According to a Medical Group Management Association survey released yesterday, your top three daily challenges of running a practice are as follows:

• Dealing with rising operating costs
  
• Managing finances with the uncertainty of Medicare reimbursement rates
  
• Selecting and implementing a new electronic health record system

In the third annual installment of MGMA's Medical Practice Today: What Members Have to Say report, the stresses have shuffled somewhat in light of the recession, health reform and other factors. In particular, Medicare reimbursement rate uncertainty had ranked No. 5 in both 2008 and 2009.

"It is not surprising that 'maintaining finances with the uncertainty of Medicare reimbursement rates' jumped to the No. 2 spot this year due to the continued congressional irresponsibility in not permanently addressing the flawed sustainable growth rate formula," said William F. Jessee, MD, FACMPE, president and CEO of MGMA.

Unfortunately, with stories like this one about the troubles physicians will face when the current six-month patch runs out, potentially exacerbated by proposed fee schedule changes, the lineup isn't surprising at all.

Physicians' cost of doing business is also no stranger to the news, either, as evidenced by today's piece about the often-prohibitive cost of providing vaccines in California (and elsewhere).

EHRs? Stress city. Not only must practices struggle to come up a way--amid their staggering operating costs--to fund and implement the technology, but guard against liability risks of which they may have not even considered.

The good news, however, is that MGMA's research reassures that FPM is hitting the pain points--and I and the rest of the Fierce team will continue to work hard to bring you solutions. In this week's issue, learn how you can better connect with patients--and avoid potential risks--for next to no cost using social media avenues such as a Facebook fan page for your business. With budgets more strained than ever, stay tuned for next month's special report on the top ways to collect on patients' increasing individual responsibilities to your practice. And don't forget to check in on what's happening in the health plan world with FierceHealthPayer. For all things EMR and beyond, look no further than FierceEMR, FierceHealthIT and FierceMobileHealthcare.

And above all, remember that you can communicate with me and other Fierce editors directly. I take every one of your comments, ideas and stories to heart in making FiercePracticeManagement the best--and most fierce--it can be. - Deb