By now, we all know the varied challenges created by the Affordable Care Act (ACA) — device tax introduction, reimbursement contraction, provider and payer consolidation, and pricing compression, just to name a few. But several years ago, the ACA’s potential impact was only speculation. We were looking into our educated crystal balls, but we didn’t have the data to see what trends would develop, or what those trends could lead to in the coming decade. Now, part of that picture is starting to take shape.