Data Insights

Medical practices overwhelmed with mounting regulatory burdens

MGMA Stat

Medicare Payment Policies

Quality Payment Program

Claire Mansbach JD
The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders attending MGMA19 | The Annual Conference: “In 2019, regulatory burden on your medical practice has?”: The vast majority (76%) answered “Increased,” 2% responded “decreased” and 22% remarked “stayed the same.”
 
This poll was conducted on October 14, 2019, during MGMA19 | The Annual Conference, with 309 applicable responses.
 
Although the Trump administration continues to pride itself on ongoing efforts to scale back regulatory burdens faced by the provider community, recent MGMA data tells a different story. In MGMA’s Annual Regulatory Burden Survey, 86% percent of medical practices stated that the overall regulatory burden on their medical practice over the past 12 months has increased, while less than 1% reported a decrease and 13% stated no change.

Annual Regulatory Burden Survey


From measuring quality to completing prior authorization requirements, medical groups face mounting regulatory hurdles that interfere with delivering high-quality patient care. MGMA conducts the Annual Regulatory Burden Survey to collect crucial information from members regarding which regulatory burdens affect practices the most. This information is used to inform Congress and the Administration of what truly stands in the way of delivering high-quality patient care. This year’s survey responses demonstrate that despite the Administration’s attempts at providing burden relief, medical groups are still bogged down by the weight of these regulations.

Value-based care


The move from fee-for-service to value-based care within the Medicare program has presented challenges from the beginning. Despite these obstacles, 46% of medical groups surveyed are supportive of paying physicians based on the value of care delivered rather than the volume of services provided, assuming clinical relevance and financial viability. However, 84% believe the move toward value-based payment, as implemented by the Medicare program, has increased regulatory burden on their practices. Additionally, 73% of survey participants stated that the move toward value-based payment, as implemented, has not improved the quality of care for their patients. Finally, 70% surveyed believe that the move toward paying physicians based on value has not be successful to date. These data points demonstrate that although several medical groups would support a move toward value-based care, the logistics of the programs make it difficult to implement successfully and without consequences to practices and their patients.

MIPS


Implementation of the Merit-based Incentive Payment System (MIPS) continues to present obstacles for participating providers. Sixty-six percent of survey respondents reported that the MIPS program, as implemented by CMS, does not support their practice’s clinical quality priorities. More specifically, 76% stated that CMS’ feedback on the MIPS quality measure performance is not actionable in assisting their practice in improving clinical outcomes. Additionally, 76% acknowledged that CMS’ feedback on the MIPS cost measure performance is not actionable in assisting their practice in improving clinical outcomes and reducing costs.

Advanced APMs


A major complaint among the physician community is the lack of relevant Advanced Alternative Payment Models (AAPMs) available to their practice. This year’s survey results indicate that this concern remains true, with 45% of respondents stating that Medicare does not offer an AAPM clinically relevant to their practice and 41% reporting that they are unsure. Forty-three percent would be interested in participating in an AAPM if it was clinically relevant and aligned with their quality goals, while only 18% said they would not be interested.

Prior authorization


Medical groups routinely rank prior authorization as one of the most significant regulatory burdens they face. In this year’s Regulatory Burden Survey, when asked to rate prior authorization on a scale of “not burdensome” to “extremely burdensome,” 83% of participants rated it as very or extremely burdensome. This should not come as a surprise, following a Sept. 17 MGMA Stat poll, which indicated that 90% of participants saw an increase in prior authorization requests over the last year. Survey respondents also noted that prior authorizations are a “drain on clinical resources.”

Conclusion

 
Physician practices continue to face regulatory burdens, despite the Administration’s attempt to provide “red tape relief.” As we move forward, MGMA Government Affairs will continue to advocate for regulatory relief and your medical group’s best interests in Washington.

Additional Resources

 
Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat.  

 
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About the Author

Claire Mansbach
Claire Mansbach JD
Associate Director MGMA
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