Ethical Challenges for Accountable Care Organizations: A Structured Review

Abstract

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.

Dialysis Payment Model Reform: Managing Conflicts Between Profits and Patient Goals of Care Decision Making

“…Ethical challenges for leaders, clinicians, and patients involved with primary care ACOs have also been noted, included that of perceived pressure to withhold care to aid ACO finances. 7 Nephrologists increasingly recognize the value of conservative management without dialysis and hospice for patients with advanced chronic kidney disease (CKD) or ESRD, 8 although the knowledge and resources to provide optimal end-of-life care for these patients are often lacking. 9,10 Among older adults in particular, the intensity of health care when dialysis is initiated can be high 11,12 despite the often limited quality of life and survival for such patients.…”

Correction to: American Heart Association’s Call to Action for Payment and Delivery System Reform

“…50 Not often discussed are the ethical challenges posed by ACOs and bundled payments, including loss of professional autonomy, the dual responsibility to the patient versus the system, and where to concentrate efforts with regard to distribution of resources. 51 Although not entirely dissimilar from the challenges originally posed by the introduction of health maintenance organizations, the questions are now a bit more sophisticated, focusing on the most appropriate site of care rather than general withholding of services. In this way, answers may come with continued delivery system adjustments.…”

Using Smartphones for Accountable Care and Evidence-based Decision Making in Managing Gestational Diabetes: An Australian Case Study

“…An examination of the literature suggests that many studies look into the importance (Shortell & Casalino, 2008), application (Shields et al, 2011), and execution of the accountable care system (McClellan et al, 2010;Lewis, McClurg, Smith, Fisher, & Bynum, 2013), ethical challenges for ACOs (DeCamp et al, 2014), and its quality performance standard (Berwick, 2011). However, issues such as how quality of care is being defined and measured remain vast and unclear (Dentzer, 2013).…”