According to a US News & World Report of 1,852 hospital executives, more than 33 percent of executives said it is “extremely likely” that their facility will, in fact, become part of an ACO. Another third said it was fairly likely. But when asked if they thought “over time ACOs will significantly improve the quality and efficient delivery of health care,” most responses fell in the middle of “extremely likely” and “not at all likely.”

The survey results come as some hospitals and physicians have expressed disappointment in how the government is handling ACOs. The American Hospital Association criticized Medicare’s ACO regulations. In a June to Dr. Donald Berwick, who heads the agency that oversees Medicare, the organization says that while many hospitals are already engaged in “ACO-like” efforts, the “excitement about Medicare ACOs has dwindled dramatically,” and, “substantial changes are needed to make the program operationally viable and attractive to potential participants.” The letter goes on to say that “the proposed rule places too much risk and burden on providers with little opportunity for reward in the form of shared savings, especially in light of the significant start-up and operating costs that providers must bear with little or no assistance.”

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