Ethical Concerns Over Referrals Within ACOs
Saturday, March 14, 2015 02:39 PM

Referrals within an Accountable Care Organization can be ethical as long as their selection is influenced in a manner that is transparent, with appropriate metrics and the right incentives,

Some ACOs are creating incentives for patients to seek specialty care inside their organization. Such influencing of referrals raises ethical concerns. 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.