The success of accountable care organizations (ACOs) under global payment may depend in part on a common yet poorly understood clinical decision: the patient referral in the outpatient setting. Fundamental to collaboration among physicians and other health care professionals, patient referrals have been largely ignored in the payment reform debate.
Referral rates in the United States more than doubled from 1999 to 2009, with about 10% of outpatient visits resulting in a consultation or visit to another physician.1 Referrals seem to be both underused and overused, with clinical information often poorly transferred between physicians and frequent confusion between primary care physicians and specialists over the specialist’s role.2 Yet little is known about referrals. By systematically measuring and evaluating referrals in their physician networks, ACOs may be able to better target efforts to improve care coordination and reduce spending.
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