Abstract: This has been an troubling year for Medicare payment. We have had so many short-term fixes to the Sustainable Growth Rate (SGR) formula that many physicians are becoming increasingly frustrated with participating in Medicare at all. All physicians are currently being paid at little more than 2001 levels while hospitals get an approximately 3% market basket increase in Medicare payments every year. Practices are discussing whether or not they can afford to continue seeing Medicare patients because the payments do not cover overhead costs.