Debate on permanent doc fix rages on

Long-term care leaders continue to brace this week for news about any new plans to pay Medicare physicians, which might siphon pay from seniors' caregivers. Medicare physicians face a 21% pay cut at the end of the month if lawmakers don't find an alternative, which most thing they will.

One plan that would circumvent the sustainable growth rate formula would cost $200 billion.

No one on Capitol Hill wants to divulge so called “additional offsets” that could defray all or part of the $130 billion in additional needed funding mechanisms. Observers say they were told by lawmakers' aides the current versions of the repeal package would only offset about $70 billion of the $200 billion necessary for a full SGR repeal: about $35 billion worth of Medicare savings from beneficiaries over 10 years and another $35 billion over a decade by reducing or delaying higher payments to nursing homes and hospitals over time, according to published reports.

Some observers say they hope it doesn't meet the same fate as another piece of “practically identical” legislation – the Medicare Provider Payment Modernization Act of 2014 – which would have allowed doctors to “participate in alternative payment and care delivery models that emphasize value over volume,” according to Bloomberg News services. That bill also passed the House but failed in the Senate after no agreement on funding could be found.

American Health Care Association Vice President Greg Crist told reporters the ongoing bipartisan discussions makes him hopeful.

Meanwhile, lawmakers seem to be at increasing odds over how to pay for the plan.

Democrats had previously said they would support the measure in exchange for concessions such as extending funding for the Child Health Insurance Program. But GOP lawmakers cannot agree on a strategy.