“Urges Congress to fix the flawed Sustainable Growth Rate Formula”

Burr Ridge, IL – In July 2008, Congress passed the “Medicare Improvements for Patients and Providers Act of 2008,” a temporary solution necessary to avoid an immediate 10.6 percent cut in Medicare payments. North American Spine Society (NASS) members today met with lawmakers on Capitol Hill to urge Congress to make permanent changes to the flawed Sustainable Growth Rate (SGR) Formula under Medicare Part B a priority in health care reform discussions.

From 1997 through 2007, total Medicare spending increased by approximately 7.5 percent per year. Conversely, Part B reimbursements decreased by 4.8 percent in 2002, with Congress intervening every year from 2003 to 2008 to avert further cuts mandated by spending that exceeded the formula driven target.

 “As a consequence of growth in the aging population, growth in Part B expenditures – which includes imaging costs, some drug costs and physician reimbursement –  is projected to increase by 8 percent annually between 2008 and 2018, while national economic growth is expected to be only 4.8 percent,” said Charles Branch, MD, NASS President. “Under the current reimbursement formula, this discrepancy will continue to produce annual reimbursement cuts in physician reimbursements. Access to spine care is likely to be significantly reduced if future scheduled cuts are allowed to take effect, and the implementation of a long‐term solution to the SGR system fails.”

NASS is urging Congress to take the following requests under consideration in Medicare Part B discussions as it relates to health care reform: 

• Remove the costs of Medicare Part B covered drugs from the reimbursement formula;
• Include only physician fees costs associated with diagnostic imaging in the reimbursement formula, and exclude from the reimbursement formula all non‐physician costs, such as the technical component of or facility fee services, associated with diagnostic imaging;
• Focus on improving patient care and providing more effective outcomes, and not on cost containment, in the development of any episode of care or coordinated care system; and
• Examine the costs of running a practice and address the SGR issues in a way that takes into account the pace at which medical costs rise.

“In the event that Congress fails to adopt a solution by the end of 2009, physicians will begin to receive a 21 percent cut in reimbursements starting on January 1, 2010, and up to 40 percent in cuts over the next decade—all while medical practice costs are expected to increase by 20 percent over the same period. Temporary fixes in recent years are only perpetuating the inevitable. A permanent change in the formula is needed in order for physicians to continue to provide the access to quality care our patients need and deserve,” said Raj Rao, MD, NASS Advocacy Committee Chair.

The North American Spine Society (NASS) is a multidisciplinary medical organization dedicated to fostering the highest quality, evidence‐based, and ethical spine care by promoting education, research, and advocacy. NASS is comprised of more than 5,000 members from several disciplines including orthopedic surgery, neurosurgery, physiatry, neurology, radiology, anesthesiology, research, physical therapy and other spine care professionals.

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