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1 1 AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES 2 3 4 Resolution: 210 5 (A-09) 6 7Introduced by: Iowa Delegation 8 9Subject: Geographic Devaluation of Medicare Payments for PQRI 10 11Referred to: Reference Committee B 12 (Monica C. Wehby, MD, Chair) 13 14 15Whereas, All physicians should be paid equally for equal work and equal expenses; and 16 17Whereas, Geographic Practice Cost Index (GPCI) adjustments result in rural physicians being 18paid less for their work, less for their E-prescribing, less for their quality by the Physician Quality 19Reporting Initiative (PQRI), and less for their practice expenses despite the fact that no practice 20expense survey has ever shown any differences; and 21 22Whereas, The Centers for Medicare & Medicaid Services is paying 2% of the GPCI-adjusted 23total Medicare payments for the PQRI bonus payments; and 24 25Whereas, The work effort for performing and reporting quality measures is the same in all 26regions; and 27 28Whereas, There are no differences in practice expenses to submit PQRI data; and 29 30Whereas, The geographic adjustment could be eliminated by applying the highest calculated 31Geographic Adjustment Factor (GAF) to a payment locality’s Physician Quality Reporting 32Initiative (PQRI) payment (e.g., Iowa’s GAF would increase from 0.921 to 1.288, thereby 33increasing Iowa’s payment for PQRI by 39.8%). This method would not decrease payments to 34any geographic payment locality’s PQRI payments; therefore be it 35 36RESOLVED, That our American Medical Association reaffirm the concept of equal pay for equal 37work (Reaffirm HOD Policy D-400.989); and be it further 38 39RESOLVED, That the American Medical Association affirm the concept of equal pay for equal 40quality (New HOD Policy); and be it further 41 42RESOLVED, That our AMA lobby Congress and the Centers for Medicare & Medicaid Services 43to prohibit geographic adjustments from being applied to Physician Quality Reporting Initiative 44payments. (Reaffirm HOD Policy D-400.985). 45 46Fiscal Note: Implement accordingly at estimated staff cost of $4,580. 47 48Received: 05/06/09

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3 Resolution: 210 (A-09) 4 Page 2 5 6 1RELEVANT AMA POLICY 2 3D-400.989 Equal Pay for Equal Work 4Our AMA: (1) shall make its first legislative priority to fix the Medicare payment update problem 5because this is the most immediate means of increasing Medicare payments to physicians in 6rural states and will have the greatest impact; (2) shall seek enactment of legislation directing 7the General Accounting Office to develop and recommend to Congress policy options for 8reducing any unjustified geographic disparities in Medicare physician payment rates and 9improving physician recruitment and retention in underserved rural areas; and (3) shall advocate 10strongly to the current administration and Congress that additional funds must be put into the 11Medicare physician payment system and that continued budget neutrality is not an option. (BOT 12Rep. 14, A-02; Reaffirmation A-06; Reaffirmation I-07; Reaffirmation A-08; Reaffirmed: Sub. 13Res. 810, I-08) 14 15D-400.985 Geographic Practice Cost Index 16Our AMA will: (1) use the AMA Physician Practice Information Survey to determine actual 17differences in rural vs. urban practice expenses; (2) seek Congressional authorization of a 18detailed study of the way rents are reflected in the Geographic Practice Cost Index (GPCI); and 19(3) advocate that payments under physician quality improvement initiatives not be subject to 20existing geographic variation adjustments (i.e., GPCIs). (Sub. Res. 810, I-08)

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