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Why Half of All Healthcare CEOs Don't Want to Be in an ACO

Philip Betbeze, for HealthLeaders Media, January 10, 2014

Randy Hountz, director of PHA's Purdue Regional Extension Center, says the fact that many executives thought their organization too small to participate was not surprising, given that respondent profile shows that roughly 30% of respondents headed 100–249-bed hospitals and 40% headed organizations with 99 or fewer beds.

"Larger systems tend to have a better infrastructure to support some of these initiatives," he says. "They have more [physician] practices, which ACO models are dependent upon. Also, not all of these smaller systems have employed physicians. It's extraordinarily more complex if you don't.

Too Small to Participate?
The "too small" complaint is likely shorthand for the fact that there is no architectural, financial, or IT model surrounding participation in ACOs that seems replicable, Hountz says.

Couple that with the fact that best practices, even if they are known, are generally not shared among organizations that see such "secret sauce" as a competitive advantage.

"There's a lot of competition, so if you do find a secret sauce, I don't know if that's for sale or borrow—as much as we as healthcare consumers would like to think that knowledge will be readily shared."

There is some good news about accountable care progress, even if these organizations aren't readily adapting to ACO models, Hountz says.

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