Doctors face as much as a 24 percent cut in Medicare fees when a deadline expires later today. So the Senate, in what has become an annual ritual, has scheduled an early evening vote on a measure to spare them. But the massively influential American Medical Association is urging a “no” vote.

At issue: Not whether to extend the “fix” that prevents Medicare fees from dropping — there is strong bipartisan support for this — but how to pay for it and whether to make it permanent.

Last week the House opted for another temporary fix, approving by a voice vote legislation that extends a patch on the program for another year. That bill, which sidesteps the question of how to pay for the cost of the reform long term, was reportedly negotiated by House Speaker John Boehner, R-Ohio, and Senate Majority Leader Harry Reid, D-Nev. (Earlier the House had approved a bill that paid for a permanent fix by delaying the individual mandate in Obamacare, which faced a certain veto.)

By rushing a surprise voice vote on the patch, House leaders avoided putting members on the record in the doc fix controversy. A roll call would have forced members to chose between the AMA and the also influential AARP. The retirees’ lobby supports the short-term fix included in the House-passed H.R. 4302.

The AMA, along with some other organizations representing physician specialty groups oppose H.R. 4302, wanting instead to get a permanent fix to the doctors’ perennial problem.

The origins of that problem date to 1997, when Congress approved a formula called the Sustainable Growth Rate (SGR), for determining physician fees under the federal Medicare program. Every year since 2001, the formula has required reductions in physician fees. But Congress has stepped in every year to extend their pay.

Sen. Ron Wyden, D-Ore., is trying to rally support for his own proposal, S. 2157, which would pay for a permanent fix by using savings from contingency funds that had been used to pay for military operations in Iran and Iraq and will no longer be needed for that purpose.

As Sunlight has reported, physician groups are generous donors in support of members of Congress and have ample lobbying budgets.

• See reports of American Medical Association PAC here on Sunlight’s Real-Time FEC tracker. The group reported spending $18 million on federal lobbying last year.
• The American College of Radiology has gotten into the outside spending game, dropping more than $100,000 in support of Sen. Mitch McConnell, R.-Ky., who is facing a tough race for re-election this November and more than $230,000 in support of Sen. John Cornyn, R-Texas.
• Other physician groups active on the issue include the American Society of Anesthesiologists, the American Academy of Family Physicians and the American College of Surgeons.