Two organizations representing the country's doctors and practice managers reiterated their position that Congress should repeal the sustainable growth-rate formula and outlined alternative approaches to the current Medicare physician payment system.

The appeals from the MGMA-ACMPE (PDF) and the American Medical Association (PDF) to the House Ways and Means Committee were in response to the panel's April request for comments on different approaches to the way physicians are reimbursed in the Medicare program.

MGMA President and CEO Dr. Susan Turney emphasized repeal of the SGR and stated that the total operating cost per full-time equivalent physician has risen by 56.1% since 2001, while Medicare payments to physicians have risen by only 2.9%. Meanwhile, a recent MGMA survey showed that of the 95% of members who participate in the Medicare program, only 16% said they will maintain current levels of access for new Medicare patients, and more than 40% said they will be forced to reduce clinical and administrative staff if a scheduled 30.9% cut to physician payment rates occurs early next year.

"There are numerous proposals for payment models that may promote integrated care delivery and encourage cost-effective medical treatment," Turney wrote. "Options for evaluation include, but are not limited to, bundled payments, partial capitation, accountable care organizations, medical homes and other hybrid approaches that couple fee-for-service payments with a risk-based bonus opportunity."

Dr. James Madara, executive vice president and CEO at the AMA, said there needs to be a transition period for physicians to shift into innovative payment and delivery models. At the same time, Madara wrote, Congress should make certain that a "menu of innovations" is available during the transition period.

"This menu should go beyond shared savings and accountable care organizations based on total costs and should also include innovations such as bundled payments, performance-based payments, global and condition-specific payment systems, warranties for care and medical homes," he said.