One limitation to profitability analysis is its focus on past, not future, performance. The economic environment is unpredictable, and consistent profitability ---brought about by great management, productive employees, and a high-quality product---does not guarantee success when economic conditions change. At that point, shifts in strategy may prove crucial. For example, the shift from payment for costs incurred to payment by diagnosis code has changed life considerably in the health-care industry, previously, insurance companies and the federal government paid doctors and hospitals for all costs incurred. Clearly, cost cutting was not important. Now, the emphasis on efficiency and cost control has had a significant impact on all participants in the medical field.