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Invited Critique
June 2013

Accountable Care Organizations in Surgery: Location, Location, Location: Comment on “Will Accountable Care Organizations Cut Costs and Improve Quality for Inpatient Surgery?”

JAMA Surg. 2013;148(6):554. doi:10.1001/jamasurg.2013.21

Accountable care organizations (ACOs) are a key component of the health care reform legislation, which some believe will improve quality and reduce costs. Findings from prior studies1 have shown that the quality improvement effect, although real, is small, so the true promise of ACOs must lay in cost reduction, particularly given their use of risk sharing and capitated episode of care payments to control spending. Prior studies,2 however, have focused primarily on outpatient care in the chronic disease process. In response, Miller et al3 explore ACOs in the setting of inpatient surgical care. They found no evidence that ACOs (in this study defined as “integrated delivery systems”) improve the quality of inpatient surgical care.