Health Information technology (HIT) , which is a considerable investment with elusive results, should be considered. Today’s average cost of implementing an Electronic Health Records (EHR) system in a medical practice is approximately $32,000 per physician, through the first 60 days after system launch. One-time hardware costs can range from $25,000 to $60,000 per practice for internet switches, cables, and wireless internet connections, plus approximately $7000 per physician for computers, printers, and other hardware. Software and maintenance costs , which begin at implementation, can range from $12,000 to $19,000 per physician annually [3]. In addition, one must consider the nonfinancial costs, which include the monetary costs of salaries per physician as well as his or her support staff and implementation team. Despite the variability in region, practice size, and vendor, there is considerable cost associated with origination and implementation of any EHR system.

Consolidation has been promoted by reform efforts seeking to reduce waste and to reward value instead of volume, but these monopolizing forces are contributing to a rise in costs and leading to lack of competition and extinction of independent medical practices. While independent practices struggle with payer pressures and management challenges, they can deliver a greater quality/value proposition overall. Through mergers and acquisitions, hospitals have grown larger in size and have thereby ensnared more physicians under their control in the last decade. Hospital acquisitions of physician practices tend to lead to higher prices, mostly because of added facility fees by the hospital systems and consolidation of practices, which has not led to either improved quality or reduced costs. It may be argued that the true role of consolidation is to enhance bargaining power with payers and not necessarily to produce integration nor to enhance performance. Advocates of healthcare consolidation, however, may continue to argue that economies of scale, in time, are likely to reduce waste in the system and to ultimately push prices down.

Patient consumer movement towards social media and shared decision-making has forced medical practices to engage in newer strategies, which attract new patients and engage their existing clientele. The internet age has helped to ease the dissemination of information, but at a cost to the provider. Ninety percent of adults state that they rely on information gathered from peers through any number of social networks and over seventy percent search online to address health concerns and referral sources. Digital healthcare marketing has seen a significant increase in the past 10 years by reaching consumers through various technologies and targeted campaigns. It has been proven to be highly measurable by allowing providers to focus on targeted populations. However, website development, paid searches, and reputation management all come at a direct cost to a medical practice and although these channels may help to improve traffic and ultimately direct patient flow, it can lead to misappropriation of funds at a cost to patient care. It is important to remember that the best and most cost-effective way to begin marketing efforts is by providing excellent care and service to existing patients. Facilitating potential patient movement, whether it’s simply through word of mouth, marketing assistants, digital marketing, or print advertisements, should not cost a lot of money. Optimizing consumer movement by letting patients know that a practice is willing and able to care for them, and by providing payers an image of quality and professionalism both show how a practice can provide high-quality, cost-effective care.