October 30, 2006
Prepared by:
NORC at the University of Chicago
1350 Connecticut Ave, NW, Suite 500
Washington, DC 20036
(202) 223-6040
Prepared for:
Office of the Assistant Secretary for Planning
and Evaluation (ASPE)
U.S. Department of Health and Human Services
(HHS)
| This report was produced under the direction of Lynn Nonnemaker, PhD, Task Order Monitor, Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office of Health Policy. The findings and conclusions of this report are those of the authors and do not necessarily represent the views of ASPE or HHS. |
This report is available on the Internet at:
http://aspe.hhs.gov/health/reports/08/sgr/sgr.html
Printer Friendly Version in PDF Format (68 pages)
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Executive Summary
1.0 Purpose and Overview
2.0 Background
Spending Trends
Per Beneficiary Spending
Decomposing Spending Growth
Physician Payment Policy
History
The SGR Process
Criticisms of the SGR Process
3.0 Modeling the SGR Process
Methods
Current Law Baseline
4.0 Potential Refinements of the SGR
Changes in the Measure of the Costs of Practice
Changes in the Design of the UAF
The UAF Floor
The Size of the UAF “Penalty”
5.0 Changes in Target-Setting Processes
Effects of Changes in SGR Values
Rebasing Target Spending
Elimination of Drug and Lab Spending from the SGR
Additional Refinements
6.0 Discussion
Appendix. SGR Spending Predictions
List of Tables and Figures
Table ES-1. Payment Reform Continuumi
Table ES-2. Conversion Factors and Spending Under Selected Payment Update Models
Table ES-3. Conversion Factors and Spending Under Selected Rebased Update Models
Figure 1. Medicare Allowed Charges by Type of Service, 1996-2004
Table 1. Medicare Spending per Enrollee, by Type of Service, 1996-2004
Table 2. Intensity and Percent Shares of Allowed Charges, 1996-2004
Table 3. Intensity and Share of Total Spending, Selected Services and Procedures, 1996-2004
Table 4. Allowed Charges by Site of Service, 1996-2004
Table 5. Ratio of Non-Inpatient to Inpatient Allowed Charges, by Type of Service, 1996-2004
Table 6. Allowed Charges and Intensity for Services Provided by Allied Health Professionals, 2000-2004
Figure 2. Calculating the SGR for the CY 2006 Physician Payment Update
Table 7a. Current Law Baseline: Conversion Factors, 2000-2014
Table 7b. Current Law Baseline: SGR Spending, 2000-2013
Table 8a. Effects of Revising the MEI: CFs, 2000-2014
Table 8b. Effects of Revising the MEI: Spending, 2000-2014
Table 9. Target and Actual SGR Spending and UAF Components, 2000-2013
Table 10. Effects of '0-Update Floor': Spending, 2000-2013
Table 11a. Effects of Simultaneous Changes in the UAF: CFs, 2000-2014
Table 11b. Effects of Simulaneous Changes in the UAF: Spending, 2000-2013
Table 12. Baseline and Revised SGRs
Table 13a. Effects of Rebasing: CFs, 2007-2014
Table 13b. Effects of Rebasing: Spending, 2007-2014
Table 14a. Effects of Rebasing and Eliminating Drug and Lab Spending from SGR Spending: CFs, 2007-2014
Table 14b. Effects of Rebasing and Eliminating Drug and Lab Spending from SGR Spending: Spending, 2007-2013
Table 15a. Rebasing V. Modification of SGR Spending with Revised SGRs: CFs, 2007-2014
Table 15b. Rebasing V. Modification of SGR Spending with Revised SGRs and UAF: CFs, 2007-2014
Table 16a. Rebasing V. Modification of SGR Spending with Revised SGRs: Spending, 2007-2013
Table 16b. Rebasing V. Modification of SGR Spending with Revised SGRs and UAF: Spending, 2007-2013
Table 17. Summary and Payment Reform Continuum
Appendix Table A1. Predicted SGR Physician Spending and Shares by Type of Service, 1996-2013
Appendix Table A2. Predicted SGR Physician Spending and Decomposition by Type of Service, 1996-2013
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Last updated: 1/10/2008