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/ RevolutionWellness Background / 14 Oct SBP prophylaxis during an active GI bleed (in patients with ESLD). For treatment failure or recurrent disease, consider GI consult. Aside from large IDS's seeking to use the ACO program as a means to protect and potentially grow market share and margin (after all, "no margin, no mission"), why would hospitals want to get involved? Hospital reimbursement is on the line here: about 70% of costs -- and potential savings -- are on the hospital side of the equation, and much of the control over those costs lies with physicians. If they are not already employed physicians, the sharing of savings means the hospital will be sharing with the physicians, and not vice versa. Despite this apparent disincentive, past experience has shown that strong physician-led initiatives can bring hospitals into the fold. Two examples: the Medicare Physician Group Practice Demonstration Project (an ACO precursor) and the Grand Junction, Colorado experience: a physician-led arrangement initially targeted by the FTC as a price-fixing scheme, eventually resolved through a settlement agreement, and now seen as a national model of collaboration, aligned incentives, cost-effectiveness, and quality improvement. 5- Gerald Bole Hawaii from The Lowest Form of Music

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