Many of the regulatory obstacles that medical practises continue to face are connected to prior authorization and the Medicare Quality Payment Program. The responsibility has frequently gotten heavier each year.
MGMA has argued in the past that Washington authorities should lessen the regulatory load on medical practises since these demands take time and resources away from providing patient care. However, as this year’s research indicates, the regulatory burden is still increasing.
According to a recent poll by the Medical Group Management Association, regulatory barriers are also becoming a bigger obstacle to achieving clinical objectives and enhancing patient outcomes.
Executives from more than 500 group practises participated in the poll, and among those who responded, 89% reported that the overall regulatory load on their business had increased over the last 12 months. Only 1% of respondents indicated it had declined, while 11% said it had stayed the same.
Prior authorization and surprise billing and good faith estimate requirements were by far the top two responses when asked which regulatory obstacles were the most troublesome.
A whopping 97% of respondents claimed that less regulation would free up resources for medical care.
The argument put up by respondents was that prior permission slows patient care while increasing provider expenses and workload. Before providing some medical treatments and prescription drugs, payers require prior authorization from medical practises; CEOs said that this cost-control measure frequently causes unnecessary delays in care at the expense of the patient’s health and the practice’s resources.
Prior authorization continues to present practises with increasing difficulties, including difficulties manually faxing or uploading documentation to the health plan’s exclusive web portal, as well as shifting standards for medical necessity and modifying appeals procedures to satisfy the needs of each health plan.
Overall, 82% of those surveyed thought obtaining prior authorisation was very or extremely onerous. 2% of respondents stated it was not at all burdensome. 95% of respondents reported that their patients had faced delays or denials for medically essential care, and 89% reported that the rise in requests necessitated the hiring or redistribution of staff to handle prior authorizations.
The No Surprises Act banned balance billing tactics for some out-of-network treatment and established a number of additional patient transparency protections, including the uninsured or self-pay good faith estimate process, provider directory standards, and continuity of care protections. However, practises report that since its adoption on January 1, this has significantly increased burdens. Eighty-two percent of practises claim the necessity for an uninsured or good faith estimate increases administrative burden. Only 26% of respondents claimed to have the necessary technological setup to meet the covening/co-provider criteria that go into effect on January 1, 2023.
Although many of the No Surprises Act’s provisions are currently in force, there is still some misunderstanding about what they entail. Since the implementation of the good faith estimate procedure for uninsured and self-pay patients on January 1 of this year, 78% of patients still need more explanation from the Centers for Medicare and Medicaid Services. On other fronts, the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models were designed by the Quality Payment Program (QPP) to revolutionise the way Medicare beneficiaries receive care by rewarding the greatest quality treatment (APMs).
73% of survey respondents will take part in MIPS in 2022. Rather than a project that advances high-quality patient care, it is typically viewed as a sophisticated compliance programme that emphasises reporting obligations. In fact, 76% of respondents said that their practise now faces a greater regulatory burden as a result of the CMS’s adoption of value-based payment changes. According to the MGMA, it has long been a worry that the MIPS cost measurements unfairly penalise doctors and group practises for expenses they have little control over. The association claimed that it frequently hears from its members that doctors and group practises do not understand how CMS evaluates them on MIPS cost metrics and that this category is a “black box” over which they have little to no control because there is a lack of timely, actionable information.
In response to the Center for Medicare and Medicaid Innovation’s recent proposal to develop a more streamlined and compact portfolio of APMs, MGMA has also voiced concerns about it. In the paper, MGMA stated that “there is no one method to APMs that will work for all practises or specialties.” There is no “one size fits all” approach to APM design because different specialisations are in charge of providing various forms of care.
- Regulatory obstacles are getting worse for medical practises
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