ASA has had a long history of meaningful engagement in the process of shaping Medicare payment policy. Our work to create fair and understandable systems dates back to the introduction of the Relative Value Guide in 1962 and the subsequent protracted (and successful) legal battle to defend it. Ironically, the extension of the “relative value” concept to the entire Medicare Part B payment system in 1992 created its own challenges for anesthesiology, with a sharp decline in the payments for our services. We persisted through two cycles of five-year updates to the Physician Fee Schedule to achieve an incomplete, but substantial, remedy to the failed alignment of anesthesiology’s relative value system to the Resource-Based Relative Value System introduced to the rest of medicine. And ASA was quick to recognize the catastrophic trajectory of the Sustainable Growth Rate (SGR) formula...

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