The last two years have brought with them radical changes to the way we think about the delivery of health care services. The Affordable Care Act was a catalyst to the development of the accountable care organization (ACO). While the Affordable Care Act did not create the concept of an ACO, it did provide substantial incentives for providers to create ACO-like organizations.

Much of the discussion today has focused on how to go about creating ACOs and the various legal risks inherent in such creation. Not much has been written about the potential risks that are inherent in operating an ACO. According to the latest count by the Centers for Medicare and Medicaid Services (CMS), 142 organizations have been approved to operate as Medicare-certified ACOs. Thus, the era of ACO operation is already here. While there are considerable legal issues to be considered in forming ACOs, health care counsel must also be cognizant of the potential risks.