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Red tape up, revenues down in 2023, MGMA says

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Health care is hot in Washington, but survey shows regulatory burdens are hammering smaller, independent, primary care practices.

© Medical Group Management Association

© Medical Group Management Association

Physicians this year are facing more red tape and less income as government and health insurance rules far outpace reimbursement for medical care.

On Nov. 13, 2023, the Medical Group Management Association published its “Annual Regulatory Burden Report.” The results, in short: Doctors and their support staff are spending more time on administration and that cuts into time spent with patients.

“MGMA has long advocated that policymakers in Washington scale back regulatory burden for medical practices, arguing that these requirements divert time and resources away from delivering patient care,” the report said. “Yet, as indicated in this year’s report, regulatory burden continues to rise.”

Key findings

Among the key findings:

  • 90% said overall regulatory burden has increased over the past 12 months.
  • 97% agreed reducing regulatory burdens would allow practices to shift resources to patient care.

Prior authorizations (PAs) for treatments continue to slow down care, with 97% of practices reporting their patients experienced delays or denials for medically necessary care due to PAs. Delays in PA decisions were the top challenged for 88% of respondents. Increasing requests have forced 92% of respondents to hire new staff or redistribute current employees to work on prior authorizations, according to MGMA.

Medicare

Medicare’s effort to shift to value-based care is not making work easier or improving patient care, according to the MGMA survey results.

As of this year, 69% of respondents were participating in Medicare’s Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). But 94% said the value-based payment initiatives have not lessened the regulatory burdens, and 72% said they have not improved quality of care. A solid majority – 68% – said the move to pay physicians based on value has not been successful to date.

Respondents said MIPS reporting requires multiple measures that “are often not drivers of meaningful improvements,” and the U.S. Centers for Medicare & Medicaid Services (CMS) offer little practical help to improve.

“MGMA has longstanding concerns that MIPS cost measures unfairly penalize clinicians and group practices for costs over which they have no control,” the report said. “MGMA regularly hears from members that clinicians and group practices do not understand how CMS evaluates them on MIPS cost measures and that the lack of actionable, timely information makes this category a ‘black box’ that they have little to no control over.”

Meanwhile, the Medicare Access and CHIP Reauthorization Act was passed to incentivize participation in APMs, according to MGMA. But 78% of respondents said Medicare does not offer and Advanced APM relevant to their practices.

Medicare reimbursement is not keeping up with inflation, according to 87% of MGMA respondents, and patients with traditional Medicare may have fewer options for health care if physicians must reduce access for them.

Small practices in peril

The regulatory burden is hammering hard on smaller practices. Among more than 350 responding group practices, 60% reported one to 20 full-time physicians in their organizations. A full 75% of respondents were independent practices, and the two largest types of practices reporting were multispecialty with primary and specialty care (18%) and family practice (14%).

The report included comments from respondents who described the financial conditions they face daily.

“As a small, independent, primary care practice, it is very hard to keep up with all the changes,” one commenter said. “While you can purchase vendors that do credentialing, programs that can reduce your denials, and many other products that can reduce the burden placed on us, we simply cannot afford it.”

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