WASHINGTON - In a rare display of bipartisanship, the House on Thursday overwhelmingly approved a Medicare overhaul bill that shields doctors from pay cuts and extends a children's health insurance program.

The 392-37 vote represented victories for House Speaker John A. Boehner (R., Ohio) and Minority Leader Nancy Pelosi (D., Calif.), who negotiated the $214 billion package and successfully muted concerns about some of its provisions within their respective caucuses.

"Don't look now, but we are actually governing," joked Rep. Renee Ellmers (R., N.C.).

The vote was also a major win for the medical lobby, which has spent millions of dollars over the years aggressively trying to get Congress to scrap a Medicare payment formula and eliminate the so-called doc fix, temporary patches that lawmakers have had to approve to protect doctors from Medicare payment cuts.

The bill would repeal Medicare's sustainable growth rate, the mechanism that determines how much doctors receive for seeing patients under the program, and would replace it with a system that rewards doctors for quality over quantity of care.

The House bill also extends the Children's Health Insurance Program, known as CHIP, which provides health insurance for eight million low-income children, for two years.

Doctors have complained that the current sustainable growth rate formula, a legacy of a 1997 law, created uncertainty with fees, and they argued that payment cuts could force physicians to stop treating Medicare patients.

Congress has voted for 17 "fixes" over the last 12 years. If Congress fails to act on the measure before it adjourns Friday for a two-week recess, doctors will face a 21 percent cut in Medicare payments starting Wednesday.

The nonpartisan Congressional Budget Office said the bill would cost $214 billion over the next 10 years and would add $141 billion to the federal budget deficit over the next decade. To help offset the costs, some higher-income Medicare recipients would be required to pay higher premiums to see their doctors and for prescription drugs.