With time running out before adjournment and the House Republican Study Committee now openly urging that the tax credit extension component of the “trifecta” (HR 5970), be passed as a separate bill, GOP House and Senate congressional leadership is beginning to look desperate. Yesterday, House Ways and Means Chair Bill Thomas (R-CA) floated the idea of adding a fourth piece to the trifecta that would stop the scheduled 5.1 percent cut in Medicare payments to physicians now set for Jan. 1. In an issue brief, the Congressional Budget Office last week estimated the five-year cost of increasing physician payment rates by one percent in 2007 at $13 billion. At a five-year cost of $60 billion, this fix may not be what the doctor ordered. Expect GOP leaders to “tri, tri” again.