Keeping balance sheets in the black and implementing electronic health records are 2 of the biggest challenges facing clinical managers today, according to the Medical Group Management Association's annual member survey.

Nearly three-fourths (73%) of the 2,077 respondents said operating costs that are increasing faster than revenues are a considerable or extreme challenge for their practice, making that the leading challenge chosen from the 30 options members were asked to rank. Reimbursement issues, from maintaining physician compensation amid declining reimbursements (which ranked second) to the uncertainty of Medicare rates (fifth) to negotiating payor contracts (seventh), also ranked high on the list.

For the second year in a row, adopting EHRs ranked among the top 3 difficulties, with nearly two-thirds (62%) of managers saying "selecting and implementing a new electronic health record system" presented a challenge.

In a notable change from last year's survey, "collecting from self-pay, high-deductible health plan, and/or Health Savings Account patients" jumped from No. 6 to No. 4 on the list, with 60% saying collecting patient payments is a considerable or extreme challenge in today's economy. (Similarly, in an online reader survey conducted by Outpatient Surgery Magazine last month, 58.5% of respondents said a growing number of their patients were taking out loans or entering payment plans to cover the cost of their procedures.)

"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," says MGMA president and CEO William F. Jessee, MD, FACMPE, in a press release.

A summary of the survey results is available on MGMA's Web site.

Irene Tsikitas

Prolonged exposure to high-concentration oxygen during or following surgery may contribute to Alzheimer's disease-like memory loss among elderly patients, says a new study.

After studying the effects of oxygen on genetically altered mice, researchers at the University of South Florida and Vanderbilt University came to suspect that oxygen may trigger the symptoms in people genetically predisposed to the disease and in those with high levels of the protein beta amyloid, which is found in brain plaques associated with Alzheimer's disease, says their article, which appeared in the Aug. 5 issue of the journal NeuroReport.

"The combination of brain beta amyloid and exposure to high concentrations of oxygen provides a perfect storm for speeding up the onset of memory loss associated with Alzheimer's disease," says lead author Gary Arendash, PhD, of the Florida Alzheimer's Disease Research Center at the University of South Florida, in a press release.

This research may help explain why some elderly patients experience confusion and memory loss in the days and weeks after surgery. "No one really knows why it happens," says L. Jackson Roberts, MD, a co-author from Vanderbilt. "If all it takes to prevent this is reducing the exposure of patients to unnecessarily high concentrations of oxygen in the operating room, this would be a major contribution to geriatric medicine."

Kent Steinriede

Two California women have been sentenced to prison for their roles in what has been described as the largest medical insurance fraud scheme in U.S. history.

Sue Nanda, 41, of Costa Mesa was sentenced to 10 years behind bars after pleading guilty to 22 counts of conspiracy, recruiting patients for fraudulent surgeries, failing to file and filing fraudulent tax returns and grand theft earlier this year.

Maria DeJesus Licea Rosales, 42, of Orange received an 8-year sentence on 96 counts.

Both Ms. Nanda and Ms. Rosales admitted to working as "cappers" for the Unity Outpatient Surgery Center in Buena Park, recruiting healthy and insured patients to undergo unneeded surgeries with the promise of cash or discounted cosmetic surgery. According to reports, Ms. Nanda recruited more than 170 patients from 16 states and Ms. Rosales more than 90.

Prosecutors say the center bilked California's insurance programs out of $154 million through a total of 2,841 fraudulent cases. Out of 19 charged in the scheme, 8 have pleaded guilty and 11 are scheduled for trial in October. The scam's ringleader, Tam Vu Pham, was sentenced to 12 years after pleading guilty last year.

David Bernard

Do you agree or disagree with this statement? Physician ownership of hospitals and ASCs presents "an unholy temptation to overorder" tests and procedures, since physicians then earn professional fees as well as a share of the facility's profits. Go to our Web site to register your opinion and to see real-time results.

(The argument was made in a recent article in the New Yorker magazine that has been stirring discussion on the healthcare reform front.)

The results of last week's InstaPoll (thanks to the 101 of you who responded) overwhelmingly showed that the main reason you don't get paid for implants is that payor contracts don't cover their costs (76%). A distant second was surgeons who prefer pricier implants to less expensive options (16%), followed by poor billing practices (5%). Interestingly, only 5% of respondents said they don't lose money on implants.

Dan O'Connor