12 ways to cut health care red tape and improve care

A physician’s job in 2025 includes a virtual mountain of red tape—everything from Medicare recordkeeping to prior authorization requirements are on the to-do list—often taking the focus off patient care and putting it into arcane and unnecessary bureaucratic demands.

But in a recent letter responding to the White House Office of Management and Budget’s (OMB) request for feedback on deregulation opportunities, the AMA has offered a dozen ways to streamline health care delivery and remove some of its biggest regulatory obstacles.

“While the AMA supports evidence-based regulation that promotes patient safety and system accountability, we also recognize that certain federal regulations impose unnecessary administrative burdens, detract from clinical care, and do not improve outcomes,” says the AMA’s May 12 letter (PDF) to OMB Director Russell Vought. “Our comments offer recommendations to revise or rescind specific regulatory requirements that interfere with physician practices, undermine efficiency, or create disparities in access to care based on concerns raised by our physician members and long-standing AMA policy

Here are the AMA’s 12 suggestions for how to cut health care red tape and increase efficiency, with timely, high-quality patient care as the end goal.

Medicare Merit-based Incentive Payment System (MIPS) requirements have placed “disproportionate burdens on small and rural practices without benefiting patients,” says the letter from AMA Executive Vice President and CEO James L. Madara, MD. 

The intense documentation requirements and punitive payment structures make it more difficult for physicians to do their jobs and get adequately compensated when treating Medicare patients. To replace the current model, the AMA and the Federation of Medicine have developed an alternative model called the Data-Driven Performance Payment System, which increases data-sharing, lowers burdens and decreases financial penalties to achieve a clinically relevant approach to improving patient outcomes and reducing avoidable spending.

More physicians could participate in Medicare Alternative Payment Models (APMs), spurring innovative changes in health care delivery and reducing growth in Medicare spending, if the administration altered its definition of financial risk, the AMA’s letter notes. There also should be changes made to how high-value services such as home-based care and preventive screening are paid for APM participants. 

Rules that significantly curtail the expansion of physician-owned hospitals, particularly in high Medicaid areas, create “barriers to expansion that disproportionately affect hospitals serving vulnerable populations,” Dr. Madara wrote. By throwing up so many roadblocks, growth is limited in many high-need communities. Access could be expanded and more patients could get the care they need if those rules are reversed.

The Physician Self-Referral Law, often called the Stark law, was adopted to prevent conflicts of interest in medical decision-making. But in rural areas, many physician specialists have had to discontinue satellite office operations to comply with some of the law’s location restrictions. Adding flexibility for rural physicians to the rules on site of service and in-office ancillary services would make it easier for patients in underserved communities to visit a specialist without having to drive long distances.

The independent-dispute resolution process in the No Surprises Act could work much more smoothly if some restrictions on batching were removed, the cooling-off period were shortened and insurer communications were improved, the AMA says. 

Better enforcement and clarity on the process is much needed to ensure that “surprise billing provisions are implemented in a way that protects patients, fairly settles out-of-claim payment disputes and encourages fair contracting between health plans and physicians,” Dr. Madara wrote.

Medicare’s “two-midnight rule,” which presumes that hospital stays shorter than a span of two midnights are unnecessary, takes medical decision-making away from physicians and introduces unnecessary red tape into hospital admission—a process that should only be about clinical care. 

The arbitrary rule has “led to increased use of outpatient observation status, often to the detriment of patients who face higher out-of-pocket costs and barriers to accessing post-acute care,” the AMA’s letter says.

With the entire country in dire need of more—not fewer—obstetrical services, it is clear that some hospitals require exemptions from upcoming, onerous new Medicare conditions of participation for this essential form of care. 

The rules, ideally, would be revoked or delayed entirely, says the AMA. But it is clear that without exemptions for rural and critical access hospitals, even more maternity units in those areas will close, and maternal health disparities will increase. Those are unacceptable outcomes for the mothers whose lives are at stake and for the physicians who have made it their mission to care for them. 

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The AMA strongly opposes information blocking, which it calls “persistent and egregious” in its letter, but the current penalty structure doesn’t take into consideration the severity of alleged misconduct, doesn’t provide a real way to appeal decisions and doesn’t first try education or corrective action. The regulations about what constitutes information blocking are new and complex, and many physicians, the AMA points out, may not even realize they are in violation. 

Cybersecurity is “a patient safety issue,” Dr. Madara wrote, but the current HIPAA Security Rule makes no distinction between gigantic organizations and small or rural physician practices. To avoid diverting limited resources from direct patient care, the rule should be either withdrawn or substantially revised to create flexibility for health care organizations of different sizes.

Medicare Part B patients can be forced to first try to properly manage their condition using certain cheaper drugs—regardless of whether their physicians believe they are the most appropriate medications—before moving on the options their doctors would like to prescribe based on the medical evidence, the patient’s condition or prior experience. The resulting delays of this step-therapy process, a form of prior authorization, can be dangerous for patients and can increase overall health care costs as well as the administrative burden on physicians. 

Buprenorphine is a critical tool in the national effort to end the overdose and death epidemic, with the gold-standard medication playing a key role in treating opioid-use disorder. But the U.S. Drug Enforcement Administration’s application of suspicious-order reporting requirements to buprenorphine has resulted in a chilling effect on pharmacies and physicians seeking to expand or begin addiction-treatment services. The AMA believes that buprenorphine prescribed for opioid-use disorder treatment should be exempt from suspicious order reporting requirements.

The AMA is urging the administration to revisit changes that allow Medicare contractors to use less transparent Local Coverage Articles for coding changes instead of the more rigorous Local Coverage Determinations. The new guidelines have led to inconsistent, opaque implementation of coverage and payment policies with little notice, burdening physicians and potentially harming patient access and safety. 

Learn more with a recent Leadership Viewpoints column by AMA President Bruce A. Scott, MD, on why reducing regulatory burden is a major opportunity for the new administration.