1. 2015;18;E101-E105Elusive “Doc Fix”: Groundhog Day 2015 for Sustainable Growth Rate (SGR)
   Public Health Policy Opinion
   Frank J.E. Falco, MD, Vijay Singh, MD, Laxmaiah Manchikanti, MD, and Joshua A. Hirsch, MD.

On Groundhog Day, Monday, February 2, 2015, across the United States, we watched Pennsylvania’s most famous groundhog see his shadow, thereby predicting 6 more weeks of winter. On the same day – an equivalent of “Groundhog Day” in the legislative arena – the infamous “Doc Fix” or sustainable growth (SGR) rate reform has become an annual or even semiannual exercise. With numerous attempted fixes, we continue to play the same-catch up game with yet another temporary patch. The groundhog’s predictions started in 1887; whereas, the first problems with the SGR formula started 110 years later with the passage of the Balanced Budget Act of 1997 – an omnibus legislative package enacted by the U.S. Congress, using the budget reconciliation process to balance the federal budget by 2002. Unfortunately, the Balanced Budget Act of 1997 focused only on the reduction of health care expenditures with $160 billion in spending reductions between 1998 and 2002. In order to reduce Medicare spending, the act reduced payments to health service providers, mainly physicians and other practitioners. The Balanced Budget Act of 1997 has been problematic since its enactment. Despite the initial increases in physician payments due to high economic growth and low medical cost growth after passage of the Balanced Budget Act, the subsequent combination of a recession with declining Gross Domestic Product (GDP) and increasing medical costs led to automatic cuts from 2001 on, with cuts of 4.8% in 2002 and each year thereafter. Thus, since 2003, Congress has legislated an alternative to the automatic cuts scheduled under SGR legislation. However, without legislative action, payments to physicians under Medicare will face a cut of 21.2% effective April 1, 2015 (1,3). Thus, the Groundhog Day of medicine and Washington starts once again.