MGMA Reports Surge in Regulatory Burdens, Including Increased Prior Authorization, Since Last Year

In the most recent annual report on regulatory burdens by the Medical Group Management Association (MGMA), nearly 90% of medical practices surveyed reported a notable rise in regulatory challenges over the past year. The primary issues highlighted by over 350 participating group practices encompassed prior authorization, audits and appeals, the Medicare Quality Payment Program (QPP), and the regulatory framework surrounding surprise billing and good faith estimates.

According to the report, the escalating regulatory burden is diverting both time and resources away from patient care. A staggering 97% of respondents asserted that a reduction in these regulatory demands would empower them to reallocate resources more effectively to enhance patient services. Additionally, 77% of practices indicated that their current regulatory and administrative burden is currently affecting or will affect access to Medicare for patients.

Among the specific regulatory concerns, prior authorization emerged as the predominant challenge, with more than 89% of respondents labeling it as “very or extremely burdensome.” A significant 92% of practices reported the need to hire or redistribute staff to concentrate on prior authorization due to an upswing in requests. Furthermore, 97% noted that patients experienced delays or denials for “medically necessary care” due to these requirements. Challenges such as decision delays (88%), prior authorizations for routinely approved services (83%), and inconsistent insurer payment policies (80%) were identified as prominent obstacles complicating the prior authorization process.

Following closely behind prior authorization, audits and appeals, along with the Medicare QPP, were identified as major regulatory challenges, with 68% and 67% of practices categorizing them as “very or extremely burdensome,” respectively. Regarding the Medicare QPP, roughly two-thirds of practices expressed dissatisfaction with the progress of value-based payment initiatives in government programs. Notably, 94% stated that this shift had not lessened their regulatory burden, and 72% observed no resultant improvements in the quality of care for their patients.

Other noteworthy regulatory concerns highlighted in the survey included surprise billing and good faith estimate requirements (63%), Medicare Advantage chart audits (62%), lack of electronic health record interoperability (47%), translation and interpretation requirements (42%), and Medicare and Medicaid credentialing (42%).

The MGMA stressed the necessity for federal intervention to alleviate regulatory burdens for medical groups. The association pledged to maintain a pivotal role in policy discussions to ensure that the voices of medical practices are heard in Washington.

It is important to note that 60% of respondents hailed from practices with fewer than 20 physicians, 16% from those with more than 100 physicians, and three-quarters from independent practices. Prior authorization consistently emerged as a top concern in MGMA’s surveys, with this year’s 89% score representing an increase from the 81% reported last year.

In response to these challenges, the Centers for Medicare & Medicaid Services (CMS) proposed a rule in December 2022 aimed at streamlining prior authorization processes and enhancing the electronic exchange of health data by 2026. While the proposal garnered support, stakeholders called for further refinements and clarification of technical provisions. As of now, CMS has yet to finalize or rescind the proposed rule.