MGMA18: The top 5 regulatory burdens faced by physician practices

U.S. Capitol with flag
“I wonder if the government understands we are not stupid," one MGMA member commented about the expense of participating in MIPS. (Getty/Andrea Izzotti)

BOSTON—The federal government has made it a top priority to decrease the regulatory burden on physician practices. But just what are the regulatory issues that medical groups see as most burdensome?

A survey conducted over the last month by the Medical Group Management Association (MGMA) of 426 individuals from group practices revealed the top five issues they rated as “very” or “extremely” burdensome:

  1. Medicare’s quality payment program (MIPS/APMs) (88%)
  2. Prior authorization (82%)
  3. Lack of EHR interoperability (80%)
  4. Government EHR requirements (77%)
  5. Audits and appeals (68%)

Nearly all of the survey respondents said a reduction in regulatory burden would allow their practice to reallocate resources toward patient care, and 78% said it would allow them to invest in new technology.


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But while the government is promising to reduce burden, it isn’t moving fast enough. Instead, 86% of survey respondents said the overall regulatory burden on their practice has actually increased over the past 12 months.

The MGMA presented the survey findings at its annual conference in Boston this week and at a forum asked its members for their feedback. The group plans to take the survey results and participants’ comments to the Department of Health and Human Services and Capitol Hill, said Anders Gilberg, senior vice president of government affairs at MGMA.

If the government wants to know how physician practices can see more patients and improve quality of care, it should “get the hell out of the way,” said one MGMA member.

The forum focused on the top two regulatory burdens: the Merit-Based Incentive Payment System (MIPS) program and prior authorizations. Both issues are responsible for “the totality of frustration in lost time,” the MGMA member said.

Another member took the microphone to ask whether participation in MIPS is worth the expense. “What is my return on this work?” he asked. “I think a lot of us feel this way.”

The day before, MGMA’s government affairs staff revealed that even top-scoring doctors earned only a 2.02% positive payment adjustment in the first year of MIPS.

The Centers for Medicare & Medicaid Services has estimated that the MIPS data collection process costs practices about $1 billion.

“In order for me to play the game, I have to spend this money,” the man said, asking why he would want to do that if it is money he will not recover. “I wonder if the government understands we are not stupid.”

A woman also agreed that the regulations put a drain on her practice’s time. “We’re not spending time on patient care. We’re spending time checking boxes,” she said.

Another member wondered what had happened with the Medicare Payment Advisory Commission’s vote in January to recommend to Congress that it scrap MIPS because the system is flawed.

With MACRA, the legislation that established MIPS, having bipartisan support, Congress still sees MACRA as the framework for physician payment, said Jennifer McLaughlin, J.D., the senior associate director of government affairs at MGMA. Deep-sixing MIPS, “that’s not on the table,” she said.

MGMA surveys indicate that payer prior authorization requirements have only increased over the years, said Robert Tennant, MGMA’s director of health information technology policy, government affairs. It’s a problem that has been around for a long time and one that impacts patient care as doctors are forced to wait for payer approval for a test or a medication, he said. There is also no way for doctors to transmit supporting documentation with their transaction, something that has been promised for 21 years.

As for the frustration over prior authorizations, one survey respondent wrote: “prior authorizations have increased dramatically across payers and payer responses are slow and hinder care.”

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