Abstract
Clinical ethics, with its emphasis on the actions of clinicians, risks overlooking the ways in which broader health-care structures influence the behavior of health-care providers. Analysis of a factual case study demonstrates that status quo reimbursement practices may place behavior analysts in a position where, no matter how they act, they risk acting unethically. By contrast, the reimbursement model set by accountable care organizations (ACOs), part of the Patient Protection and Affordable Care Act (also known as Obamacare), may offer a solution. However, making good on the promise of ACOs will require more resources than any individual behavior analyst possesses. In order to encourage institutional structures that facilitate ethical practice, behavior analysts’ professional organizations should engage in contemporary political discussions about the state of American health care.
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Notes
The three codes that would regularly be used in Clinic 1 are
0365T, adaptive behavior treatment by protocol administered by a technician; 0369T, adaptive behavior treatment with protocol modification administered by a physician or other qualified health care professional (QHCP); and 0370T, family adaptive behavior treatment guidance administered by a physician or QHCP. (J. W. Minton, T. Thompson, G. Green, J. Carr, & M. Wasmer, personal communication, April 26, 2017)
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As the spouse of an applied behavior analysis (ABA) service provider, Abraham Graber has an interest in the reimbursement rate for behavior analysts. As a clinic director and an ABA service provider, Matthew O’Brien has an interest in the reimbursement rate for behavior analysts.
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Graber, A., O’Brien, M. The Promise of Accountable Care Organizations: “The Code,” Reimbursement, and an Ethical No-Win Situation for Behavior Analysts. Behav Analysis Practice 12, 247–254 (2019). https://doi.org/10.1007/s40617-018-0209-0
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DOI: https://doi.org/10.1007/s40617-018-0209-0