Bowing to the inexorable pressure of the sustainable growth rate formula, the newly proposed Medicare Physician Fee Schedule would cut physician payment by a 21.5% for calendar year 2010. The SGR formula, part of the Balanced Budget Act of 1997, has mandated increasingly painful cuts to physician payment every year since 2002—cuts that have either been avoided by administrative steps or by Congressional action, says Sg2 consultant Christa Van der Eb.