The U.S. Senate Special Committee on Aging convened a hearing on Feb. 11 titled, “The Doctor Is Out: How Washington’s Rules Drove Physicians Out of Medicine.” The hearing examined how federal regulations, administrative burden, and payment policies are contributing to widespread clinician burnout and workforce shortages within the healthcare system. In their opening statements, Chairman Rick Scott and Ranking Member Kirsten Gillibrand both highlighted bureaucratic complexity and regulatory overload as major factors pushing clinicians away from practice.
As many doctors of chiropractic have experienced, administrative hurdles affect practices when billing Medicare, Medicare Advantage, or private insurers. Increased paperwork payment challenges contribute to strain in small, independent practices, in particular. While much of the testimony at the hearing came from medical doctors, the core concerns they expressed regarding administrative burden, insurance complexity and workforce shortages are directly relevant to all physicians, including DCs, and especially those who care for Medicare beneficiaries and interact with federal health programs.
The American Hospital Association submitted testimony at the hearing, including the following statement: “Hospitals and health systems have long raised concerns that the administrative practices that some commercial insurers rely on — especially the improper application of prior authorization in the Medicare Advantage (MA) program — have very real consequences for patients and providers.”
Medicare Advantage plans vary widely on accepted methods of prior authorization requests and how to submit supporting documentation; some still require faxing and call center follow-ups. This creates a heavily burdensome process that contributes to patient uncertainty about the care they will receive, delays important care, and eats up a large portion of providers’ time, leading to worker burnout. Committee members expressed concerns that physicians must spend important time on the phone urging an insurance company to cover care, rather than devoting it to caring for more patients. To address this, Scott and Gillibrand have co-sponsored a bill aimed at standardizing prior authorization under Medicare Advantage plans with a system that is electronic, more transparent, and has stricter timeline guidelines, the Improving Seniors’ Timely Access to Care Act.
Dr. Alma Littles, the dean and chief academic officer at the Florida State University College of Medicine, testified that physician burnout is increasingly prominent due to extensive administrative burdens. She explained that the volume and complexity of mandates, documentation requirements, reporting systems, compliance checklists, and insurance regulations are continually increasing. Littles stated that many physicians in independent practices see their workload as unmanageable, when discounting the many hours dealing with administrative burdens such as prior authorization.
The hearing repeatedly referenced real administrative burdens and specific insurer practices. When witnesses described the strains of prior authorization and variable insurer processes, they identifed the exact regulations and practices that make daily clinical practice harder. The congressional spotlight placed on these unnecessary regulatory burdens further underscores the need to pass the Chiropractic Medicare Coverage Modernization Act, which would allow doctors of chiropractic to provide treatments within their full, existing scope of practice to senior patients, who age out of the care they receive while on private insurance. Limiting DCs to manual manipulation of the spine when treating Medicare patients is just another unnecessary and harmful federal regulation placed on providers.
Contact your members of Congress here and tell them to co-sponsor the Chiropractic Medicare Coverage Modernization Act to end another undue burden placed on doctors of chiropractic.
Emma Meehan is ACA’s associate manager of federal government relations.
