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Unsustainable growth rate: physician perspective
1Department of Anesthesiology/Critical Care Medicine, School of Nursing, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
The sustainable growth rate (SGR) was designed to control healthcare costs but is now reducing physician payments. Its flawed calculation and inclusion of drug costs make the SGR unsustainable.
Area of Science:
- Healthcare economics
- Physician payment models
Background:
- The Sustainable Growth Rate (SGR) was implemented to manage healthcare expenditure growth.
- Current SGR mechanisms contribute to reduced physician payments.
- Key flaws include the inability to correct past assumptions and the inclusion of drug costs.
Purpose of the Study:
- To detail the history and calculation of the SGR.
- To explain why the current SGR model is unsustainable.
- To discuss potential remedies and their impact on physicians and Medicare premiums.
Main Methods:
- Historical analysis of SGR policy.
- Examination of SGR calculation components.
- Review of proposed SGR reformulations.
Main Results:
- The SGR's design flaws lead to unintended reductions in physician reimbursement.
- The formula's rigidity prevents adjustments for inaccurate historical data.
- Drug costs, when included, distort the SGR's intended function.
Conclusions:
- Physicians often lack a clear understanding of the SGR's impact on their payment.
- The SGR is a significant factor in determining physician payment conversion factors.
- Revising the SGR is crucial to ensure fair physician compensation and manage Medicare costs.
Objective:
To describe the sustainable growth rate history and calculations and why the present approach is not sustainable.
Background:
The sustainable growth rate was created to help control the growth rate in healthcare expenditures. Presently, it is responsible, at least in part, for reductions in physician payment. Two components of the sustainable growth rate make it unsustainable in its present form. These components are 1) the inability to go back and correct for values based on the wrong assumptions and 2) the inclusion of drug-related costs into the sustainable growth rate.
Discussion:
Few physicians have a full grasp of how their payment is structured from a mechanistic standpoint. A significant component of determining physician payment is established by the relative value unit, and how these are derived has been discussed in another article in this supplement. Once the relative value unit has been established, it is multiplied by the established conversion factor. A major component of the conversion factor is the sustainable growth rate. This article attempts to explain how the sustainable growth rate came into being, how it is calculated, and how it is flawed and contributing to decreasing physician payments. A few possible remedies are discussed, and the potential ramifications of those remedies on the physician community and the premiums of Medicare patients are examined.
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