Chart of the Day: Blame Oncology!

Fight disinformation: Sign up for the free Mother Jones Daily newsletter and follow the news that matters.

Sarah Kliff points us to an article in the New England Journal of Medicine that tries to isolate the reason that Medicare payments for physician services have gone up faster than Congress predicted in the late 90s. The chart below tells the basic story. General surgery, anesthesiology, and internal medicine have basically done OK. Emergency medicine, geriatric medicine, and radiation oncology have skyrocketed.

Using this data, the authors draw the following conclusion about the Sustainable Growth Rate formula adopted by Congress (and temporarily rescinded every year when they pass the annual “doc fix”):

We do not mean to suggest that the SGR physician-payment system should be restructured according to either state or specialty. For example, the arrival of new technologies in one area of medicine may justify faster growth in some specialties relative to others. Rather, our analysis illustrates that across-the-board cuts in fees are too blunt an instrument to restrain the growth of spending on physician services. In fact, any form of target expenditures for physicians who are not part of a coherent risk-bearing organization that is responsible for patient care will produce pathologies similar to those revealed in the graphs.

Unfortunately, that sentence in bold is key. It’s not clear to me that the data here justifies any conclusion at all, because it measures total spending, not the amount spent specifically on physician fees, which is the subject of SGR. If hospitals are eagerly building $100 million proton therapy centers for cancer treatment — and they are — then Medicare spending on radiation oncology is going to skyrocket. But does that mean that oncologist fees should go up? Not really.

Now, the SGR formula might well be broken regardless. Doctors set their fees to cover their overhead, and if overhead is going up faster in some areas than in others then that means fees will go up faster in some areas than in others. But I’m not sure how looking at total spending allows us to draw conclusions about that one way or the other.

A BETTER WAY TO DO THIS?

We have an ambitious $350,000 online fundraising goal this month and we can't afford to come up short. But when a reader recently asked how being a nonprofit makes Mother Jones different from other news organizations, we realized we needed to lay this out better: Because "in absolutely every way" is essentially the answer.

So we tried to explain why your year-end donations are so essential, and we'd like your help refining our pitch about what make Mother Jones valuable and worth reading to you.

We'd also like your support of our journalism with a year-end donation if you can right now—all online gifts will be doubled until we hit our $350,000 goal thanks to an incredibly generous donor's matching gift pledge.

payment methods

A BETTER WAY TO DO THIS?

We have an ambitious $350,000 online fundraising goal this month and we can't afford to come up short. But when a reader recently asked how being a nonprofit makes Mother Jones different from other news organizations, we realized we needed to lay this out better: Because "in absolutely every way" is essentially the answer.

So we tried to explain why your year-end donations are so essential, and we'd like your help refining our pitch about what make Mother Jones valuable and worth reading to you.

We'd also like your support of our journalism with a year-end donation if you can right now—all online gifts will be doubled until we hit our $350,000 goal thanks to an incredibly generous donor's matching gift pledge.

payment methods

We Recommend

Latest

Sign up for our free newsletter

Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate