Originally from Dispute Resolution Journal

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ACCOUNTABLE CARE ORGANIZATION
DISPUTES: WHY WILL THEY HAPPEN AND
HOW SHOULD WE SOLVE THEM?
Stephanie Sprague Sobkowiak and Paul E. Knag ∗

As of January 2014, there were over 600 Accountable Care
Organizations (“ACO”), and this number is growing. Of these, 366
are Medicare Shared Savings Program (“MSSP”) ACOs, 123 of
which were new in 2013. Approximately 14% of the United States
population is served by an ACO, and many of these people may not
understand it or even know it.

I. ACO, MSSP, PPACA—ACRONYM SOUP AND HOW ALL
OF THE PIECES FIT TOGETHER
ACOs are networks of hospitals, physicians and other providers
that share medical and financial responsibility for coordinating patient
care with the goals of reducing unnecessary spending and improving
care. The recent growth in ACOs stems from Section 30221 of the
Patient Protection and Affordable Care Act (“PPACA”)2 which
established the MSSP and spiked parallel interest in ACOs by
providers and private payors.
The final MSSP rule was published in the Federal Register on
November 2, 2011.3 Under the regulations, CMS assesses each
ACO’s quality and financial performance based on a given10
population’s use of primary care services at the end of each year.
Based on that assessment, Medicare determines whether the ACO
should be credited with improving care and reducing growth in
expenditures compared to a benchmark population. In one model, the