Accountable care organizations are responsible for all their patients' costs — yet they have little control over costs when patients seek specialty care outside the organization.
Influencing referrals to specialty physicians could help ACOs control quality and cost, but it must be done ethically.
A recent article in The New England Journal of Medicine offered the following guidance on influencing ethical referrals within an ACO.
1. At the time of the referral, offer preferred referral lists with full disclosure of what the lists are and how the lists are compiled. Many organizations choose to make this information available on public websites for patients.
2. Physicians must make sure the preferred referral lists are based on the quality of medical care in addition to costs. It is the physician's responsibility to make sure the referrals are based on appropriate medical metrics.
3. Patient concerns should also be addressed. These factors include scheduling times, location, racial, cultural or gender concordance and communication skills.
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