Only a small portion of hospitals are taking part in accountable care organizations, according to a survey recently released by the American Hospital Association. Why is unclear, though the AHA speculates that wait-and-see attitudes and a hesitance to take on the hefty startup costs may be motivators.

The 2013 edition of AHA Hospital Statistics found that only about 6 percent of hospitals that responded to its survey took part in ACOs in 2011. Most of those involved in accountable care were of much large institutions or systems, more likely to be nonprofit, and more likely to be teaching hospitals.

Meanwhile, about 15 percent of survey respondents said they were participating in a patient-centered medical home, defined as an arrangement where "patients have a direct relationship with a provider who coordinates a cooperative team of health care professionals, takes collective responsibility for the care provided to the patient, and arranges for appropriate care with other qualified providers as needed." Only 6.5 percent of respondents were participating in a bundled payment program at the time of the survey.

Why ACO participation was so low at the time of the survey is unclear, according to the AHA. But the organization speculates that some waited until the final ACO rules were released in October 2011, while others may have shied away from the estimated $5.3 to $12 million startup costs for such arrangements.

Here are some other highlights from the survey:

  • Of the hospitals or health systems that had established an ACO, 27 percent said they were serving Medicaid patients, 50 percent were serving privately insurered patients and 58 percent were serving Medicare patients.
  • The mean net revenue for ACO hospitals was about $22.4 million, compared to $10.2 million for non-ACO hospitals.
  • About 27 percent of responding hospitals are using some kind of electronic health record system, while 18 percent said they were meaningful users of certified EHR technology as of September 2011. Twenty-three percent said they expected to become meaningful users this year.