Each year the Medical Group Management Association (MGMA) publishes a report highlighting the perceived burden associated with prior authorization and the Medicare Quality Payment Program (QPP). As in previous years, the survey respondents see the burden getting worse.
In the MGMA’s 2023 Annual Regulatory Burden Report, prior authorization requirements once again ranked as the top burden for medical practices with requirements stemming from audits and appeals coming in second, and Medicare's QPP coming in third.
The survey includes responses from executives representing more than 350 group practices. Sixty percent of respondents are in practices with fewer than 20 physicians and 16 percent are in practices with more than 100 physicians. Seventy-five percent of respondents are in independent practices.
Here are some of the overall findings:
• 90 percent of respondents reported that the overall regulatory burden on their medical practice had increased over the previous 12 months.
• 97 percent of respondents agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.
• 77 percent of respondents say that regulatory/administrative burden impacts current and future Medicare patient access.
Prior authorization key findings:
• 89 percent of respondents rated prior authorization requirements as very or extremely burdensome.
• 97 percent of respondents reported their patients have experienced delays or denials for medically necessary care due to prior authorization requirements.
• 92 percent of respondents have hired or redistributed staff to work on prior authorizations due to the increase in requests.
The Quality Payment Program (QPP) created two new reporting pathways to transform care delivery for Medicare beneficiaries by incentivizing the highest quality care: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
In 2023, 69 percent of respondents are participating in MIPS. MGMA said that it is generally seen as a complex compliance program that focuses on reporting requirements rather than an initiative that furthers high-quality patient care.
CMS introduced MIPS Value Pathways (MVPs) for voluntary reporting in 2023 to further transition practices into value-based care arrangements. Eleven percent of practices responded that they are currently reporting under an MVP, while 89 percent report not voluntarily reporting under an MVP due to either not having an MVP clinically relevant to their practice, choosing to continue under traditional MIPS, or not understanding MVPs.
QPP key findings:
• 72 percent of respondents reported that the move toward value-based payment initiatives (in Medicare/Medicaid) has not improved the quality of care for their patients.
• 94 percent of respondents reported that the move toward value-based payment initiatives (in Medicare/Medicaid) has not lessened the regulatory burden on their practice.
• 68 percent of respondents reported that the move toward paying physicians based on value has not been successful to date.
• 94 percent of respondents reported that positive payment adjustments do not cover the costs of time and resources spent preparing for and reporting under the MIPS program.
• 78 percent of respondents reported that Medicare does not offer an Advanced APM that is clinically relevant to their practice.