Referrals can be merit-based
MACRA is designed to break down barriers between care settings in order to deliver a higher level of coordinated care. Essential to this mission is being able to refer patients to the best doctors available for their conditions rather than being bound to refer to another physician in the network even if quality is reduced. That approach is acting in the best interests of the patient as well as the public at large, and ensures the physician’s primary role is being a trusted advisor rather than a contributor to generating hospital revenue.
While it is generally understood that the cost of care is higher in health system settings, there is little evidence that the outcomes are superior. Independent physicians have the autonomy to base referrals strictly on medical factors and to exclude non-medical criteria.