In summary, if an organization is thinking of putting together a PSO they should do a thorough due diligence with a focus on their physician interest and competencies. The feasibility needs to be realistic. Some physician organizations we've talked with aren't even considering a PSO. They have too many other fish to fry. Not only that, there is a natural reluctance to dive into a pool without a bottom. Medicare can be counted on to keep changing the rules. Without a set of rules you can count on, why should you engage in the game? It's facinating to watch HCFA staff engaged in their intramural, camp-fire deliberations. They sit around in a circle and ask "what if?" If we reward providers for taking care of sick people, will they simply recruit more sick people? Think about that question for a minute. Isn't there something twisted in this? To be sure, a PSO is not for the naive or faint of heart. To be realistic, budget a minimum of 3 years to break even. If you decide to go ahead with a PSO, the tuition you pay today for the learning curve should benefit you in the years to come. Plan for the best. Prepare for the worst. With opportunity comes risk. Find a visionary to lead this new venture. Only those who see the invisible, can do the impossible.