Prior authorization, Medicare Advantage requirements and quality reporting are among the leading drivers of practices’ administrative woes, which respondents to an annual survey on regulatory burden said have worsened over recent years.
The Medical Group Management Association (MGMA), for its latest report released Thursday, polled executives from over 230 group practices, about half of which have 20 or fewer physicians and 60% of which are independent.
The lobbying group found that 40% of those practices have three or more full-time administrative staff per physician to handle these and other regulatory-related requirements. Ninety-five percent of respondents said their practice’s regulatory burden had increased over the past three years, and that burden was also cited as the top contributor to physician burnout.
When asked to rank their top regulatory burdens, audits and appeals led the way and was followed by prior authorization in Medicare Advantage (MA). Other top pain points, in descending order, were MA denials, automating downcoding in MA, electronic health record interoperability and information blocking, and Medicare Quality Payment Program reporting.
“It is no surprise that this year’s MGMA regulatory burden report further illustrates the strain medical practices experience every day,” Anders Gilberg, senior vice president of MGMA government affairs, said in a release accompanying the report. “Medicare Advantage prior authorization, excessive denials and automatic downcoding are delaying care and undermining appropriate physician payment, while Medicare quality reporting requirements and additional federal mandates increase administrative burden.”
MGMA, in the report, noted that three of the top five cited burdens are exclusively tied to MA, and that the top issue of audits and appeals “also is commonly associated with MA as practices must comply with mandatory Risk Adjustment Data Validation (RADV) audits and appeal denied claims.”
Among the survey’s respondents, 90% said they’d recently observed an increasing shift among patients to MA coverage, and 79% said the change has had a negative impact on their practice.
Further, 90% of practices outlined a rise in prior authorization burden within the past year, and most often cited MA and then commercial plans as the most burdensome payers within that arena.
Not to be excluded was MGMA and its members’ longstanding gripes with quality reporting, which the group wrote “force[s] clinicians to report on quality measures that are not clinically relevant to them and even hold[] them responsible for costs outside their control.” Here, 86% of respondents said Merit-based Incentive Payment System (MIPS) reporting “greatly impacts physician administrative burden.” Participation in Advanced Alternative Payment Models (APMs), a potential off-ramp from MIPS for practices, was cited by only 31% of the survey’s respondents.
Expanding access to those models and overhauling MIPS to limit reporting burdens are among policy recommendations outlined by MGMA in the report. The group also called for policymakers to standardize electronic prior authorization and increase transparency for prior authorization in MA and commercial plans, as well as generally reducing the overall volume of prior authorization and strengthening MA plan oversight.
“MGMA urges Congress to confront the complexity of government regulations impacting medical groups and strengthen oversight of Medicare Advantage plans to hold insurers accountable for practices that delay care, deny payment and inflate administrative overhead,” Gilberg said.
Regulatory burden relief is among the stated priorities of the Trump administration, with agencies across the government putting out the call for suggestions on how they could meet the president’s 10:1 deregulation agenda. Recent rulemaking from the Centers for Medicare & Medicaid Services and other agencies has also put regulatory pullbacks squarely in the spotlight.
Payers themselves pledged last summer to cut down on unnecessary and obstructive prior authorization. Just this week, a report from AHIP and the Blue Cross Blue Shield Association outlined an 11% decline in prior authorizations for a range of services since that pledge was made—though provider revenue cycle data through the end of 2025 suggest the pullback on some prior authorizations was accompanied by stiffer clinical claims denials elsewhere.
