Top Regulatory Burdens for 2023

November 20, 2023

An overwhelming majority of medical group practices reported that their regulatory burden had increased during 2023, according to a new report from the Medical Group Management Association.

The report, released this month, identifies the top issues facing medical practices, including prior authorization, claims appeals, and Medicare reimbursement, among others. About 90 percent of medical practices indicated their overall medical burden had increased during the past 12 months.

“Year over year, medical groups face increasing regulatory and administrative burden in their practices,” the MGMA report notes. “In the wake of physician workforce shortages, and an increasing Medicare population, medical groups report struggling to maintain access for patients with traditional Medicare.”

Here’s what you need to know.

• Top concern:  Prior authorization ranked as the top regulatory concern, with 89 percent of respondents saying it was “very” or “extremely” burdensome.
  • About 97 percent of practices reported delaying care due to prior authorization requirements and 92 percent had hired or redistributed staff to work on these prior authorization requests.
• Top prior authorization challenges:  The top prior authorization concerns included inconsistent policies (80%); prior authorization requirements for routinely approved services (83%); and delays in prior authorization decisions (88%).
• Other top regulatory concerns:  Other issues that were at least “very” burdensome included audits and appeals (68.2%), the Medicare quality payment program (67.19%), and surprise billing and good faith estimate requirements (63.38%).   
• Medicare against inflation:  About 87 percent of respondents reported that inadequate Medicare reimbursement (below inflation) affected access to care.
• Quotable:  “Practices continue to face growing challenges with prior authorization, including issues submitting documentation manually via fax or through a health plan’s proprietary web portal, as well as changing medical necessity requirements and appeals processes to meet each health plan’s requirements,” the report notes.

The survey includes responses from executives representing over 350 group practices. The practices were largely independent medical practices (75%) or hospital/integrated delivery systems (14%).

HAP continues to advocate for policies and regulations that provide proper oversight while ensuring patients receive the right care, at the right time, and in the right setting. This includes reforms to the prior authorization process that remove administrative barriers that delay care and services, burden providers, and result in hospital underpayments.

The report is available online.