Efforts to pass a permanent repeal of the Medicare sustainable growth rate (SGR) formula got a boost as the House GOP Doctors Caucus went on record with its support in a letter to the House leadership.

Late last month, the American Academy of Family Physicians had written to the influential group of Congressional representatives who are also health care providers (primarily physicians) asking them to officially endorse the bi-partisan compromise H.R. 4015, The SGR Repeal and Medicare Provider Payment Modernization Act of 2014, introduced by fellow republican and physican Rep. Michael Burgess, M.D., (R-Tex.) because “as physicians, nurses and other healthcare providers, members of the Doctors Caucus know from experience how disruptive the Medicare SGR formula is and the negative impact it potentially has on seniors’  access to physician services.”

However, the non-partisan Congressional Budget Office (CBO) has estimated that passing a permanent repeal of the SGR will cost about $138 billion over the next 10 years, and so far, details on where this money will come from have not been included in the bill. Asking any group of conservative legislators to go on record as endorsing a costly change ahead of decisions on how it will be paid for is a big request.

In addition, GOP Doctors Caucus co-chair Rep. Phil Gingrey, M.D., (R-Ga.) has spoken publicly about the repeal not being a real slam-dunk win for doctors because the physician payment increase it contains is only for five years and is so low that it will make little real difference for doctors. (This is especially true if one considers that the across-the-board sequester cut of 2 percent to Medicare payments is likely to continue for several more years.)

“Please don’t say we got what we wanted because what we wanted was a 10-year update of a half a percent, which doesn't even keep up with inflation," Gingrey told Politico after a 40-minute meeting of the group on the SGR legislation last month. “They had to bring us kicking and screaming, I guess you could say,” he added.

Of course, even a payment increase that is below inflation is better than the nearly 25 percent cut physicians would endure if the SGR formula goes into effect on April 1 as mandated when the current temporary fix expires. The direness of the alternative to the SGR repeal is what likely brought the GOP Doctor's Caucus to endorse the bill officially.