The Senate has passed the $1.1. trillion budget deal, clearing the way for President Obama to sign a measure that has disappointed many physician groups. The budget bill, which was passed by the House on Thursday, passed the Senate Saturday night by a vote of 56-40. The bill lacks any fix to the widely hated sustainable growth rate (SGR) formula for physician reimbursement under Medicare. Also missing in action: an extension of the current pay bump for primary care physicians who see Medicaid patients.