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Backers of legislation to set up a new system of Medicare payments to doctors and other providers are seeking to settle a flurry of last-minute skirmishes that threaten its quick passage in the Senate when Congress returns from a two-week recess Monday. The main concern is from conservatives who are frustrated that two-thirds of the measure’s $214 billion cost would be financed through higher deficits and are looking at ways to pay for the measure without resorting to borrowing. (Hughes, 4/12)

Conservative objections over spending are raising doubts over whether the U.S. Senate can quickly approve legislation fixing the Medicare physician payment system, in a possible setback for Republicans keen to show they can get things done. Some Senate conservatives are threatening to insist that the measure be fully paid for, after the House of Representatives passed a version of the "doc fix" bill two weeks ago that would expand the federal deficit. (Cornwell, 4/10)

The Senate is expected to vote next week on the permanent Medicare payment reform bill that overwhelmingly passed in the House last month. But exactly how that vote will happen is still unclear, especially since a group of conservatives wants to upend leadership’s plans to approve the bill fast. (Haberkorn, 4/10)

The House-passed plan to end the annual congressional ritual of blocking deep, automatic cuts in Medicare reimbursements for doctors has just run into more hot water. Before the Senate takes up the measure after a two-week break, Paul Spitalnic, the chief actuary for the Centers for Medicare and Medicaid Services, released a new analysis. It cautions that the bill passed by the House in March will increase Medicare spending by $150.5 billion in the coming decade – with much of that tacked onto the deficit. (Pianin 4/12)

The CMS actuary is warning that the House’s SGR repeal-and-replacement bill will in the long run create the same shortfalls in Medicare physician payments that Congress thought it was remedying with H.R. 2. ... [Spitalnic] warns that when the bill’s 5 percent annual bonuses in physician payments expire as scheduled in 2024, a major payment cut for most physicians would follow the next year. The payment structure would also be troublesome in years with high inflation, according to the actuary. By 2048, Medicare prices under the new system will actually be less than those called for under the SGR, Spitalnic wrote. (Haberkorn, 4/10)