ACO can be ethical as long as their selection is influenced in a manner that is transparent, with appropriate metrics and the right incentives, according to a perspective piece published in the Jan. 15 issue of the New England Journal of Medicine.

Matthew DeCamp, M.D., Ph.D., from John Hopkins University in Baltimore, and Lisa Soleymani Lehmann, M.D., Ph.D., from Brigham and Women’s Hospital in Boston, discuss ethical concerns relating to referrals within ACOs.

The authors note that some ACOs are creating incentives for patients to seek specialty care inside their organization. Influencing referrals raises ethical concerns regarding a patient’s right to select their own physicians. ACOs can influence referrals in an ethical manner that enhances choice and improves patient outcomes if three issues are considered: transparency, appropriate metrics, and correct incentives. Transparency requires informing physicians and patients about the use of preferred referral lists, disclosure of the rationale behind these lists, and their consequences. Metrics to be considered should include medical outcomes as well as cost. In terms of incentives, financial incentives may be controversial; provision of adequate information to select high-value care may be incentive enough. Additional nonfinancial incentives can also be adopted.

“As health care organizations assume increasing financial risk, the need to influence referrals will probably grow, and today’s ACOs have an opportunity to develop and disseminate models for doing so ethically,” the authors write.

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