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Accountable care organizations may be back on hospitals' to-do lists because of the improvements in the incentive payment structure in the final ACO regulations. Still, the shared-savings model represents a significant change in managing patients' health. Data from the American Hospital Association's 2009 Annual Survey suggest most community hospitals and systems no longer have the competencies or infrastructure needed to support an ACO because they have backed away from capitated payment and holdings in managed care plans. Equity interests in fee-for-service plans declined the least since 2000, and most experts recommend eliminating them.

The small percentage of community hospitals and systems that maintain an equity interest in an HMO or receive some revenue on a capitated basis are better positioned for the future. They already have the information technology and coordinated care foundations on which to build an ACO.

For more information on AHA data, contact the AHA Resource Center at rc@aha.org or 312-422-2050.

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