Ali Alhassani and Amitabh Chandra, PhD, of Harvard University's Kennedy School of Government and Michael Chernew, PhD, of Harvard's Department of Health Care Policy computed SGR spending targets from 2002 — when the SGR was last adjusted — and 2009 by applying the SGR's national target growth rate to each state's per capita expenses and to several different medical specialties.
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New England Journal of Medicine SGR Study |
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States With Largest % Share of 2002 Medicare Part B Payments |
States With the Largest Excess Per Capita Expenditure as % of 2002 Baseline |
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California |
Alaska |
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Florida |
Florida |
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New York |
Texas |
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Texas |
Indiana |
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Pennsylvania |
Illinois |
The study's authors found large variations among states and specialties. States that contributed most to the current SGR hole include Florida, New York and Texas. Florida had 7 percent of Medicare Part B beneficiaries in 2002, and the state went over its estimated per capita SGR target by 80 percent over the following seven-year span, according to the study.
Other states grossly overshot their SGR targets, too. For example, Alaska went over its target Medicare Part B expenditures by 110 percent, but the state did not contribute heavily to the SGR deficit because of its low population and consequential low number of Medicare Part B beneficiaries. Conversely, other states with low populations (e.g., Vermont, North Dakota, Maine and Montana) contributed least to the SGR deficit.
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New England Journal of Medicine SGR Study |
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Specialties With Largest % Share of 2002 Medicare Part B Payments |
Specialties With the Largest Excess Per Capita Expenditure as % of 2002 Baseline |
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Internal Medicine |
Radiation Oncology |
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Cardiology |
Geriatric Medicine |
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Ophthalmology |
Emergency Medicine |
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Diagnostic Radiology |
Vascular Surgery |
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Family Practice |
Infectious Disease |
Several specialties also went beyond their estimated per capita SGR targets. Specialties with the highest excess growth and the largest share of total expenses that contributed to the SGR deficit were internal medicine, cardiology, diagnostic radiology and family practice. Internal medicine did not overshoot its target by a large amount, but it accounted for nearly 14 percent of all Medicare Part B expenditures. Cardiology accounted for about 10 percent of total expenditures on physician services in 2002, and between 2003 and 2009, it overshot its target expenses by 79 percent.
Conversely, specialties such as general surgery, anesthesiology and thoracic surgery did not exceed expenditure targets from 2003 to 2009 as a percentage of 2002 totals. General surgery was below its estimated expenses by 106 percent, while thoracic surgery undershot its expenses by nearly 200 percent.
For the full list of data from The New England Journal of Medicine, click here (pdf).
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