From Doctors' Perspective, Regulatory Burdens Are Increasing

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New nationwide survey finds vast majority say new rules and regulations have not improved patient care

Results from a new survey of doctors across the country echo the growing frustrations expressed by American College of Physician members about regulatory hurdles and duplicative processes that seem to put paperwork before patients.

Conducted by the Medical Group Management Association, the survey – which included 426 doctors from group practices – found that 86 percent believe that regulatory burdens overall increased in the past year, and 79 percent believe that their overall burden due to Medicare increased as well.

Among the biggest burdens cited were those associated with the Quality Payment Program (QPP), which created two payment pathways for physicians treating Medicare patients – the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). The QPP, created by the Medicare Access and CHIP Reauthorization Act of 2015, was designed to help move away from a volume-based payment system and toward value-based, quality care.

However, 76 percent of survey respondents said that this has not improved the quality of care for patients, and 90 percent said it has increased the regulatory burden on their practice.

“ACP members are not alone in their frustration,” said Shari Erickson, vice president for governmental affairs and medical practice for ACP. “The survey results are extremely reflective of what we have been hearing from our members and the feedback that we have been giving to the Centers for Medicare and Medicaid Services.”

“These results are helpful in that they give us more data to support the feedback we are giving to CMS on these issues,” she added.

ACP's own initiative, called Patients Before Paperwork, highlights these concerns and includes potential solutions.

In the survey, 55 percent of physician respondents said that there is no APM that is clinically relevant to their practice. This is a key ACP advocacy issue, and the College recently called on the committee that advises the government on proposals for new APMs to provide feedback much earlier in the APM development process, along with greater transparency, to encourage the testing and implementation of clinically relevant APMs.

Overcoming the current APM stalemate would have spillover benefits that could reduce other burdens, Erickson said.

“Once physicians are truly being paid based on their value and outcomes in a more meaningful way as part of an APM, there is an opportunity to remove many of these administrative challenges, like prior authorization,” she explained. “If you know patients are doing well and practices are saving money, the need for prior authorization simply goes away.”

ACP is also calling for an end to so-called “fail first” step therapy protocols that require patients to try and fail certain treatments before allowing access to other drugs. ACP believes that ending that would ease prior authorization burdens on practices and improve patient care.

Increased administrative burdens are also believed to be a big contributor to high rates of physician burnout, and team-based care is thought to be a potential solution.

Many APMs encourage and incentivize team-based care, Erickson said.

“There is a greater opportunity to engage when doctors are freed up from having to generate visit after visit,” she said. “When we move away from a fee-for-service model, there is more collaboration and sharing of best practices, and this would reduce burden and improve job satisfaction, even if there are still some burdensome requirements.”

Dr. Cynthia Smith, ACP's vice president for clinical programs, recently co-authored a paper in NAM Perspectives on preventing burnout through such team-based care.

In further efforts to reduce burden and put patients before paperwork, the College offered input to Congress on some aspects of the Opioid Crisis Response Act of 2018 that could be burdensome for doctors, including comments on provisions associated with the use of prescription drug monitoring programs, prior authorizations and mandatory fill limits.

ACP also has addressed another issue among physicians, the CMS Meaningful Measures Initiative, suggesting removal of some low-value measures – and the agency is now taking steps to get rid of some of them, Erickson said.

“This is a work in progress and indicative that our advocacy is having an effect,” she said. “It takes time to get it right.”

“ACP is advocating hard to move these issues forward and put patients ahead of paperwork,” she said.

More Information

The Regulatory Burden Survey is available on the website of the Medical Group Management Association.

Details on ACP's Patients Before Paperwork initiative can be found on the College's website. Also on the site are advocacy letters on physician burdens related to opioid legislation, diagnostic imaging and prior authorizations for medication.

Dr. Smith's paper, Implementing Optimal Team-Based Care to Reduce Clinician Burnout, is on the website of the National Academy of Medicine.

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Back to the October 19, 2018 issue of ACP Advocate