A product of 1989 legislation, the Physician Fee Schedule went into effect on January 1, 1992.  (And William Hsiao, PhD, whose study of Resource-Based Relative Value Systems was the foundation for the change from charge-based payment methodology, is still teaching at the Harvard School of Public Health today.)The national anesthesia conversion factor (CF), unadjusted for geographic practice cost differences, was $13.68 in 1992, and the general CF for other services was $31.00.  Twenty years later, the national anesthesia CF is $21.49, and the general CF is $34.04 – at least for the period ending on February 29, 2012.  In mid-December, Congress passed the “Middle Class Tax Relief and Job Creation Act,” setting a zero percent update and postponing the scheduled 27.4 percent CF reduction mandated by the Sustainable Growth Rate (SGR) for just two months.  If Congress cannot agree on a longer-term deal averting the SGR cuts, Medicare payments will drop...