The Sg2 Impact of Change (IoC) forecast, updated annually, uses proprietary impact factors to project 10-year patient demand across inpatient and outpatient services, allowing health system leaders to more accurately anticipate future opportunities and risks. Our 2019 IoC forecast indicates that inpatient procedure volumes will remain flat over the coming decade but all ambulatory sites, including hospital outpatient departments (HOPD) and ASCs, will experience robust expansion. ASCs will see the highest growth but also will be challenged by provider shortages across multiple specialties.