Hard to believe, but January is less than half a month away.

Among other things, that means we’ll soon be treated to a boatload of predictions for 2019. Most will probably be much more than you need.

So in the spirit of less is more, here are a mere four developments you may want to keep an eye on.

1.     Tell-offs and sell-offs

You know that big ol’ bullseye that always seems to be on your back? It’s about to get bigger. Our government is racking up record deficits and Medicare is about seven years from insolvency. As the day of reckoning gets nearer, the feds will likely demand belt-tightening, and yes, closer scrutiny.

The Centers for Medicare & Medicaid Services has more tools than ever to monitor and audit who has been naughty and nice. So it’s a safe bet they – and others – will be more than happy to reveal what’s found. Particularly if it comes at your expense.

And while the Cavalry (also known as aging baby boomers) will be here in a few years, they obviously haven’t arrived yet. That means many operators are struggling to meet payroll and other fiscal obligations. By choice, necessity or both, we can expect to see many independently-run facilities seeking buyers. That’s especially the case for communities that are old-school in their approach to care, located in rural areas, or who happen to be on the naughty list with local hospitals.

2.     The big print may taketh away, but the small print will giveth

Speaking of belt tightening, the general trend toward demanding better and cheaper care will continue. Operators can expect to see both the government and insurance companies putting new rules in place to trim outlays as much as possible.

But if the skilled care sector is nothing else, it is resourceful. Its army of lawyers, consultants and accountants has an amazing ability to sniff out buried clauses, passages and other loopholes that can be spun into gold. If past behavior is a good predictor of future outcomes, we very likely will see history repeat itself here.

3.     Out with the old …

To be sure, we are seeing a general upstream push among many skilled-care players. The jury is still out on whether PDPM will help or hinder that trend. Regardless, most operators will need to adapt in ways both large and small. For some that will mean better alignment with what used to be called hospital systems (“health systems” appears to be the term du jour). Others will become quite familiar with Medicare Disadvantage, er Medicare Advantage. For still others, change will mean better community integration, maybe even applied population health tactics. Then there will be the few renegades who completely blow the doors off, and opt to make geriatric-focused care and services just a part of an overall portfolio.

4.     Smart will beat strong

Who would have thought a decade ago that skilled care would be a driving force in technology, analytics or even artificial intelligence?

To be sure, the advance of new knowledge is uneven. But it’s clearly happening. Moreover, it is increasingly going to be the tool that separates the haves from the have-nots. For as the saying goes, the strong take from the weak, and the smart take from the strong. Skilled care will increasingly become a game that favors the smart.

Will there be other notable developments as well? Of course. But these four will surely leave a mark.

John O’Connor is the Editorial Director at McKnight’s.