Article Text

Download PDFPDF
The sustainable growth rate: a 2014 update
  1. Joshua A Hirsch1,
  2. Laxmaiah Manchikanti2,3
  1. 1Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
  2. 2Pain Management Center of Paducah, Paducah, Kentucky, USA
  3. 3Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Dr Joshua A Hirsch, Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Hirsch{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

In April 2013 we reviewed the definition and historical development of the sustainable growth rate (SGR) formula that plagues the American healthcare system.1 We examined and contrasted a number of serious policy proposals designed to fix this broken system. Finally, we explored what at the time were late breaking estimates of the perceived diminution in cost of permanently fixing the SGR.

As described in that foundational article, while there may have been a rational basis in developing the SGR to curb costs, in fact the SGR is at present a discredited approach. By design it is meant to restrain the growth of Medicare spending on physician services that critically links to the US gross domestic product (GDP).2–4 Current estimates are that application of the SGR formula would result in a diminution of professional fees for physicians accepting Medicare of 24.4% on 1 April 2014.2–4 We seek to update readers of JNIS on some meaningful developments related to the SGR discussion.

On 26 December 2013, President Obama signed the Bipartisan Budget Act of 2013 into law.5 This ‘fix’ is really a postponement of application of the SGR correction of 3 months; the irony being that the cuts are delayed to 1 April 2014. What is not a joke is that there was a pathway for the SGR Reform Act of 2013. There appears to be growing light at the end of the tunnel.

The Bipartisan Budget Act of 2013 established federal budget targets for 2014 and 2015 and, …

View Full Text


  • Contributors Both authors contributed equally to the preparation of this manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.