Growing concerns about administrative burdens on physicians have led both the Trump administration and members of Congress to push red-tape reduction efforts.

Aug. 9—Nearly half of physicians are spending at least $40,000 a year to comply with federal healthcare regulations, including the most burdensome Medicare payment rules, according to a new survey.

The first-time survey by the Medical Group Management Association (MGMA) found that 82 percent of medical practices view the Merit-based Incentive Payment System (MIPS)—the new payment system created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—as "very" or "extremely" burdensome.

In comparison, 74 percent said the lack of national standards for electronic attachments is burdensome, while 69 percent said the same of audits and appeals and 68 percent cited the lack of electronic health record interoperability.

A big issue with MIPS requirements is a lack of clinical relevance, according to 80 percent of practices.

“If the penalties reach such a point where you are being reimbursed below costs and there are other payers that’ll pay you to see your patients at a higher rate, then it could create Medicare access problems,” said Anders Gilberg, senior vice president for government affairs for MGMA.

The findings from 750 group practices echoed concerns in a Physicians Foundation 2016 survey of 17,236 individual physicians. Although 56 percent of physicians indicated at the time that they were unfamiliar with the specifics of MACRA, 58 percent cited “regulatory/paperwork burdens” as the least satisfying aspect of their practice (far exceeding loss of clinical autonomy and liability concerns).

Regulatory compliance concerns also were identified in a 2016 Annals of Internal Medicine study. That research found that during a typical day, a primary care physician spends 27 percent of his or her time on clinical activities and 49 percent on administrative activities. Similarly, a March 2016 Health Affairs study found that primary care physicians spend 3.9 hours per week on reporting for quality programs, and the average annual cost of compliance with quality programs alone was $40,069 per physician.

Other Consequences

Among the possible downsides of excessive regulatory burdens is greater physician burnout, according to industry advisers. For instance, 54 percent of physicians reported overall negative feelings about their profession in the Physicians Foundation survey.

Higher levels of burnout could lead to increased movement toward employment by larger practices, hospitals, or other facilities.

“You’re talking about millions and millions of dollars of software that are needed to develop a set of measurements for MIPS reporting,” said Jeffrey LeBenger, MD, chairman and CEO of Summit Health Management. “And that’s why a lot of doctors join a hospital ACO, because it has the data infrastructure for ACOs or for something of that nature.”

Although 66 percent of Physicians Foundation survey respondents thought hospital employment of physicians would not enhance care quality and decrease costs, the authors concluded that regulatory burdens were among the factors pushing more toward employment.

“Employment also is thought to lessen the regulatory and compliance burden private practice physicians face, while providing them with the financial support and technical expertise needed to implement mandated use of information technology,” the authors wrote.

Six percent of physicians said they were planning to seek hospital employment.

LeBenger agreed that regulatory burdens will continue to spur more physicians to seek hospital employment but warned that when designing compensation packages, those facilities may not have accounted for the cuts many physicians soon will face under MACRA.

“They’re setting a compensation formula that is fair market value, but if you don’t meet the quality requirements, [their revenue] is going to be below a fair market value,” LeBenger said.

Coming Response

Growing concerns about administrative burdens on physicians have led both the Trump administration and members of Congress to push red-tape reduction efforts. Both the Centers for Medicare & Medicaid Services (CMS) and the House Ways and Means Committee are soliciting ideas for reducing federal administrative burdens on physicians.

The leading rule tweak sought by MGMA is for CMS to continue a 2017 regulation that allows practices to report only 90 days of quality data and still qualify for a bonus payment, instead of moving to reporting for the full year included in the 2018 MACRA proposed rule.

“That’s the number-one thing we see that would be the highest burden,” Gilberg said in an interview.

The American Academy of Family Physicians (AAFP) likewise has urged MACRA simplification to lighten the regulatory burden. Among the changes sought by AAFP is elimination of all documentation guidelines for evaluation and management codes for primary care physicians in both the MIPS and advanced alternative payment model arms of MACRA, the organization wrote in an April letter to CMS.

Some efforts to reduce the regulatory burden may not provide the promised relief. For instance, the proposed rule promised to exclude 134,000 additional clinicians from MIPS reporting along with the 700,000 who CMS estimated were excluded in 2017.

But MACRA’s group-reporting incentives, organizational costs, and logistical obstacles actually could mean that many practices will need to report quality data for many physicians who technically have been excluded from reporting requirements, Gilberg said.

LeBenger doubted that tweaks to MACRA rules will be enough to significantly reduce the law’s regulatory burden on practices because MIPS bonuses and penalties are revenue-neutral. So half of all MIPS practices face cuts even if they spend large sums on compliance.

“They did it so that the losers are going to equal the winners,” LeBenger said.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, August 09, 2017