Prior Authorizations Beat COVID Workplace as Top Regulatory Burden

Prior authorizations are troubling medical groups more than regulations governing the workplace during COVID-19 and Medicare’s Quality Payment Program, according to survey results from the Medical Group Management Association (MGMA).

The 2021 Annual Regulatory Burden Report surveyed 420 medical group practices to uncover the impact federal regulations on the healthcare system. An overwhelming majority (91 percent) of respondents said that the overall regulatory burden in the US has increased over the last 12 months.

Additionally, 95 percent of medical group respondents said a reduction in regulatory burden would enable their practice to reallocate resources to patient care.

The top regulatory burden once again was prior authorization requirements, followed by the Quality Payment Program and COVID-19 workplace mandates, which tied for the second-most burdensome regulations.

Other burdensome regulatory issues, according to over half of medical groups, included COVID-19 Provider Relief Fun reporting requirements, audits and appeals, Medicare Advantage chart audits, and lack of EHR interoperability.

“Medical practices continue to report an increase in regulatory burden, with challenges associated with the COVID-19 pandemic further compounding the issue,” Anders Gilberg, senior vice president of Government Affairs at MGMA, said in a press release.

“Practices are currently experiencing unprecedented shortages of clinical and administrative staff, yet the federal government continues to add layer upon layer of new regulatory requirements. Medical groups are reporting that there are barely enough nurses to take care of patients, let alone spend time navigating onerous prior authorization requirements or reporting clinically irrelevant quality measures to Medicare. Regulatory burden is diverting precious resources away from patient care.”

Prior authorization requirements have been linked to adverse patient outcomes. According to the American Medical Association’s 2020 AMA Prior Authorization Physician Survey, 90 percent of physicians reported that prior authorization requirements have a negative impact on patient care. Additionally, 30 percent of physicians said that prior authorization has led to a serious adverse event for a patient in their care.

Despite the troubling statistics, most physicians (85 percent) said the burden of prior authorizations was high or extremely high. The process of completing the requirements took an average of two business days each week.

Medical groups told MGMA they faced growing challenges with prior authorizations, such as issues with submitting documentation through non-standardized health plan web portals and changing medical necessity requirements and appeals processes.

The survey also found that the transition to value-based payment is increasing regulatory burden on medical groups. About 79 percent of survey respondents said the shift to value-based payment in Medicare or Medicaid has increased regulatory burden on practices. What’s more, 70 percent of respondents, respectively, said the move has not improved quality of care for patients nor has the transition been successful to date.

The Quality Payment Program’s Merit-Based Incentive Payment System (MIPS)—a top regulatory challenge for medical groups over the years—is a major source of regulatory burden related to value-based payment. Most medical group respondents agreed that CMS’ feedback across MIPS categories are not actionable. Rather, the program is more of a “complex compliance program that focuses on reporting requirements,” MGMA stated in the report.

MGMA also reported that about 73 percent of respondents participate in MIPS over the Quality Payment Program’s other track, Advanced Alternative Payment Models.

Medical groups warned that increasing regulatory burden could contribute to further healthcare consolidation—a trend that has been heavily scrutinized by stakeholders. Three-quarters of respondents said increases in regulatory requirements are a significant driver of consolidation, and nearly the same amount (72 percent) said the overall impact of consolidation is negative.