One thing I've noticed with regard to ACO formation is that the ACO creates its "agreements" and then presents them to the physicians for participation and execution. The physicians, who are generally afraid to "lose out" on the ACO trend, just tend to just sign them. In other words, there is a total lack of review and due diligence by the physicians. Many of these agreements fail to address things like credentialing criteria, disciplinary procedures, financial provisions, and how the financial up side or down side can affect physician compensation. Regardless of a doctor’s view of ACOs, no document ought to be signed unless all the questions raised by them are addressed, very clearly and in writing. Dear doctor: Don't be cheap – make sure you hire competent legal counsel to review these documents before you sign them!!!