When I wrote in my last Editor's Message (March/April 2011, available online at PracticalNeurology.net) that neurologists did not have as many opportunities as some other special- ties to increase practice revenues, I was thinking of fields like dermatology, where a significant proportion of clini- cians now offer cosmetic services, and many sell high quality skin- care products. A reader pointed out that one option open to neurolo- gists is to opt out of Medicare (See the Letter to the Editor on p. 15). When they read about the slew of new initiatives that are going into effect for healthcare providers—especially Medicare providers (p.57)—many neurologists may see opting out of Medicare as an attractive option.

Clinicians who fail to comply with new standards or participate in new initiatives will find not simply that their collections will decrease. Fines can be leveled against providers who will actually lose money. For example, if you're not already e-prescribing, you've probably already missed out on the opportunity to earn incentives for this year. If you're not on-board with e-prescribing soon, you risk additional penalties.

Few physicians go into medicine because they enjoy the minuti- ae of running a business. Those individuals with a true interest in business could find much greater success in other commercial endeavors. (This is not to suggest, however, that there aren't some rather savvy physicians.) Doctors go into practice to help patients. And for many, issues like paperwork, billing and coding, meeting with banks, or hiring and managing staff are unfortunate distrac- tions from the work at hand.

The harsh reality is that you cannot help patients if you cannot maintain a practice, and you cannot maintain a practice unless you remain solvent. It's an unfortunate fact of medical professional life today that every physician—whether or not he or she participates in Medicare—consistently must make tough financial decisions that impact the practice and, as a result, the patient experience. In com- ing months we'll continue to provide you information about looming deadlines and provide practice tips for navigating your way through the multi-step processes. We'll also continue to provide the kind of practical, patient care information that we hope will add to your clin- ical efficiency so that, at the end of the day, you'll even have time for a personal life.