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Even small physician groups that feel like guppies in a sea of payer piranhas have more contracting leverage than they think, according to Randy Cook, MPH, CMPE, senior medical practice consultant for Medical Practice Services at State Volunteer Mutual Insurance Company in Brentwood, TN, and speaker at the Medical Group Management Association's 2007 annual conference in Philadelphia in October. Often, groups simply need to look creatively at ways to exploit their market