Docs Still Overwhelmed by Regulatory Burdens: Survey

Keith L. Martin

October 15, 2019

NEW ORLEANS ― Regulatory burdens and administrative requirements, such as prior authorizations, continue to hinder the nation's medical practices and divert attention from patient care, according to a new survey by the Medical Group Management Association (MGMA).

More than 8 in 10 practices (86%) said the overall regulatory burden on their medical practice has risen over the past year, with 96% agreeing that a reduction in such burden would allow them to reallocate resources back to patient care.

The association's annual regulatory burden report was released during their annual conference in New Orleans.


Prior authorization requirements were noted as the top burden by the more than 400 group practices that participated in the survey. That was followed closely by participation in Medicare's Quality Payment Program (QPP).

Eighty-three percent of respondents ranked prior authorization as either very or extremely burdensome. Respondents added that seeking permission before carrying out physicians' orders has resulted in hiring employees just to obtain prior authorizations and that things are not getting better but worse in dealing with payers.

More than 80% of respondents participate in the Merit-based Incentive System under the QPP, one of the program's value-based initiatives. Eighty-seven percent of respondents said the payment adjustment for meeting quality benchmarks does not cover the costs in time and resources to participate in the program. One respondent noted that their practice spends $300 per month for an MIPS advisor through their electronic health record vendor.

Overall, more than half (58%) of those participating in MIPS said they were dissatisfied or very dissatisfied with MIPS cost measures.

Good Intentions vs Actual Practice Reality

Anders Gilberg, senior vice president of government affairs at MGMA, told Medscape Medical News that although value-based initiatives have promise in aiding physicians in the common goal of high-quality, low-cost care, there is a disconnect between that goal and the true effects on frontline physicians.

Gilberg said the results of this year's report are not startling to the organization but rather are an example of what MGMA does well: assessing medical practices across the country to show the true impact of regulations disseminated from Washington, DC.

"[The Centers for Medicare & Medicaid Services] is vocal in what they believe is a very, very effective effort to reduce the regulatory burden upon physicians in this country," he said. "We can only respond to what our members feel and experience on the front lines of delivering care and not just what the government is telling us they are doing."

Halee Fischer-Wright, MD, the association's CEO, added that the report validates part of the reason US healthcare still primarily follows a fee-for-service payment model.

"We have not found an effective, value-based approach to delivering care," she said. "Despite the best efforts of our government, and I do believe they are making valiant efforts, the report clearly states that people on the front lines find this burdensome."

Who Can Truly Reduce Burden?

The MGMA report comes one day after gastroenterologist Sen. Bill Cassidy (R-LA) told those attending the conference that if they are looking to Washington, DC, to reduce burden, they should probably look elsewhere.

Fischer-Wright agrees with Cassidy and said he is an example of how frontline experience as a physician can help drive change on a larger scale.

"The most effective solutions are not driven by government but from within the industry itself," she said. "[Burden reduction and further change] will come from a combination of frontline care ― the people who want to figure it out because they want to survive ― and probably some disruption in healthcare, in the form of an external player, alternative models, or simply something we just aren't doing right now."

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