A study commissioned by the American Hospital Association estimates start-up costs for establishing an accountable care organization are many times higher than estimates from the Centers for Medicare and Medicaid Services.

"The analysis indicates that the per organization investment required to put in place and sustain the elements necessary for success is considerably higher--$11.6 to $26.1 million--than the $1.8 million estimated by CMS in its proposed rule for start-up and one year of operating expenses," according to a May 13 letter from AHA to CMS Administrator Donald Berwick, M.D.

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