EHR adoption and finances remain the top challenges facing medical practices, according to a new survey from the Medical Group Management Association.

For the second year in a row, medical practice professionals sounded off to the MGMA about a variety of challenges faced while safeguarding their practices' financial solvency.

The 2009 survey "Medical practice today: What members have to say" reveals the three top challenges of running a group practice remain the same as in 2008.

* Dealing with operating costs that are rising more rapidly than revenues;
* Maintaining physician compensation levels in an environment of declining reimbursement; and
* Selecting and implementing a new electronic health record.

After those top three concerns, the other priorities changed somewhat from 2008.

This year, respondents listed collecting from self-pay patients and those with high-deductible health plans and health savings accounts as the fourth-highest challenge. In 2008, the fourth-ranked challenge was recruiting physicians, which ranked sixth this year. Managing finances in the face of uncertain Medicare reimbursement rates rounded out the top five for the second year in a row.

"Medical practice managers have one of the most difficult jobs in healthcare," said William F. Jessee, MD, the MGMA's president and CEO. "Running a successful business that provides medical care is an incredibly difficult task in these economically challenging times. But the professionalism that MGMA members bring to their work enables them to persevere."

The MGMA asked respondents to rate and listen to lead MGMA researcher James Margolis' podcast. The organization also asked how the recession is affecting their medical groups and how they are responding.

Ranked by average score, the participants indicated the most probable effects of the recession on their practices are:

* An increase in uninsured patients;
* Improved billing and collections and/or denial management processes;
* Decreased revenues;
* Postponed capital expenditures;
* Operating budget cuts; and
* Staff hiring freezes.

Many respondents said they are experiencing the effects of the recession on their practices:

* 36.6 percent said they have postponed capital expenditures;
* 34.7 percent are seeing a rise in uninsured patients;
* 34.5 percent have implemented a staff hiring freeze;
* 33.9 percent have cut operating budgets;
* 33.3 percent have improved billing and collections processes; and
* 33.1 percent have witnessed a decrease in revenue.

"At their core, medical practices are small- to medium-sized businesses, and the recession has affected them in many of the same ways as other businesses," Jessee said.

On the positive side, nearly 82 percent of respondents said there is a zero probability that their group will file for bankruptcy protection and nearly 80 percent said there is a zero probability their practice will close because of the poor economy.

The MGMA conducted the online survey Feb. 2-26, It received 2,077 responses, a rate of 13.4 percent.