Resolution 19: Freedom of Patient Choice and Physician Referral Freedom

Introduced by:   Richard F. Bruch, MD – Delegate, NCMS Past President

Referred to:        Reference Committee No. 1 – Timothy M. Beittel, MD, Chair

WHEREAS, large physician networks have developed within North Carolina, many of these owned and or administered by hospitals, and some of these networks have placed restrictions on their physicians and licensed mid-level practitioners.  These physicians and mid-level practitioners are instructed to only refer their patients for ongoing evaluation and care to other practices within their network; and

WHEREAS, an administrator of one of these large physician networks has been quoted as saying, “If I own the primary care, I own the referrals”; and

WHEREAS, contractual language has been included in North Carolina physician employment contracts specifically limiting primary care physicians to only refer patients to other physicians within their healthcare network; and

WHEREAS, referral coordinators have been placed in physician offices to enforce patient referral restrictions; and

WHEREAS, patients often have longstanding familiarity with specialist physicians and physician practices; and

WHEREAS, many of these primary care physicians and mid-level practitioners have longstanding familiarity with specialist physicians and their practices; and

WHEREAS, patient freedom of choice of their physician and physician referral freedom are longstanding American traditions; therefore be it

RESOLVED, That the North Carolina Medical Society supports the freedom of choice of patients to choose their physician, and the freedom of choice of physicians and mid-level practitioners to refer their patients to the physician or physician practice or hospital that they think is most able to provide the best medical care; and be it further  (policy)

RESOLVED, That the North Carolina Medical Society opposes the limitation of patient choice of their physician and opposes the limitation of physician and mid-level practitioner referral choice; and be it further  (policy)

RESOLVED, That the North Carolina Medical Society seek to ban any limitation or restriction, including banning contractual restriction, by any hospital or physician network on their member physicians or mid-level practitioners which limits the ability of these physicians and mid-level practitioners to refer their patients to the physicians, or physician practices, or hospitals that they and their patients believe is preferable.  (action)

Fiscal Note:  Estimated additional budget impact:  $30,000.  Current resources will be allocated based on the priorities of the Society and the NCMS budget.

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  • Richard F. Bruch, MD

    Doug, Thanks for the question regarding ACOs being able to control referrals. If the patient’s insurance coverage includes the physician, physician practice, or hospital that the patient and the referring physician or mid-level practitioner prefer, why should there be a barrier? This is the barrier faced TODAY in North Carolina by patients and referring physicians and mid-level practitioners.

    ACOs in many cases will likely be dominated by hospital systems that will try to enforce patient referrals to their health systems with associated high point of service costs. For example, if the MRI scanner and physician interpretations are the same, why have the patient’s MRI study performed on an outpatient basis at a hospital with an extra $1,000 cost for the study compared to having the same study performed at a physician’s office?

  • Doug Sheets MD

    I would wonder if this would inhibit an ACO from being able to control referral patterns and therefore limit their ability to control costs .