Later this week, I hear, CMS may finally release its rules for accountable care organizations. Pardon my skepticism, since the rules were originally expected out last fall, then in January. But sometime soon—and it better be, since the program is slated to launch next New Year's Day—the tough work of turning ACOs, often dubbed unicorns for their mysterious nature, into a tangible being will commence.

Despite the confusion about the finished product, ACOs have been seemingly everywhere since their inclusion in the Affordable Care Act a year ago. In nearly every interview I've done this year—from hospital CEOs to health IT gurus to industry thought leaders—and in nearly every health care article I've read, ACOs have crept into the conversation, often dominating it. Hospitals want to join them, the IT folks want to build systems to support them and everyone wants them to bend the cost curve.

Any new innovation with that much buzz was bound to invite a backlash, which is now in full swing. Lately, the conversations I've had about ACOs have swung from measured enthusiasm to skepticism. Some folks are worried that ACOs are too focused on the structural work of linking providers together, at the expense of the equally, if not more important work of redesigning clinical care. Others think many would-be ACO players, including hospitals, haven't fundamentally prepared for the seismic changes in payment and care delivery poised to shake things up in the next decade. Still others think that the age-old challenges of working with physicians—whether they are employed, as is increasingly the case, or in affiliated medical groups—will bedevil many a would-be ACO.

But no matter how well your average ACO ends up functioning, Medicare and private payers are moving to new models designed to increase accountability. Whether ACOs are around in 10 years remains to be seen. But it's unquestionable that hospitals will be held much more accountable for their work in the very near future, whether as part of a formal partnership or not. Valinda Rutledge, CEO of Caromont Health in North Carolina, sums up this new reality in today's H&HN Daily podcast.

"We will have to assume some responsibility and accountability for health outcomes in which we will have some type of risk," Rutledge told me. "… We have to move from hospital-centric to community-centric in terms of our delivery of care."