As happens every year, on July 1, 2012, the Centers for Medicare and Medicaid Services issued
a proposed policy and payment rate for services furnished under the Medicare physician fee
schedule for 2013. The proposed rule would provide certified registered nurse anesthetists to
practice independent interventional pain management. Other issues, though no less important,
include a 27% sustainable growth rate formula cut in reimbursement, along with a 2%
sequester, which could lead to a potential cut of 29%.
Since the inception of Medicare programs in 1965, several methods have been used to
determine the amounts paid to physicians for each covered service. The sustainable growth
rate was enacted in 1997 to determine physician payment updates under Medicare Part B. Its
intent was to reduce Medicare physician payment updates to offset the growth and utilization
of physician services that exceed gross domestic product growth. This is achieved by setting
an overall target amount of spending for physicians’ services and adjusting payment rates
annually to reflect differences between actual spending and the spending target. Since 2002,
the sustainable growth rate has annually been used to recommend reductions in Medicare
reimbursements. Payments were cut in 2002 by 4.8%. Since then, Congress has intervened on
multiple occasions to prevent additional cuts from being imposed.
In this manuscript, we will describe important proposed changes to the physician fee schedule.
Additionally, the impact of multiple changes on interventional pain management will be briefly
described.
Key words: Health policy, physician payment policy, physician fee schedule, Medicare,
sustained growth rate formula, interventional pain management, regulatory reform.
The impact of risk management on internal and sustainable growth rate: Evidence from Tehran Stock Exchange
