For-profit hospital companies must weather looming threats of market disruption, regulatory changes and technological advancements that may change where patients get care in 2018, analysts say.

In its 2018 outlook, Fitch Ratings said for-profit companies, including hospitals, are prime targets for competition from companies like Amazon, which could exploit inefficiencies that keep hospital care expensive.

. . . Overall, Costa said a would-be disruptor would need to have the money to build up infrastructure and meet regulatory requirements, but that the barriers are not insurmountable.

Rich Bajner, managing director for Navigant, said he thinks hospitals of all stripes should focus more attention on a combination of more near-term challenges, including a payer mix that continues to shift away from commercial and toward government payers.

Hospitals also need to strengthen their revenue cycles as more patients buy high deductible health plans.

. . . The industry also must contend with the continued focus on affordability. Big data and analytics permit price transparency and let consumers shop around, Fitch noted in its report.

. . . There’s also the question of whether Congress will approve a tax reform bill that would reduce Medicare spending levels in the coming years.

But Rick Gundling, senior vice president for the Healthcare Financial Management Association, said hospitals have adapted to uncertainty.

“I think this uncertain environment is really the environment,” he said.

That sounds like a lot of bad news, but overall, Fitch predicts for-profit healthcare will remain stable in 2018, with aggregate revenue growth of 4% and aggregate cash flow of $135.3 billion.

Despite the numerous cautions, Costa said he sees solid, long-term demand on the horizon.

“Ultimately there is still a core role for the hospital in terms of a continuum of care,” he said.