Regulatory Burdens in Healthcare Take Away from Patient Care

Regulatory burdens in healthcare, such as prior authorizations, surprise billing requirements, and audits and appeals, are taking resources away from patient care as practices face more oversight.

MGMA’s latest “Annual Regulatory Burden Survey” polled executives from over 350 group practices, including independent practices. This year’s survey reaffirmed the burden policy and regulation in healthcare have on group practices.

Approximately 90 percent of respondents said the overall regulatory burden on their medical practice has increased over the past 12 months. Meanwhile, less than 1 percent said overall regulatory burden decreased and about 9 percent said it has not changed.

The regulatory requirement burdening practices the most was once again prior authorization, with about 89 percent of respondents reporting prior authorization as very or extremely burdensome. Audits and appeals followed with 68 percent of executives saying they are very or extremely burdensome and Medicare’s Quality Payment Program, including the Merit-Based Incentive Program (MIPS) and Advanced Alternative Payment Models (APMs), with 67 percent of executives in the very or extremely burdensome bucket.

Other regulatory requirements with a higher proportion of respondents selecting very or extremely burdensome included surprise billing and good faith estimate requirements (63 percent), Medicare Advantage chart audits (61 percent), and lack of EHR interoperability (47 percent). Other options included translation and interoperation requirements and credentialing for Medicare and Medicaid.

While each regulatory issue carries its own burdens, together, the rules and requirements placed on providers are diverting time and resources away from patient care, the survey indicated.

For example, prior authorizations and other utilization management tools — which have topped the list of most burdensome regulatory issues for years — have shifted resources in group practices. Nearly all respondents (92 percent) said their practice has hired or redistributed staff to work on prior authorizations due to the increase in requests. Even more respondents (97 percent) said their patients have experienced delays or denials for medically necessary care due to prior authorization requirements.

The top challenges associated with prior authorizations include inconsistent payer payment policies, requests for routinely approved items and services, and delays in decisions, the survey found.

If group practices did not have to overcome these challenges and other regulatory issues, they might have more time to focus on patients, the survey suggested.

An overwhelming majority of respondents (97 percent) agreed that a reduction in regulatory burden would allow their practices to reallocate resources toward patient care.

“Reducing regulatory requirements that do not improve patient care will assist group practices in focusing on patient care and allow them to invest resources in initiatives that improve healthcare delivery, further clinical priorities, and reduce costs,” the survey report stated.

In addition to the patient care issues associated with prior authorizations, practice leaders also called out Medicare’s Quality Payment Program for having little benefit on patient care.

Almost three-quarters of respondents (72 percent) said the move toward value-based payment initiatives in Medicare and Medicaid have not improved the quality of care for patients. Significantly more respondents (94 percent) also said this move has not lessened the regulatory burden on their practices.

Only about a third of executives (32 percent) said the move toward value-based payment has been successful to date.

Practice leaders see MIPS, a track within the Quality Payment Program, as a “a complex compliance program that focuses on reporting requirements rather than an initiative that furthers high-quality patient care,” MGMA reported.