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Hospital CEOs know change is coming, because in healthcare, change is always coming. Any hospital CEO with a strand of gray hair has lived through the Balanced Budget Act of 1997, seen physician employment rise, fall, and rise again, fought the managed care contract wars, and watched as computers took over the information side of healthcare. But all of that change pales in comparison to what is coming. Words like "systemic" and "sea change" come from CEOs' lips when describing what could-and should-happen to the healthcare industry's financial underpinnings in the next few years.