The three biggest challenges for physician group practices, in order, are rising operational costs, managing finances with uncertain Medicare reimbursement rates, and selecting and implementing a new electronic health record system.

That's the results of an annual Medical Group Management Association survey of its member practice administrators. Medicare uncertainty rose from the No. 5 biggest challenge during the past two years to No. 2 in 2010. Implementing a patient-centered medical home model of care jumped from No. 22 in 2009 to No. 12 this year.

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