Just 18 months after Medicare’s launch of the Pioneer ACO Model, nine of the program’s participating organizations may opt out. The 32 Pioneer organizations must decide by the end of the month whether they want to continue to participate in the program. According to an article on ModernHealthcare.com, four organizations have already started to notify providers of their exit, while four others tentatively say they will join the Shared Savings Program, a low-risk alternative ACO model. The Pioneer Model is the most ambitious version of the ACO program. Organizations that perform better than an established benchmark are eligible for rewards, while those that do not meet the standard are subject to penalties. The lower-risk Shared Saving Program offers smaller rewards without the risk of penalties. Representatives from CMS said exits from the program were not unexpected. “We fully anticipated that as these programs get up and running, some groups would shift between models,” Brian Cook, a CMS spokesman, told Bloomberg. Cook goes on to say that some organizations may have realized that they do not have the control on patients that they thought they would. Indeed, an executive from Presbyterian Healthcare Services, based in Albuquerque, said the inability to restrict patients to providers within the system makes it difficult to meet performance benchmarks. Organizations are still responsible for the quality and cost of the patient’s care no matter where they receive care. Participants have also challenged proposed quality benchmarks and expressed concerns about geographic variations that could affect incentives. The cost and quality results from the Pioneer Model’s first year have not been made available yet, but when they are, it will be interesting to see how each of the organizations performed. That will be a better indicator of the future success of the program.