Physicians' Informal Referral Habits Could Defy ACOs

Physicians are more likely to refer patients to providers who have similar backgrounds as the referring physician, and such informal networks could have implications for structures like accountable care organizations, according to a new study.

The study, led by researchers from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, examined Medicare data from 2006 representing roughly 4.5 million patients, 70,000 physicians and 51 hospital referral regions.

Researchers found physicians tend to "cluster together along attributes that characterize their own backgrounds and the clinical circumstances of their patients." In Albuquerque, N.M., physicians are mostly connected to other physicians within their hospitals and not as likely to refer outside the hospital. In Minneapolis, however, physicians were more likely to share patients within and across hospitals.

Study leaders said the findings may have implications for ACOs, which are typically formed from the top down by existing organizations.

"But the natural networks we've identified could be a more rational way of identifying organizations that are ready to become ACOs by using this bottom-up approach to identify organic groups of doctors who are already interacting with each other, who know each other well and understand a shared patient base," said lead author Bruce E. Landon, MD, a member of the division of general medicine primary care at Beth Israel Deaconess Medical Center and professor of healthcare policy at Harvard Medical School.

More Articles on ACOs:

Cigna Launches Two New ACOs in Ohio, Maine
'Completely Independent' ACO's Physician Leader Shares Its Story
'Absolutely Important' That Physicians Lead ACOs Says California Medical Association VP

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