The top 10 regulatory burdens weighing on physician practices in 2026

Administrative work continues to consume a growing share of physician practice resources, with audits and appeals topping the Medical Group Management Association (MGMA)'s 2026 list of regulatory burdens and Medicare Advantage (MA) accounting for three of the top five.

MGMA released its 2026 Regulatory Burden Report on April 9, based on survey responses from leaders at more than 230 group practices. About 95% reported an increase in regulatory burden over the past three years, and 40% said they now employ at least three full-time administrative staff per physician to manage tasks like prior authorization, denials and quality reporting.

"It is no surprise that this year's MGMA regulatory burden report further illustrates the strain medical practices experience every day," Anders Gilberg, senior vice president of MGMA government affairs, said in a statement. He cited Medicare Advantage prior authorization, denials and automatic downcoding as the chief drivers, along with quality reporting and other federal mandates.

Medicare Advantage's outsized footprint

Three of the top five burdens are exclusively related to Medicare Advantage: prior authorization, denials and automatic downcoding. The top-ranked burden, audits and appeals, is also commonly associated with MA, MGMA noted, as practices must comply with mandatory Risk Adjustment Data Validation (RADV) audits and appeal denied claims.

Ninety percent of practices reported a shift toward MA, and 79% of those said the change has had a negative impact on operations. MA enrollment now exceeds Traditional Medicare in many markets, MGMA said, and while the program has helped certain patients and helped accelerate value-based care arrangements, it has "also placed a significant burden on practices."

The report warns that without prompt payment and relief from utilization tactics, "participating in MA will become increasing unsustainable and practices may decide to end MA contracts."

Prior authorization keeps climbing

Ninety percent of practices said prior authorization burden grew in the past 12 months, with MA ranked as the most burdensome payer for obtaining prior authorization, ahead of commercial plans, Medicaid and Traditional Medicare.

One practice executive quoted in the report described adding two full-time staff over the past year to handle the growing volume, bringing the team dedicated to prior authorization to four. "This was the only way to ensure prior authorizations were completed on time and to avoid rescheduling patients, since nearly all of our visits require authorization," the executive said. "As a result, our payroll and overall clinic costs have increased significantly."

MGMA also flagged the Centers for Medicare & Medicaid Services' Wasteful and Inappropriate Service Reduction (WISeR) Model, which extends prior authorization into Traditional Medicare for certain services, as a new pressure point.

The report argues that faster response times required of MA plans "alone will not alleviate the immense burden of prior authorization on practices" and that meaningful reform requires reducing the sheer volume of services that require prior authorization.

Burnout and the workforce pipeline

Seventy-seven percent of respondents named regulatory burden a significant factor in physician burnout. Excessive regulatory and administrative work was the top-ranked contributor in the survey, ahead of financial stress, EHR inefficiencies and staffing shortages.

Members linked burnout to longer wait times for appointments, shorter visits, an inability to accept new patients and reduced practice hours. One practice executive described a cycle in which "declining reimbursement" compounds the problem: "Physicians are doing more work for less pay, which also makes it harder to recruit new physicians, all while contributing to the physician shortage."

The report notes that when physicians retire early or leave clinical practice, groups must devote months or even years to recruitment, and prolonged vacancies limit a practice's ability to operate at full capacity and optimize revenue.

MIPS and quality reporting

Sixty-nine percent of practices remain in the Merit-based Incentive Payment System, and 86% said quality reporting has led to increased administrative burden. Just 31% participate in an Advanced Alternative Payment Model, with many citing a lack of clinically relevant options for their specialty.

MGMA is calling for a comprehensive overhaul of MIPS to reduce reporting burden and end its tournament-style scoring model, as well as a long-term extension of the Advanced APM incentive payment and a freeze on qualifying participant thresholds.

Policy recommendations

Beyond MIPS reform and prior authorization relief, MGMA's recommendations include increased oversight of MA plans to ensure prompt payment of accurately coded claims, more federally funded graduate medical education slots, annual Medicare conversion factor updates tied to inflation, and modernization of Medicare's budget neutrality requirements.

"MGMA urges Congress to confront the complexity of government regulations impacting medical groups and strengthen oversight of Medicare Advantage plans to hold insurers accountable for practices that delay care, deny payment and inflate administrative overhead," Gilberg said.