MGMA 2022: As COVID-19 goes away, regulatory burdens spring up to occupy physicians

COVID-19 pandemic conditions are getting better, but red tape and paperwork are getting worse in the last year, according to a survey of physician practices and health care system leaders around the nation.

The Medical Group Management Association published its “2022 Annual Regulatory Burden Report,” a survey of more than 500 group practices, including 64% with fewer than 20 physicians, and more than 75% in independent practices.

If the poll was an election, increasing overall regulatory burden would win in a landslide, with 89% of respondents reporting it got worse in the last 12 months. If that burden was reduced, 97% of respondents said that would allow them to reallocate resources toward patient care.

“In a time of runaway inflation and unprecedented workforce shortages, the federal government is layering on additional regulatory burdens that, while in theory are beneficial to patients, act more as an impediment to delivering care,” said Anders Gilberg, MGMA’s senior vice president of government affairs, said in a news release. “From longstanding challenges associated with the Quality Payment Program, to new obstacles related to the No Surprises Act, it is evident that policymakers must consider the totality of these burdens and their ultimate impact on patient care.”

The results were published on Oct. 11, the day when MGMA was concluding its 2022 Medical Practice Excellence Leaders Conference.

Burdens in medicine

The top contenders for consuming the most time and effort in physicians’ practices, with percentages of respondents reporting it very or extremely burdensome:

• Prior authorization, 81.93%.
• Surprise billing and good faith estimates, 70.45%.
• Medicare Quality Payment Program, 64.56%.
• Audits and appeals, 63.90%.
• Translation and interpretation requirements, 50.75%.
• Lack of electronic health record interoperability, 50.44%.
• Medicare and Medicaid credentialing, 41.17%.

The COVID-19 pandemic has not yet dropped out of sight, with 42.38% of respondents calling the very or extremely burdensome.

Prior authorizations

Getting prior authorizations from payers has caused 89% of practices to hire additional staff or redistribute current staffing resources to process prior authorizations due to the increased number of requests, according to the survey.

Along with an expense to physician practice resources, doctors, patients, and their advocates argue the processes delay patient care unnecessarily, according to MGMA.

“The increase in prior authorization requirements year after year is simply unsustainable,” Gilberg said. “Practices are being forced to divert resources away from delivering care to contend with these onerous and ever-changing requirements. It is time that Congress acts to put commonsense guardrails around prior authorization programs. We urge the expedient passage of the Improving Seniors’ Timely Access to Care Act before the end of this year.”

That act has been approved in the U.S. House of Representatives and has strong support in the Senate, along with backing by numerous medical associations.

No Suprises Act

The federal No Surprises Act aims to protect patients from malicious balance billing practices and ensure patients have cost estimates to make informed decisions about their care – positions that MGMA supports. But the association members remain concerned the policies, as implemented, create undue burden without improving care, the report said.

In the survey, 82% of respondents said the required uninsured or self-pay good faith estimates have increased administrative burdens on their practices.

Meanwhile, health care mergers and acquisitions are growing, along with government scrutiny of that consolidation. The MGMA survey found 90% of medical group leaders believe health care consolidation is increasing, and 76% of medical groups indicated the increasing regulatory burdens have been a major contributor to that.