Caught between healthcare reform mandates and a weak economy, many physicians are fretting that financial conditions will force them to postpone retirement indefinitely. It's no surprise that baby boomer and older "Silent Generation" physicians plan to delay their retirement. What is surprising is that Generation Xers are also thinking about it, even though retirement is many years away, according to Jackson & Coker, an Alpharetta, GA, physician placement firm.

Under healthcare reform, the payment structure will move from fee-for-service to a pay-for-outcome model, such as bundled payments, medical homes, or accountable care organizations (ACO). However, the change to a new payment model is going to be a bumpy and expensive one-and few organizations have the margins to lose reimbursement dollars during the transition period. With most providers having little margin to put toward a pilot program, and with an expectation of losing reimbursements once it's under way, a medical home is unappealing under the current payment system. However, there are pathways to making margin in the medical home.

Implementing an EMR requires planning and avoiding some common pitfalls, says Bruce Boissonnault, president of the Niagara Health Quality Coalition (NHQC), a nonprofit collaboration of business, healthcare, government, and consumer leaders in Williamsville, NY. Boissonnault also is the founding president of the Alliance for Quality Health Care (AQHC), a New York state col­laboration of leaders working to improve healthcare trans­parency nationally.

More physicians and practices can expect to avoid cuts in Medicare payments now that CMS has softened e-prescribing rules. In its final rule, published in the Federal Register at the end of August, CMS added new "significant hardship" exemptions, agreed to exempt those practices that are already meaningful users of certified electronic health records (EHR), and extended the deadline to apply for those exceptions by one month to November 1, 2011, for the 2012 payment adjustment. A 1% cut in fees for those who are not successful ­e-prescribers will begin in 2012. Providers also face a potential 1.5% and 2% cut for 2013 and 2014, respectively.

Accountable care is not a new concept to physicians, but the Patient Protection and Affordable Care Act of 2010 (PPACA) is creating new pressure to get patients more actively involved in their care, says Erica Drazen, managing partner for emerging practices with the healthcare consulting firm CSC in Waltham, MA. Not only will patients' health improve, but the practice's revenue also can benefit. PPACA includes several provisions that will tie reimbursement to performance, including:

Medical practices cut operating expenses 2.2% in 2010, according to a survey from MGMA.