Ethical challenges for accountable care organizations: A structured review

Matthew Decamp, Neil J. Farber, Alexia Torke, Maura George, Zackary Berger, Carla C. Keirns, Lauris C. Kaldjian

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: Accountable care organizations (ACOs) are proliferating as a solution to the cost crisis in American health care, and already involve as many as 31 million patients. ACOs hold clinicians, group practices, and in many circumstances hospitals financially accountable for reducing expenditures and improving their patients' health outcomes. The structure of health care affects the ethical issues arising in the practice of medicine; therefore, like all health care organizational structures, ACOs will experience ethical challenges. No framework exists to assist key ACO stakeholders in identifying or managing these challenges. Methods: We conducted a structured review of the medical ACO literature using qualitative content analysis to inform identification of ethical challenges for ACOs. Results: Our analysis found infrequent discussion of ethics as an explicit concern for ACOs. Nonetheless, we identified nine critical ethical challenges, often described in other terms, for ACO stakeholders. Leaders could face challenges regarding fair resource allocation (e.g., about fairly using ACOs' shared savings), protection of professionals' ethical obligations (especially related to the design of financial incentives), and development of fair decision processes (e.g., ensuring that beneficiary representatives on the ACO board truly represent the ACO's patients). Clinicians could perceive threats to their professional autonomy (e.g., through cost control measures), a sense of dual or conflicted responsibility to their patients and the ACO, or competition with other clinicians. For patients, critical ethical challenges will include protecting their autonomy, ensuring privacy and confidentiality, and effectively engaging them with the ACO. Discussion: ACOs are not inherently more or less "ethical" than other health care payment models, such as fee-for-service or pure capitation. ACOs' nascent development and flexibility in design, however, present a time-sensitive opportunity to ensure their ethical operation, promote their success, and refine their design and implementation by identifying, managing, and conducting research into the ethical issues they might face.

Original languageEnglish (US)
Pages (from-to)1392-1399
Number of pages8
JournalJournal of General Internal Medicine
Volume29
Issue number10
DOIs
StatePublished - Oct 1 2014

Fingerprint

Accountable Care Organizations
Ethics
Delivery of Health Care
Professional Autonomy
Costs and Cost Analysis
Fee-for-Service Plans
Group Practice
Resource Allocation
Cost Control
Privacy
Confidentiality

Keywords

  • accountable care organizations
  • ethics
  • health reform
  • physician-patient relationship

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Decamp, M., Farber, N. J., Torke, A., George, M., Berger, Z., Keirns, C. C., & Kaldjian, L. C. (2014). Ethical challenges for accountable care organizations: A structured review. Journal of General Internal Medicine, 29(10), 1392-1399. https://doi.org/10.1007/s11606-014-2833-x

Ethical challenges for accountable care organizations : A structured review. / Decamp, Matthew; Farber, Neil J.; Torke, Alexia; George, Maura; Berger, Zackary; Keirns, Carla C.; Kaldjian, Lauris C.

In: Journal of General Internal Medicine, Vol. 29, No. 10, 01.10.2014, p. 1392-1399.

Research output: Contribution to journalArticle

Decamp, M, Farber, NJ, Torke, A, George, M, Berger, Z, Keirns, CC & Kaldjian, LC 2014, 'Ethical challenges for accountable care organizations: A structured review', Journal of General Internal Medicine, vol. 29, no. 10, pp. 1392-1399. https://doi.org/10.1007/s11606-014-2833-x
Decamp, Matthew ; Farber, Neil J. ; Torke, Alexia ; George, Maura ; Berger, Zackary ; Keirns, Carla C. ; Kaldjian, Lauris C. / Ethical challenges for accountable care organizations : A structured review. In: Journal of General Internal Medicine. 2014 ; Vol. 29, No. 10. pp. 1392-1399.
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