During its January meeting, the Medicare Payment Advisory Commission (MedPAC) voted unanimously to recommend that Congress increase the physician payment update for physicians by 1.7 percent in 2008.  In addition, the Commission's March report to Congress is expected to outline two possible pathways for fixing the flawed physician payment system.  One approach would expand expenditure targets to all Medicare providers.  Currently, only physicians operate under a target, known as the sustainable growth rate (SGR).  The other approach would repeal the SGR in favor of a new system targeted at "developing and adopting new approaches for improving the value" of Medicare spending.