Each and every yr the Scientific Crew Control Affiliation (MGMA) publishes a file 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 weight getting worse.
Within the MGMA’s 2023 Annual Regulatory Burden File, prior authorization necessities as soon as once more ranked as the highest burden for clinical practices with necessities stemming from audits and appeals coming in 2nd, and Medicare’s QPP coming in 3rd.
The survey contains responses from executives representing greater than 350 crew 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 full findings:
• 90 p.c of respondents reported that the full regulatory burden on their clinical apply had larger over the former one year.
• 97 p.c of respondents agreed a discount in regulatory burden would permit their apply to reallocate assets towards affected person care.
• 77 p.c of respondents say that regulatory/administrative burden affects present and long run Medicare affected person get admission to.
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 vital care because of prior authorization necessities.
• 92 p.c of respondents have employed or redistributed workforce to paintings on prior authorizations because of the rise in requests.
The High quality Fee Program (QPP) created two new reporting pathways to become care supply for Medicare beneficiaries by means of incentivizing the best quality care: the Benefit-based Incentive Fee Gadget (MIPS) and Complex Selection Fee Fashions (APMs).
In 2023, 69 p.c of respondents are collaborating in MIPS. MGMA stated that it’s typically observed as a fancy compliance program that specializes in reporting necessities quite than an initiative that furthers fine quality affected person care.
CMS presented MIPS Worth Pathways (MVPs) for voluntary reporting in 2023 to additional transition practices into value-based care preparations. 11 p.c of practices answered that they’re these days reporting below an MVP, whilst 89 p.c file now not voluntarily reporting below an MVP because of both now not having an MVP clinically related to their apply, opting for to proceed below conventional MIPS, or now not figuring out MVPs.
QPP key findings:
• 72 p.c of respondents reported that the transfer towards value-based fee tasks (in Medicare/Medicaid) has now not stepped forward the standard of handle their sufferers.
• 94 p.c of respondents reported that the transfer towards value-based fee tasks (in Medicare/Medicaid) has now not lessened the regulatory burden on their apply.
• 68 p.c of respondents reported that the transfer towards paying physicians in line with price has now not been a success up to now.
• 94 p.c of respondents reported that sure fee changes don’t duvet the prices of time and assets spent making ready for and reporting below the MIPS program.
• 78 p.c of respondents reported that Medicare does now not be offering an Complex APM this is clinically related to their apply.
