Short-Term Fixes to the Sustainable Growth Rate Process . 4.1 Changes in the Measure of the Costs of Practice

10/30/2006

The MEI is a fixed-weight input price index reflecting average annual changes in prices for inputs required to produce physician services, namely the physician’s own time and practice expense.  The MEI is an important ingredient in the SGR process, affecting payment updates in two ways (Figure 2).  The measure is used directly in the calculation of CFs.  The MEI is also used as a measure in the calculation of the fee component of the SGR (which, in turn, is used to calculate target spending levels). 

Under the current SGR formula, the MEI is adjusted for changes in physician productivity over time using a 10-year moving average of a measure of economy-wide multifactor productivity.  Because the MEI is not net of the price effects of improvements in human productivity, for example, the rationale for including the productivity adjustment is to offset the increase in medical care prices that reflect advances in productivity.  Critics of the productivity adjustment argue that the productivity adjustment factor is an inadequate proxy measure of physician productivity.  The measure may be deficient, because it is an economy-wide measure, reflecting input prices for many different types of markets, including non-service markets that differ from health care markets.

Elimination of the productivity adjustment increases the value the MEI.  A larger MEI has a direct effect on the size of the update because the product of the MEI factor and UAF is the main determinant of the payment update (Figure 2 above).  But as noted, a larger MEI also increases the size of the SGR.  This increase affects the payment update in two ways: an increased SGR lowers the size of the prior year penalty in the UAF (as the SGR is in the denominator of the cumulated spending term), and increases the size of spending targets in future years.  The combination of effects of changes in the MEI is positive: payment updates should increase with the MEI.  

Table 8a. Effects of Revising the MEI: CFs, 2000-2014
 

Baseline

Revised MEI

Update
Year (t)

SGR

MEI

CFt

Percent
change

SGR

MEI

CFt

Percent
change

2000

1.021

1.024

36.61

5.42

1.029

1.033

36.61

5.42

2001

1.056

1.021

38.26

4.49

1.070

1.035

38.26

4.49

2002

1.056

1.026

36.20

-5.38

1.070

1.041

36.20

-5.38

2003

1.075

1.030

36.79

1.62

1.081

1.038

36.79

1.62

2004

1.074

1.029

37.34

1.50

1.082

1.038

37.34

1.50

2005

1.043

1.031

37.90

1.50

1.046

1.040

37.90

1.50

2006

1.017

1.029

37.90

0.00

1.025

1.038

37.90

0.00

2007

1.007

1.026

36.16

-4.58

1.015

1.035

36.48

-3.75

2008

1.039

1.024

34.37

-4.96

1.048

1.033

34.97

-4.12

2009

1.035

1.021

32.63

-5.05

1.044

1.030

33.50

-4.21

2010

1.029

1.019

30.93

-5.23

1.039

1.028

32.03

-4.40

2011

1.034

1.020

29.34

-5.14

1.043

1.029

30.65

-4.30

2012

1.042

1.021

27.86

-5.05

1.051

1.030

29.36

-4.21

2013

1.045

1.023

26.50

-4.86

1.054

1.032

28.18

-4.02

2014

1.039

1.023

25.21

-4.86

1.048

1.032

27.04

-4.02

Notes: Baseline estimates are as in Table 3a; baseline values of the MEI are from Global Insight, Inc. (see Appendix).  Revised MEI values are undjusted for productivity; values through 2006 are from various Federal Registers documenting CFs.  Productivity adjustments for 2007-2014 are assumed to be 0.9 percent per year based on data from the Bureau of Labor Statistics (see Appendix).  SGRs were recalculated using the unadjusted MEIs through 2006; from 2007-2014, the MEI is assumed to be the fee component used to calculate the SGR.  Baseline data items in italics subject to change.

To simulate effects of eliminating the productivity adjustment, an unchanging productivity adjustment factor of 0.9 percent from 2007 through 2014 was assumed.  This is the value of the productivity adjustment factor used to calculate the adjusted MEI in 2004 and 2005.  (The value used for 2006 was 1.0.)10  The CF for 2006 would have been $39.85, 5 percent larger that its current value of $37.90.  Compared to baseline, conversion factors under the simulation would be larger and decline at slightly slower rates through 2014 (Table 8a).  Expected spending with increases in the MEI would by about 1 percent larger than under baseline between 2006 and 2010, and 4 percent larger for 2011 through 2013 (Table 8b).

Table 8b. Effects of Revising the MEI: Spending, 2000-2014
 

Baseline (billions)

With Revised MEI (billions)

Period

Physician

Lab and
Drug

Total

Physician

Lab and
Drug

Total

2000-2005

380.4

74.6

455.0

380.4

74.6

455.0

2006-2010

401.8

99.0

500.8

409.0

99.0

507.9

2011-2013

228.1

80.3

308.5

240.4

80.3

320.8

Total

1010.4

253.9

$1,264.3

1029.8

253.9

$1,283.7

Note: Spending estimates were derived using CFs displayed in Table 8a, adjusted for data corrections routinely reported by CMS.

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