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Accountable care organizations: How will they affect your practice?

Take-home message

So what should the average ob/gyn do today? Is it time to hand over your practice to a local hospital and/or leap into the first ACO that forms in your vicinity?

Relax. Fortunately, our field is in a somewhat unique position vis--vis the rest of medicine. Many ob/gyn practices, particularly newer ones, have a relatively minor Medicare footprint, and thus see no urgency to join an ACO focusing on Medicare contracts. If and when ACOs begin to contract with commercial payors or directly with employers, we will be an attractive participant because we already receive "bundled" payments for obstetrics and provide a significant amount of primary care in the office. Moreover, many ob/gyns already are using some form of an EHR in our race to achieve "meaningful use" to recoup government subsidies, facilitating integration into an ACO. Thus, we can exist outside of ACOs for a bit longer than most other disciplines and will have the luxury of watching to see whether we are in for a repeat of the 1990s or whether we really are at the dawn of a new age in healthcare delivery. My guess is the latter but I always like to hedge my bets.


1. Patient Protection and Affordable Care Act. Public Law 111-148. American Telemedicine Association Web site. Accessed March 8, 2011.

2. Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-2481.

3. Fiscal Year 2012 Budget of the U.S. Government. The White House Office of Management and Budget Web site. Accessed March 8, 2011.

4. Greaney TL. Accountable care organizations--the fork in the road. N Engl J Med. 2011;364(1):e1(1)-e1(2).

5. Luft HS. Becoming accountable—opportunities and obstacles for ACOs. N Engl J Med. 2010;363(15):1389-1391.

DR LOCKWOOD, editor in chief, is Anita O'Keeffe Young Professor and chair, Department of Obstetrics, Gynecology, and Reproductive Services, Yale University School of Medicine, New Haven, Connecticut.

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