SGR fix

Of course, looming over the whole discussion is the so-called "doc fix" -- that is, the repeal of the sustainable growth-rate formula.

The offspring of a bout of budget-hawkery in the early 1990s, the SGR is meant to keep Medicare payments to doctors in line with the growth of the economy. Long delayed, if it should go into effect this January, as scheduled, it would represent a 29.4 percent cut to physicians' Medicare reimbursements.

But the Obama administration's deficit-cutting proposals were built around an assumed SGR fix, presumably to be tackled by the supercomittee.

How exactly this fix will be reached is unknown. But to help come up with the nearly $300 billion required for a 10-year fix, MedPAC recommended last week to freeze the payment rate for primary care doctors, while docking specialists 5.9 percent every year for the next three years, and then instituting a seven-year pay rate freeze.

In a MedPAC transcript released this week, the group further called for about $233 billion in offsets to help pay for the SGR repeal, including reduced payment for clinical lab services and the above-mentioned prior authorization for "outlier" doctors.

Predictably, the specialist-docking plan brought denunciations from groups representing surgeons, cardiologists and others who would bear the brunt of the changes.

Moran thinks the recommendation all but ensures that when the supercommittee argues the SGR issue, they will again reach for a short-term patch, delaying the cuts for another six months or a year, as has been done practically since the program started, rather than reach a final compromise.

"It's so non-credible," she said. "That policy of penalizing specialist medicine: there's not one winner in that argument. It would create civil war in the house of medicine, and the people that are going to be the most disadvantaged by that are the patients who depend on primary care physicians and specialists talking with each other."

But what will actually happen remains to be seen. Right now, Moran says, all eyes in Washington will be on the 12 members of the supercommittee as they work towards their deadlines.

As for the impact on imaging, the medical society says it's gearing up for a fight. But it can be hard to undo proposals, especially when there's a promise of savings.

"Once an idea is out there and it's in print, and there's one dollar savings attached to it, it becomes very difficult to get that off the table," Moran said.

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