Only 3% of hospitals surveyed a year ago were participating in an accountable care organization, while another 10% were planning to participate and 12% were not sure, according to a new report by the Commonwealth Fund. Hospitals in both groups tended to be larger than other hospitals, belong to a health system, located in large urban areas, and teaching and nonprofit organizations. The findings are based on a survey by the AHA's Health Research & Educational Trust, which was completed before the Centers for Medicare & Medicaid Services released its final rules for the Medicare Shared Savings Program. More than half of the hospitals in ACOs or planning to participate were pursuing ACO contracts with commercial payers and nearly one-third were pursuing contracts through CMS' Pioneer ACO program. Others were pursuing partnerships with Medicaid ACO programs (16%) and the MSSP (15%). The most common ACO governance models were joint ventures between physicians and hospitals (51%) or physician-led (20%). Only half of the hospitals in ACOs or planning to participate reported having the financial strength to accept risk.