With a congressional conference committee finalizing the 2006 budget reconciliation bill, the AMA and 128 other health care organizations sent a letter to Congress to urge that the budget include two years of positive updates in payments, instead of a series of drastic cuts. The groups urged that Congress replace the flawed Medicare payment formula with one based on the cost of delivering care. Furthermore, the letter called for additional payments in 2007 to physicians who voluntarily participate in a pay-for-reporting program that would be designed to allow for participation by physicians in all specialties. It also called for elimination of any punitive value-based purchasing or pay-for-performance program that would result in negative updates for those who are unable to participate in the voluntary pay-for-reporting program. The AMC/NOMA has also sent letters to Congress urging support for positive Medicare payment updates.