Every year the Medical Group Administration Affiliation (MGMA) publishes a report highlighting the perceived burden related to prior authorization and the Medicare High quality Fee Program (QPP). As in earlier years, the survey respondents see the burden getting worse. 

Within the MGMA’s 2023 Annual Regulatory Burden Report, prior authorization necessities as soon as once more ranked as the highest burden for medical practices with necessities stemming from audits and appeals coming in second, and Medicare’s QPP coming in third. 

The survey consists of responses from executives representing greater than 350 group practices. Sixty p.c of respondents are in practices with fewer than 20 physicians and 16 p.c are in practices with greater than 100 physicians. Seventy-five p.c of respondents are in unbiased practices. 

Listed below are a few of the general findings:

• 90 p.c of respondents reported that the general regulatory burden on their medical observe had elevated over the earlier 12 months.
• 97 p.c of respondents agreed a discount in regulatory burden would permit their observe to reallocate assets towards affected person care.
• 77 p.c of respondents say that regulatory/administrative burden impacts present and future Medicare affected person entry.

Prior authorization key findings: 
 
• 89 p.c of respondents rated prior authorization necessities as very or extraordinarily burdensome.
• 97 p.c of respondents reported their sufferers have skilled delays or denials for medically essential care on account of prior authorization necessities.
• 92 p.c of respondents have employed or redistributed workers to work on prior authorizations as a result of improve in requests.

The High quality Fee Program (QPP) created two new reporting pathways to remodel care supply for Medicare beneficiaries by incentivizing the best high quality care: the Advantage-based Incentive Fee System (MIPS) and Superior Various Fee Fashions (APMs).

In 2023, 69 p.c of respondents are taking part in MIPS. MGMA stated that it’s typically seen as a posh compliance program that focuses on reporting necessities somewhat than an initiative that furthers high-quality affected person care. 

CMS launched MIPS Worth Pathways (MVPs) for voluntary reporting in 2023 to additional transition practices into value-based care preparations. Eleven p.c of practices responded that they’re at present reporting below an MVP, whereas 89 p.c report not voluntarily reporting below an MVP on account of both not having an MVP clinically related to their observe, selecting to proceed below conventional MIPS, or not understanding MVPs.

QPP key findings: 
 
• 72 p.c of respondents reported that the transfer towards value-based fee initiatives (in Medicare/Medicaid) has not improved the standard of care for his or her sufferers.
• 94 p.c of respondents reported that the transfer towards value-based fee initiatives (in Medicare/Medicaid) has not lessened the regulatory burden on their observe.
• 68 p.c of respondents reported that the transfer towards paying physicians based mostly on worth has not been profitable so far.
• 94 p.c of respondents reported that optimistic fee changes don’t cowl the prices of time and assets spent making ready for and reporting below the MIPS program.
• 78 p.c of respondents reported that Medicare doesn’t provide an Superior APM that’s clinically related to their observe.