It is interesting to note the number of health care organizations, including some rather large radiology practices, that have set their sights on the attainment of ACO status. Although no-one that I talk to regularly can define what a truly accountable care organization will look like, it is safe to say that there will be quite a devil in the details when the outlines begin to emerge in real time. Chief among these pesky details will be the assumption of true risk way beyond what was once assumed in a similar way back in the early days of capitation or DRGs. The notion that essentially competing providers will set aside their turf battles and vested interests to combine into an entity that takes on the risks associated with the continuum of care, quality, outcomes, and associated bureaucracies, is part of the equation that I don’t think has been completely vetted by those developing strategies to morph into an ACO. Be careful what you wish for because you just might get it in all its glory.