The Las Vegas casinos were teeming with activity last week, but the true bets from orthopedic surgeons who descended upon sin city during the American Academy of Orthopedic Surgeons (AAOS) weren’t originating from the tables in their hotel lobbies. True bets were being placed on what would happen regarding the Sustainable Growth Rate (SGR). Ultimately the House would overwhelmingly pass the bill. But the Senate went into recess before making a final vote.

For the uninitiated, in 1997, Congress adopted the SGR formula as part of the Balanced Budget Act. The idea was to control federal health care spending. The SGR formula – in broadest terms – keeps the total increase in Medicare reimbursement to physicians from exceeding the change in the Gross Domestic Product (GDP). But every year since its passage, the cost of healthcare delivery has gone up faster than the increase in GDP.

The chatter from AAOS annual meeting was centered around the implications of SGR - so much so that AAOS had a round-table discussion for reporters hosted by Thomas Barber, Chair of the AAOS Council on Advocacy. Barber noted that on the ground level, most physicians are not aware of the scope of the issue and what it could mean. “Most people [surgeons] today don’t understand that 6% of their pay is at risk,” he said.

The message at the conference was that surgeons and devicemakers had best get prepared for their worlds to change and to take ownership to help develop and mold a model where they defined quality and not government agencies or elected officials.