In a letter to congressional leaders (PDF), the Alliance of Specialty Medicine is calling on Congress to create a permanent replacement for the sustainable growth-rate Medicare payment formula by the end of the year.

If Congress does not act, an SGR-driven 26.5% pay cut will take effect Jan. 1. The letter from the alliance—a coalition of 13 medical specialty societies—notes that there is also the potential for another 2% Medicare pay decrease if Congress does not act to stop across-the-board cuts called for in 2011's Budget Control Act.

This payment uncertainty has led to physicians not making investments in electronic health records or other improvements to their practice infrastructure, the alliance said in the letter. It added that others are reconsidering their Medicare participation or limiting the number of Medicare patients they see. Ultimately, they argued, these potential cuts threaten seniors' access to healthcare and lead to longer waits to see a physician.

While some in Congress have predicted that Congress will pass another temporary suspension or "patch" to avoid the SGR-driven cut, the cost to do so is now $25.2 billion, according to an estimate from the Congressional Budget Office.

"Physicians and seniors have waited long enough for Congress to address this significant flaw in our nation's largest health program," the alliance letter stated. "These short-term 'fixes' have served only to exacerbate the problem and continue to undermine physician and beneficiary confidence in the Medicare program."