Annually 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 contains 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 impartial practices.
Listed below are a few of the general findings:
• 90 p.c of respondents reported that the general regulatory burden on their medical follow had elevated over the earlier 12 months.
• 97 p.c of respondents agreed a discount in regulatory burden would enable their follow to reallocate sources 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 obligatory care attributable to prior authorization necessities.
• 92 p.c of respondents have employed or redistributed employees to work on prior authorizations as a result of enhance in requests.
The High quality Fee Program (QPP) created two new reporting pathways to rework care supply for Medicare beneficiaries by incentivizing the best high quality care: the Advantage-based Incentive Fee System (MIPS) and Superior Different Fee Fashions (APMs).
In 2023, 69 p.c of respondents are taking part in MIPS. MGMA mentioned that it’s usually seen as a posh compliance program that focuses on reporting necessities relatively 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 the moment reporting underneath an MVP, whereas 89 p.c report not voluntarily reporting underneath an MVP attributable to both not having an MVP clinically related to their follow, selecting to proceed underneath conventional MIPS, or not understanding MVPs.
QPP key findings:
• 72 p.c of respondents reported that the transfer towards value-based cost 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 cost initiatives (in Medicare/Medicaid) has not lessened the regulatory burden on their follow.
• 68 p.c of respondents reported that the transfer towards paying physicians based mostly on worth has not been profitable to this point.
• 94 p.c of respondents reported that constructive cost changes don’t cowl the prices of time and sources spent making ready for and reporting underneath the MIPS program.
• 78 p.c of respondents reported that Medicare doesn’t provide an Superior APM that’s clinically related to their follow.
