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Whether it's an OB/GYN practice paying high medical liability insurance rates, a group of anesthetists employing certified registered nurse anesthetists (CRNA), or a pediatrician struggling to purchase vaccines, high practice costs are forcing most medical groups to operate on what MGMA President and CEO William F. Jessee, MD, FACMPE, referrs to as "razor-thin margins." Most practices are staying within the margins by increasing revenue to offset rising costs, but Medicare payment freezes, and other reimbursement woes don't make that easy.