A recent report from the Medical Group Management Association (MGMA) found that medical practices experienced greater regulatory burdens as a result of the COVID-19 pandemic. Out of the 420 medical group practices that responded to the survey, prior authorization requirements were the most frequently cited hurdle. Requirements for Medicare’s Quality Payment Program (QPP) and COVID-19 workplace mandates tied for the second most frequent hurdle.
Recurring Challenges
Challenges with prior authorization continue to grow and evolve, including issues submitting documentation through non-standardized health plan web portals, as well as changing medical necessity requirements and appeals processes. According to one survey respondent, “The requirements and inconsistencies have repeatedly delayed care and have forced us to hire additional staff simply to keep up with the ever-changing prior authorization environment.”
Additionally, of the 73% of respondents that participate in the Merit-based Incentive Payment System (MIPS) as part of the QPP, 93% reported that MIPS payment adjustments do not cover the costs of time and resources spent preparing for and reporting under the program.
“MGMA’s survey results indicate that most medical groups share CMS’ vision of transitioning into value-based care arrangements,” Anders Gilberg, SVP of government affairs at MGMA, said in a release. “Unfortunately, 80% of respondents reported that there was not an alternative payment model [APM] 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.”
The Impact of Staffing Shortages
While prior authorization and MIPS program requirements are often found at the top of MGMA’s list, staffing shortages experienced by healthcare providers throughout the country are complicating things this year.
“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,” said Gilberg.
It isn’t just the staff strain, but the vast majority (91%) of respondents reported that the overall regulatory burden on their medical practice has increased over the past 12 months. Even more respondents (95%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.
What’s Next
MGMA concluded that “there is still much to be done at the federal level to provide regulatory relief for medical groups” and pledged its continued role in policy discussions in Washington, D.C.
About the Survey
More than 400 group practices responded to the MGMA surgery, 70% of which were practices with less than 20 physicians and 10% were practices with more than 100 physicians. More than 80% of survey respondents were in independent practices.