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Today's independent physician is overwhelmed by the challenges posed by the 3 "big Rs": reimbursement, regulation, and recession. As a result, many are falling victim to hospitals, which see the opportunity to buy up individual practices unable to cope with the 3 Rs, and thereby control healthcare in their region.

Limited medical plans

Employers that offer their employees limited medical plans are impacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, since they are considered group health insurance plans.

The financial services reform legislation passed in July contains numerous provisions, two of which will be of interest to physicians. One concerns banking and lending; the other involves investing.

The tough get innovating

Some physicians have held their financial ground during the tough economy by innovating at their practices. Anne Trussell, MD, a solo internist in Little Rock, Arkansas, added ancillary cosmetic services to boost revenue at her practice when some patients limited office visits due to the cost. She always has kept her overhead low, so expanding services was the solution during these challenging times.

I felt numb, confused, and a bit scared as I sat in my car, staring at the steering wheel and going nowhere. Then the tears came. I could not believe that I had just quit the only remotely stable job I had held, after 11 years, and I was going to have to leave the office staff that had become like family. For what purpose? More money? Was I having a mid-life crisis? I didn't have an answer for myself, but I had opened my mouth in frustration and said 7 words to my long-time employer and friend that haunted me for months afterward: "I will have to make other plans." Meanwhile, how was I going to pay the bills?

If cost is a significant consideration and you can tolerate the hospital's primary care EHR templates, you should research any offers by local hospitals to subsidize your EHR purchase if you choose their system

More than 90 medical groups signed a letter to U.S. Treasury Department opposing any changes to the tax code that would allow trial attorneys to deduct litigation expenses from their taxes in certain cases.

Alternatives to 401(k) plan

Consider some low-risk retirement benefit options to offer employees instead of a 401(k) plan.

The Certification Commission for Health Information Technology of Chicago, and the Drummond Group Inc. of Austin, Texas, were named in August by the Office of the National Coordinator for Health Information Technology as the first technology review bodies that have been authorized to test and certify electronic health record systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services earlier this year.

The Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis will partner with the Indiana Health Information Exchange, the largest health information exchange organization in the United States, to securely exchange electronic health record (EHR) information using the Nationwide Health Information Network in the third of three pilot programs announced by the U.S. Department of Veterans Affairs to improve the delivery of veterans? health information.

Cincinnati and Detroit are the two final pilot cities selected under the U.S. Department of Health and Human Services Beacon Community Program, which aims to use health information technology to help tackle leading health problems in communities across the country and accelerate development of a nationwide health IT infrastructure.

The Certification Commission for Health Information Technology and the Drummond Group Inc. are the first two technology review bodies authorized by the Office of the National Coordinator for Health Information Technology to test and certify electronic health record systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services earlier this year. Applications for additional certification bodies also are under review.

Medical Economics convened a panel of experts to discuss the things you can control to strengthen your medical practice to withstand factors beyond your control. We share their advice related to operations, practice valuation, front office matters, and accounting and finances.