Regulatory burdens strapped medical practices over the past year, MGMA finds

Dive Brief:

• Medical practices experienced greater regulatory burdens over the past year that directed resources away from patient care, according to a report out Tuesday from the Medical Group Management Association.
• Among 420 medical group practices responding to a survey included in the report, prior authorization requirements were the most frequently cited hurdle, while requirements for Medicare’s Quality Payment Program and COVID-19 workplace mandates tied for second.
• Prior authorization challenges include issues submitting documents through non-standardized health plan web portals and changes in medical necessity requirements and appeals processes, according to the report.

Dive Insight:

Healthcare providers have always faced regulatory burdens that can divert resources away from patient care, but the COVID-19 pandemic made it an especially burdensome year for medical practices, according to MGMA’s survey.

Prior authorization traditionally tops MGMA’s list, along with MIPS program requirements, though staffing shortages are exacerbating those strains this time around.

“Medical groups are reporting that there are barely enough nurses to take care of patients, let alone spend time navigating onerous prior authorization requirements or reporting clinically irrelevant quality measures to Medicare,” Anders Gilberg, SVP of government affairs at MGMA, said in a release.

Of the group practice executives surveyed, 70% have fewer than 20 physicians and 10% have over 100 physicians, while over 80% of respondents are in independent practices.

Some 91% of respondents said the overall regulatory burden on their medical practice increased over the past 12 months, and 95% said reducing those burdens would allow them to reallocate more resources toward caring for patients.

The requirements and inconsistencies around prior authorization specifically “have repeatedly delayed care and have forced us to hire additional staff simply to keep up with the ever-changing prior authorization environment,” one respondent noted, according to the report.

Provider groups like MGMA for years have advocated for CMS to reduce the overall volume and burden of prior authorization requirements.

“Obtaining prior authorization is often manually completed by the practice using the phone, fax, mail, or via a health plan proprietary web portal. Further complicating the process, health plans typically have different medical necessity requirements and the authorization submission and appeals process varies across payers,” a 2019 report from MGMA said.

Medicare’s quality payment program requirements are another ongoing pain point for providers.

Among 73% of respondents who participate in the Merit-based Incentive Payment System MIPS as part of the QPP, 93% said the payment adjustments do not cover the costs, time and resources spent preparing and reporting for the program. And 90% of respondents said CMS feedback on MIPS cost and quality measure performance is not useful for reducing costs or clinical outcomes.

At the same time, 79% of respondents reported that CMS implementation of value-based payment policies has increased the regulatory burden on their practice.

CMS is working to overhaul the Quality Payment Program with a new push toward value-based arrangements as proposed in the 2022 Physician Fee Schedule.

The agency also laid out a goal to get every Medicare beneficiary and a majority of Medicaid members in an accountable care arrangement within the next 10 years, officials said during a webinar last week.

“MGMA’s survey results indicate that most medical groups share CMS’ vision of transitioning into value-based care arrangements,” Gilberg said in the release.

“Unfortunately, 80% of respondents reported that there was not an alternative payment model clinically relevant to their practice. We urge CMS to collaborate with stakeholders in the development of an APM portfolio that meaningfully addresses and transforms patient care,” he said.