Really?  I mean, come on.  Only two months ago, Paul Ryan and CNN somberly pronounced that Obamacare was the "law of the land" and that we'd be living with it for the foreseeable future.  (By the way, so did we at the blog!) Many of us in healthcare exhaled as we saw the future of our reimbursements come into sharper relief.  After all, uncertainty is perhaps the worst situation to be in.

...and that new certainty, that Obamacare would be around for some time, has been summarily removed.  Did you and your health system hedge against the downside risk of an Obamacare repeal and replace?  Perhaps Paul Ryan and President Trump allowed the previous measure to fail in order to demonstrate what a GOP failure to repeal and replace would do in midterm elections.  

Perhaps they allowed GOP colleagues to claim a victory and demonstrate that they strongly represented their view, only to knowingly wink at each other that they would soon resurrect the bill in the coming months.

Whether we credit Mr. Trump and Paul Ryan with a strategic temporary setback or no, we can safely say that, now, the repeal and replace measure is progressing.

Perhaps you've already focused on continuing to improve your quality and to progress on the march from volume to value, or perhaps you took other steps to maximize your service to your community, your margin, and your quality of care so that you are positioned in the best manner possible no matter what comes next.  Whatever idea you've labored under until now, it seems like the ground is again shifting under our feet.

It's times like these that we remember classic aphorisms like "The only thing certain is change.", and "It is not necessary to change.  Survival is not mandatory." Classics, yes, but they provide only a little comfort when we are actually going through turbulent times.

Regardless of your specific choices (some suggestions are listed here by the way) something will be different.  Make some choices and do something, because inaction is also a choice but perhaps the least adaptive.  Trump and his team are confident that this bill will be sheparded through the Senate.  Are you ready?  Buckle up for changes.