Increase in Provider Administrative Burdens Could Impact Access to Care 

Sarasota, FL (WorkersCompensation.com) – Healthcare has seen an 84 percent increase in provider bankruptcies according to evidence presented before the House Committee on Ways and Means in September. While reductions and delays in payment, as well as changes in the payer landscape due to the No Surprises Act was cited as a likely contributor, increase in cost in all areas of healthcare has certainly been a catalyst for the financial woes. 

In February this year, reports surfaced that providers have seen an 11 percent increase in the number denials, with authorization denials seeing a 67 percent increase. In addition to denials, providers are seeing an increase in administrative costs related to authorization and quality requirements, according to the latest Medical Group Management Association’s (MGMA) Annual Regulatory Burden Survey.

MGMA surveyed executives from 350 physicians groups, of which 60 percent were 20 physicians or less, and 16 percent were 100 physicians or more. Around 75 percent of the survey participants worked at an independent practice. The top specialties included multi-specialty with primary at 18 percent of the participants, family practice totaled 14 percent, and orthopedics totaled 7 percent. 

Overall, 9 out of 10 participants indicated that their administrative burdens associated with quality, authorizations, and surprise billing had dramatically increased over the past year. Across the board, 89.35 percent of the survey participants ranked prior authorizations as the top regulatory burden. Audits and appeals were ranked top burden by 68.23 percent, followed by Merit-Based Incentive Payment System (MIPS) at 67.19 percent, and surprise billing at 63.38 percent. 

Ninety-seven percent of participants stated that their patients had delays in medically necessary care due to authorization requirements, and 92 percent stated that they have had to hire or reorganize staff to meet the increase in prior authorization needs. The top challenges related to prior authorizations that were cited included delays in prior authorization decisions at 88 percent, following by authorizations required for routinely approved services at 83 percent, and inconsistent payer policies at 80 percent. 

Requirements for Medicare quality programs were mentioned as a large burden with little benefit for patients. Ninety-four percent of participants felt that the regulatory requirements had not lessoned the administrative burden on their practice, and 72 percent felt that these burdens had not improved the quality of care that patients receive. Overall, 68 percent of the practices polled felt that the value based payment programs had not been successful. 

Earlier this month, CMS announced a reduction in reimbursement for physicians at an additional 3.4 percent on top of the 2 percent sequestration reduction already in place. The latest CMS decision is an ongoing consideration in patient access as 87 percent of the practices polled indicated that reimbursement would be factor. 

In an effort to stay in business, based on this report it’s very possible that providers may lean harder towards payers that require less administrative burdens and offer better reimbursement. Depending on the workers compensation reimbursement structure, this could ultimately mean an increase or decrease for workers compensation business. 

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