Forty percent of medical practices now employ three or more full-time staff members for the sole job of managing regulatory and payer paperwork. They added that headcount because 95% of practice leaders say regulatory burden has increased over the past three years, according to the Medical Group Management Association's 2026 Regulatory Burden Report.

MGMA surveyed leaders from more than 230 group practices for the report, published April 9, 2026. Fifty-two percent of respondents work in practices with 20 or fewer physicians, 26% work in practices with 100 or more physicians, and 60% represent independent practices, the group least able to absorb fixed compliance costs that stay flat regardless of practice size.

What the 2026 Regulatory Burden Report Found

MGMA's report names three specific areas driving the load: prior authorization, Medicare Advantage requirements, and quality reporting. Ninety percent of surveyed practices said prior authorization requirements increased over the past year, and 86% said quality reporting added to their administrative burden. Seventy-nine percent of practices dealing with a shift toward Medicare Advantage plans reported a negative operational impact from that shift.

Seventy-seven percent of respondents named regulatory burden a major contributor to physician burnout. MGMA links that burnout to patient access: as physicians cut hours, retire early, or leave practice, wait times grow and fewer providers remain to see patients.

Prior Authorization Still Tops the List

A separate 2026 survey backs this up with physician-level detail. The American Medical Association surveyed 1,000 practicing physicians and published results on May 13, 2026: prior authorization now consumes an average of 13 hours of physician and staff time per week, spent processing an average of 40 requests. Forty percent of physicians employ staff whose only job is prior authorization work.

The same survey found 95% of physicians say prior authorization delays access to necessary care, and 79% say patients abandon treatment because of the process. Seventy-four percent say denials have increased over the past five years. Only 33% of physicians believe a 2025 industry pledge from insurers to cut prior authorization delays will make a meaningful difference.

The volume adds up in other ways too. Thirty-two percent of physicians say prior authorization requests are often or always denied outright, and 88% say the process raises overall use of health care resources, including repeat office visits, additional testing, and emergency care, as patients wait or go without treatment during the review period.

Regulatory Burden, 2023 vs. 2026

MGMA has asked practice leaders similar questions before. Comparing its November 2023 survey of 350-plus group practice executives to the April 2026 report shows the burden has not eased.

Metric20232026
Practice leaders surveyed350+230+
Report burden has increased90% (prior 12 months)95% (prior 3 years)
Prior authorization named a major issue89% call it very or extremely burdensome90% say it increased this year
Staff added or redirected because of prior authorization92%40% keep 3+ FTE staff on compliance
Practices still participating in MIPS69%50%+

Source: Medical Group Management Association, 2023 Regulatory Burden Survey and 2026 Regulatory Burden Report.

Medicare Advantage and Quality Reporting Add More Load

Medicare Advantage now covers more than half of Medicare-eligible beneficiaries, according to MGMA's report, and the plan-specific rules that come with it make up a growing share of the burden practices describe. Seventy-nine percent of practices navigating a shift toward Medicare Advantage said the change hurt their operations.

Quality reporting adds a separate layer. Under MIPS, more than half of practices still report data for Medicare's quality payment program, down from 69% in 2023. MGMA's 2023 survey found 94% of practices said positive MIPS payment adjustments did not cover what it cost them to prepare and report the data, a gap practices say has not closed. That 2023 survey also found 78% of respondents said Medicare lacks a clinically relevant alternative payment model option, leaving MIPS as the only realistic reporting path for most independent groups.

What Automation Is Fixing, and What It Isn't

Some of the burden is shifting toward automated workflows. The CAQH Index, based on 2024 transaction data from more than 600 provider organizations and health plans covering 63% of insured lives, found the industry avoided $258 billion in administrative costs in 2024 through electronic transactions, a 17% increase in avoidance over the prior year. CAQH estimates $21 billion more in savings remains available if providers and plans automate fully. More than half of health plans and 25% of provider organizations now use artificial intelligence tools somewhere in their administrative workflow, the first time CAQH has tracked majority AI use on the plan side.

Electronic prior authorization adoption rose from 31% in CAQH's 2023 Index to 40% in the 2025 Index, published February 19, 2026. That leaves 60% of prior authorization transactions running through phone, fax, portal entry, or other manual channels, the same channels behind the 13 hours a week the AMA survey measured. A federal interoperability mandate takes effect January 2027, and CAQH's data shows most practices have not yet made the switch.

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