1. Pharmaceutical costs particularly non-generic.
2. Payers expanding into providers and combining with providers.
3. Payer market share.
4. Health IT and cybersecurity costs.
5. Labor costs and a labor intensive business.
6. High costs of bricks and mortar.
7. Medicare as a larger percentage of health system revenue and Medicare reimbursement softening now and over time as federal deficits rise.
8. Slowing overall healthcare inflation as hospital costs rise.
9. Siphoning off of better paying commercial patients.
10. Siphoning off of profitable ancillaries.
11. Entry of big technology firms into healthcare.
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