ACOs? Who are they keeping Accountable?

Accountable Care Organizations, or ACOs, are a new trend that has been emerging in the healthcare industry.  The idea is simple enough; build a complete healthcare system that will make the patients' flow through the maze of cross continuum of care simplified.  Hospital systems will include not just hospitals any more but also LTAC's, SNF's, Hospice, VNA and a large and varied range of services for the rehabilitation and post acute care settings.

The article written by Kip Sullivan (The History and Definition of Accountable Care Organizations) gives the best definition and explanation of the ACO idea.

My concerns are these; what patient services are the ACOs not going to directly provide and what sort of “Accountability” will they require from the vendors that they contract with?  Will there be a control in place for patient care?  Will there be standardize reporting systems so all parts of the ACO, internal or external, are rating the patient satisfaction, outcome and care on a 1 for 1 basis? Will CMS actually set up standardize information on what establishes the cost of any given service that it pays for, so a true price can be placed on the service for equitable reimbursement, regardless of the vendor or facility? Will CMS force the ACOs to have multiple vendors for similar services or will the ACO be a “one-stop-shop”, disregarding the growing and popular trend of an educated patient choice?

The fact that the evolution of health care in the United States is so rapid leads me to believe that these standards are only in their infancy of development. ACOs can be successful, if these, plus many other concerns are appropriately discussed, prior to the implementation of ACOs in the healthcare marketplace.