Health

Medical practices say regulations adding more red tape that hamstrings patient care

Medical practices say they have shouldered more and more regulatory burden as of late and that rolling back requirements—particularly those around prior authorization—would help them deliver better care to patients.

The sentiment comes courtesy of the Medical Group Management Association (MGMA), which polled 420 medical practices of various sizes on regulatory, reimbursement and other industry issues.

This year, 91% of the survey’s respondents said that they have seen an increase in overall regulatory burden over the past 12 months—an increase over the 86% of respondents who indicated a similar sentiment in the association’s 2018 and 2019 surveys (MGMA did not conduct its survey in 2020 due to COVID-19).

Ninety-five percent of this year’s respondents said that reducing the regulatory burdens on their practice would allow them to reallocate resources toward patient care.

Respondents quoted anecdotally in MGMA’s report said they needed to hire additional administrative staff and vendors to comply with regulatory requirements and that federal offices “grossly underestimate” the weight their regulations are placing on practices.

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“Medical practices continue to report an increase in regulatory burden, with challenges associated with the COVID-19 pandemic further compounding the issue,” Anders Gilberg, senior vice president of government affairs at MGMA, said in an accompanying statement.

“Practices are currently experiencing unprecedented shortages of clinical and administrative staff, yet the federal government continues to add layer upon layer of new regulatory requirements. 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,” he said.

Burdens tied to prior authorization were by and large the main offender, with 88% of survey respondents describing the requirement as “very or extremely burdensome.” This was similarly up from what MGMA heard in its surveys from 2018 (82%) and 2019 (83%).

Other issues frequently cited by the practices included COVID-19 workplace mandates (71%), the Medicare Quality Payment Program (71%) and reporting requirements for the COVID-19 Provider Relief Fund (67%).

Quality payment programs like the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) were sore spots for the practices across multiple metrics.

Alongside generally increasing regulatory burden, 70% of the responding practices said that the government’s push toward value-based payments has so far not improved the quality of patient care and has been unsuccessful.

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Practices overwhelmingly said that federal feedback on MIPS evaluations has not helped them improve their performances in regard to costs (92%) and quality (88%). Four in five said that there are currently no APMs that are clinically relevant to their practice, although nearly two-thirds said they would be interested in APM participation if it was relevant and aligned with their quality goals.

“MGMA’s survey results indicate that most medical groups share CMS’ vision of transitioning into value-based care arrangements,” Gilberg said. “We urge CMS to collaborate with stakeholders in the development of an APM portfolio that meaningfully addresses and transforms patient care.”

MGMA’s poll was largely comprised of independent medical practices (83%) and organizations with 20 or fewer full-time-equivalent physicians (71%). 

Issues like MIPS and prior authorization have seen broad criticisms across the spectrum of healthcare providers.

In August, a JAMA Network Open study found “limited evidence” suggesting that MIPS scores are actually tied to better outcomes among surgical patients. An accompanying editorial argued that private practice clinicians are near-forced to participate to secure reimbursement but generally “regard MIPS as a regulatory tax to be met with the least possible investment of either money or time.”

Prior authorization, meanwhile, got a callout just last week from the American Hospital Association, which applauded a proposed rule designed to streamline the process but argued that more could be done to lessen the reporting burden on providers.

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