Modern Healthcare reported yesterday on a letter sent by the Cleveland Clinic to the head of CMS.  The letter, coming on the heels of the Clinic's review of the published ACO regulations, was not warm and fuzzy.

'Disappointed generally,' was the summary headline.

Specific concerns were raised about the financial uncertainty related to the ability to achieve bonuses; the need for an option that includes upside, but not downside; the preference for requiring financial reserves instead of withholding payment; and the redundancy and confusion around the quality measures coming from various governmental mandates.

Deep questions about the effect of the ACO model have been raised here regularly.  And now that large provider organizations have taken a hard look, objections are becoming louder.

What is notable about this story is the source.  If the Cleveland Clinic, long held up as an example of what integrated and coordinated care should be, has this level of concern, how is a garden variety community health system, who is starting where the Clinic was years and years ago, going to pull this off?

If our policy makers will not give us a better alternative to address the overall issues in healthcare, maybe it is time for local market players to step back from the collective lemming rush to the sea and figure out what works in their community.