“There is just too much to worry about to keep our practice afloat,” complained the office manager to the health care lawyer speaking at a medical-legal seminar. “Our physicians are not helping me and just tell me to figure it out,” she followed up.

“First we had to do Red Flags compliance, then we did not, Stark is so unbelievably complicated and Congressman Stark regretted it got passed, now there are hefty HIPAA fines, all the payors are auditing us left and right and treating us like criminals, and there is federal reform, and all the rules that are being drafted like we have to return Medicare overpayments within 60 days, and compliance programs may be mandatory for us Medicare providers, and well, we are not sure yet until the Supreme Court weighs in, and the whole Medicaid program in Oregon is being totally re-written and taken over by hospitals and health plans,” the office manager panted almost exhausted.

“I know, I would not want to be a physician today,” the speaker sympathized.

Is the office manager right or just complaining? Well, probably a bit of both.

On the legal side, today’s medical practice certainly has far more regulatory issues to worry about than a practice of ten or twenty years ago, and with federal reform in 2010, the flurry of rulemaking by federal agencies is a constant struggle to keep up with.

On the business side, third party payors, including state and federal government, are seeking ways to meet a greater demand for services with less money. The concepts of accountable or coordinated care organizations are being touted as a way to greatly reduce expenditures for services. Some states like Oregon passed massive Medicaid reform based upon a promise that reform could save the state $11 billion over ten years (more than $1 billion a year). The office manager in the scenario above has grown cynical enough to know that the $1 billion per year is coming out of someone’s pocket and likely her office’s. She worries about the effect those deep cuts will have on the practice and the local economy in her town where medical and dental practices are significant employers.

So what to do if a medical practice feels under pressure to meet the demands of keeping up to date with regulatory changes and servicing their patients effectively without going out of business?

First, take a breath, the sky is not falling, it is just that change is happening at a more rapid pace. There may very well be opportunity associated with the change, so rather than toss hands up and say “fuggedaboutit,” study the change and try to adapt. Better yet, try to be the first to adapt.

How do you do that? Well, be cost-effective, but get help if you are not willing to train yourself up or implement some type of internal compliance-like effort to learn about change and take action to meet the change. Use trade associations and other organizations like state medical societies or independent practice associations to obtain cost-effective training materials. If a society or association is lacking in an area, tell them, make them go get good materials for you. If you need to hire consultants, be frugal, but not cheap. Steer the project yourself, if possible, and keep the consultants like a lawyer or security expert focused on specific and narrow tasks. Finally, break down the risk areas in the practice into manageable pieces and approach the pieces in a step-wise manner. Becoming more adaptable to change does not happen overnight, it is a daily process if the practice has a plan and begins to check off the pieces of the plan, one by one.

In sum, managing a medical practice clearly can be overwhelming today. And, smaller medical practices are especially at risk given their limited resources to keep on top of every proposed change. Adapting to change is not impossible though, it just takes a plan and some effort (and perhaps a sympathetic speaker at a seminar to vent to once in a while).