Unsustainable growth rate: physician perspective.
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.


CONCLUSIONS
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.
Department of Anesthesiology/Critical Care Medicine, School of Nursing, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Todd
T
Dorman
D001291:Attitude of Health Personnel; D003422:Critical Care / Q000191:economics*; D005245:Fee Schedules / Q000191:economics*; D005544:Forecasting; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D006278:Medicare / Q000191:economics*; D011445:Prospective Payment System / Q000191:economics; D011907:Rate Setting and Review / Q000379:methods; D012051:Reimbursement Mechanisms / Q000191:economics*; D015895:Relative Value Scales; D014481:United States