1) volume of medical services per medicare beneficiary has averaged 5% increases annually
2) physicians may provide more services to increase inadequate reimbursement
3) the increased services decrease physician payments, probably unevenly
4) “A total solution to the problem of inappropriate increases in the volume of physician services remains to be developed.”
5) large physician groups implementing EHRs should be allowed to carve their populations out of the general SGR pool so that they can be incentivized to be more efficient with resources

In my opinion, finding #1 means little by itself. As medicine advances, we are able to offer more services to older and sicker patients. Unless there is some evidence of the “inappropriate increases” referenced in finding #4, I suspect their role in this 5% increase is limited. Finding #2 is speculative. It may be more common in larger groups than in solo and small group practices where that option is not even available to them. Finding #3 speaks to the core of the SGR problem, a flawed system which leads to inadequate payment.

On the one hand, Dr. Crosson’s suggestion is a novel approach which should not be dismissed. If #2 is occurring and if it is more likely in large groups, then his solution may work. If successful, it would benefit Medicare and its beneficiaries by cutting costs and help solo and small group practices since their services would be separated from larger group practices. However, in the long run, even this change would be only a minimal improvement which ignores the much bigger problem with the SGR.

I would hate to see implementation of these pilots further delay significant reform of a flawed SGR system. As long as the SGR promotes a socialized system of payments for services which must pay costs under a capitalist system, then our entire healthcare system heads towards insolvency. We need to eliminate the SGR now while our system is still salvageable. If this problem of “inappropriate increases” still exists after eliminating the SGR, I would prefer to wait to implement Dr. Crosson’s pilot then.