Many of us get dry mouths and lumps in our throats at the thought of speaking in public, regardless of whether we're addressing a small group of coworkers or making a presentation to a conference room full of strangers.

As young doctors researching the modern primary care system, Rushika Fernandopulle, MD, MPP, and Pranav Kothari, MD quickly drew the same conclusion regarding patients' experiences with doctor office visits in the 21st century. "In almost every way, the system is poor," says Fernandopulle, who founded the Arlington, MA, practice Renaissance Health in 2004 alongside Kothari and a third physician, Amy Schoenbaum, MD. "And nobody's innovated this model for primary care in a long time."

With all the vital numeric codes that coding and billing staff deal with, it's no wonder that some of the secondary codes-such as late effect codes-often slip through the cracks.

Maintaining a healthy practice requires new patients-jewels treasured by most practices and specialty groups. However, the busiest primary care practices are often tempted to close to new patients simply out of necessity. This is a dangerous and short-sighted decision that, over time, will cause a decline in visit volume and reimbursement. Your established patients will age, move out of the area, or choose to go to other providers.

Although they were greeted with suspicion and skepticism when President Bush signed them into existence as part of the Medicare reforms in December 2003, health savings accounts (HSA) now seem poised to become a major player in consumer-participatory health benefits in 2005 and beyond.

Over dinner one night in 2004, a discussion about the upcoming presidential election between Thomas Suarez,1 MD, and a colleague led to a lingering question. "We were talking about how policies regarding state-to-state medical malpractice seemed to have gone so awry, and we said, 'Wouldn't it be wonderful if people in the Congress and the Senate really understood the problem?' " Suarez says. "And from there, it turned into trying to find out how many of these elected officials were actually doctors."