There is nothing as constant as change and based upon seven pages of provisions (out of almost 3000 pages) in the new Health Reform Legislation (PPACA), our entire healthcare delivery system will begin to significantly change for Medicare patients between 1/1/2012 and 1/1/2014. These changes will not be due to the issues of mandated benefits and the possibility of the elimination of the current employer based system of providing benefits, but rather because of the legislation, which created Accountable Care Organizations (ACO). But is it really a change or more like the old philosopher, and great Yankee catcher says, “It’s déjà u all over again”? You be the judge after we more carefully examine ACO’s and how they are expected to work along with how your healthcare will be impacted. Now that Health and Human Services (HHS) has issued the final ACO regulations, we have much more clarity.