Regulatory burden reaches near-universal levels at medical practices, MGMA report finds

Administrative and regulatory demands on medical practices have reached a breaking point, with prior authorization, Medicare Advantage requirements and quality reporting consuming time and resources that physicians say should be going to patients.

That is the central finding of the 2026 MGMA Regulatory Burden Report, released this month by the Medical Group Management Association. Anders Gilberg, senior vice president of government affairs at MGMA, said the results reflect a system that has grown increasingly difficult to navigate, driven largely by the expansion of Medicare Advantage.

"There's been a big shift over the last couple of years, and that shift is largely a result of the growth of Medicare Advantage," Gilberg said. "A lot of the frustrations that MGMA members have had with commercial insurers are now bleeding over into the quasi-government administration of Medicare. Medicare Advantage has just shot to the top of the biggest challenges for our members."

The report, based on survey responses from leaders at more than 230 medical group practices nationwide, found that 95 percent of respondents reported an increase in regulatory burden over the past three years. Sixty percent of respondents represent independent practices.

Three of the top five administrative burdens cited in the report tie directly to Medicare Advantage: prior authorization, claim denials and automatic downcoding. Audits and appeals, the top-ranked burden overall, are also commonly associated with Medicare Advantage, as practices must comply with mandatory Risk Adjustment Data Validation audits and appeal denied claims.

Gilberg said the problem is not with Medicare Advantage as a concept but with how commercial insurers administer it. Large commercial insurers, he said, often bundle Medicare Advantage contracts into broader annual negotiations, leaving practices with little leverage.

"More or less they put something on the table that practices have to take it or leave it, because otherwise they would have to turn down that entire book of business," he said. "Prior authorization, denials, audits and appeals: these are all the things that have now risen to the top of our regulatory burden survey."

Prior authorization burden keeps climbing

Ninety percent of practices reported an increase in prior authorization burden in the past 12 months, making it one of the most persistent and costly administrative challenges in the report. Medicare Advantage and commercial plans ranked as the most burdensome payers for obtaining prior authorization, followed by Medicaid and traditional Medicare.

Gilberg said the problem is rooted in fragmentation. A typical medical group may contract with a dozen or more managed care plans, each requiring staff to log into separate portals with different workflows and documentation requirements.

"It has not abated," he said. "No matter what the insurers have said recently, it is not abating whatsoever."

The staffing cost is significant. Forty percent of practices reported employing three or more full-time administrative staff per physician to manage payer rules, prior authorization requests, audits and quality reporting. Gilberg noted that administrative overhead now accounts for roughly a quarter of all health care spending in the United States, a figure he said exceeds comparable nations.

A new threat on the horizon is the Wasteful and Inappropriate Service Reduction Model, known as WISeR, which would introduce prior authorization requirements into traditional Medicare for 17 procedures across six states. Gilberg described it as a troubling precedent.

"Traditional Medicare has not even had prior authorization," he said. "It's kind of a foot in the door, a slippery slope, and could easily be expanded to more than six states, more than 17 services."

He added that the WISeR model does not use the standardized electronic prior authorization approach that the Centers for Medicare and Medicaid Services is simultaneously rolling out for Medicare Advantage plans, compounding the inconsistency.

Most practices still stuck in MIPS

On the quality reporting front, 69 percent of practices remain in the Merit-based Incentive Payment System, or MIPS, despite the program being designed years ago as a temporary bridge to value-based alternative payment models. Eighty-six percent of respondents said quality reporting has increased their administrative burden.

Gilberg said the transition to Advanced Alternative Payment Models has stalled because clinically relevant models simply do not exist for most specialties.

"Over the last decade, there hasn't been a single program or APM rolled out of the Physician Technical Advisory Committee," he said. "For the vast majority of medical practices that don't do those specific things, they're stuck in MIPS because there's no alternative."

Burnout threatening workforce and access

Seventy-seven percent of respondents cited regulatory burden as a significant factor in physician burnout, which the report identifies as an escalating threat to workforce stability. The top impacts of burnout on patient access include longer appointment wait times, shorter visit lengths, inability to accept new patients and reduced practice hours.

Gilberg said MGMA testified before the U.S. Senate on the issue roughly a month before the report's release. He said the downstream effects on rural and underserved communities are particularly acute.

"Physicians want to go to medical school to take care of patients," he said. "When they get tired of the paperwork, oftentimes they retire early, leave communities, go work for a larger system so they don't have to deal with it themselves. Those rural areas and areas that need access to primary care then have access problems that can't easily be solved."

MGMA's policy asks

The report closes with a set of policy recommendations that MGMA is advancing before Congress and federal agencies. Those include an overhaul of MIPS to reduce reporting burden and eliminate what Gilberg called the "tournament model," in which some physicians must receive payment cuts in order to fund quality bonuses for others.

On physician payment more broadly, Gilberg said the most important thing Congress can do is tie Medicare conversion factor updates to inflation.

"We've had several years of pretty hot inflation and basically flat payments for Medicare to physicians," he said. "One of our priorities, and the priorities of some of the major physician organizations, is to deal with this once and for all and get us back on a good trajectory."

Additional MGMA recommendations include standardizing electronic prior authorization transactions, increasing oversight of Medicare Advantage plans to ensure prompt and accurate payment, and investing in federally funded graduate medical education slots to expand the physician pipeline.

The full 2026 MGMA Regulatory Burden Report is available at mgma.com.