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1 1 AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES 2 3 4 Resolution: 211 5 (A-09) 6 7Introduced by: Iowa Delegation 8 9Subject: Geographic Devaluation of E-Prescribing Payments 10 11Referred to: Reference Committee B 12 (Monica C. Wehby, MD, Chair) 13 14 15Whereas, Medicare payments for E-prescribing are 2% of physicians’ Medicare total allowable 16charges; and 17 18Whereas, Geographic Practice Cost Index (GPCI) adjustments to physician Medicare fees 19make the differential payments to physicians as high as 30-41%; and 20 21Whereas, This GPCI adjustment of E-prescribing payments ignores the fact that the cost of 22E-prescribing equipment and supplies are the same geographically; and 23 24Whereas, Vendors do not offer geographic discounts for E-prescribing or other health 25information technology equipment; and 26 27Whereas, The physician work effort for E-prescribing is the same in all geographic regions; and 28 29Whereas, All physicians should be paid equally for equal work and equal expenses; and 30 31Whereas, GPCI adjustments result in rural physicians being paid less for their work, less for 32their E-prescribing, less for their quality by the Physician Quality Reporting Initiative, and less for 33their practice expenses despite the fact that no practice expense survey has ever shown any 34differences; and 35 36Whereas, The geographic adjustment could be eliminated by applying the highest calculated 37Geographic Adjustment Factor (GAF) to a payment locality’s E-prescribing payment (e.g., Iowa’s 38GAF would increase from 0.921 to 1.288, thereby increasing Iowa’s payment for 39E-prescribing by 39.8%). This method would not decrease payments to any geographic 40payment locality’s e-prescribing payments; therefore be it 41 42RESOLVED, That our American Medical Association lobby Congress and the Centers for 43Medicare & Medicaid Services to prohibit geographic adjustments for E-prescribing payments. 44(Directive to Take Action) 45 46Fiscal Note: Implement accordingly at estimated staff cost of $4,580. 47 48Received: 05/06/09

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3 Resolution: 211 (A-09) 4 Page 2 5 6 1RELEVANT AMA POLICY 2 3D-120.958 Federal Roadblocks to E-Prescribing 41. Our AMA will initiate discussions with the Centers for Medicare and Medicaid Services and 5state Medicaid directors to remove barriers to electronic prescribing including removal of the 6Medicaid requirement that physicians write, in their own hand, “brand medically necessary” on a 7paper prescription form. 2. Our AMA will initiate discussions with the Drug Enforcement 8Administration to allow electronic prescribing of Schedule II prescription drugs. 3. It is AMA 9policy that physician Medicare or Medicaid payments not be reduced for non-adoption of E10prescribing 4. Our AMA will work with federal and private entities to ensure universal 11acceptance by pharmacies of electronically transmitted prescriptions 5. Our AMA will advocate 12for appropriate financial and other incentives to physicians to facilitate electronic prescribing 13adoption. (Res. 230, A-08; Reaffirmed in lieu of Res. 215, I-08) 14 15D-120.957 Electronic Prescribing Incentive Program 16Our AMA will continue to work with CMS to ensure that the Electronic Prescribing Incentive 17Program policies and reporting procedures provide the greatest flexibility to physicians who 18electronically prescribe and elect to participate in the program. (Res. 223, I-08) 19 20D-400.985 Geographic Practice Cost Index 21Our AMA will: (1) use the AMA Physician Practice Information Survey to determine actual 22differences in rural vs. urban practice expenses; (2) seek Congressional authorization of a 23detailed study of the way rents are reflected in the Geographic Practice Cost Index (GPCI); and 24(3) advocate that payments under physician quality improvement initiatives not be subject to 25existing geographic variation adjustments (i.e., GPCIs). (Sub. Res. 810, I-08) 26 27H-400.988 Medicare Reimbursement, Geographical Differences 28The AMA reaffirms its policy that geographic variations under a Medicare payment schedule 29should reflect only valid and demonstrable differences in physician practice costs, especially 30liability premiums, with further adjustments as needed to remedy demonstrable access 31problems in specific geographic areas. (Sub. Res. 82, A-89; Reaffirmed: BOT Rep. DD, I-92; 32Reaffirmed: CMS Rep. 10, A-03; Reaffirmation A-06; Reaffirmation I-07; Reaffirmation A-08) 33 34D-400.989 Equal Pay for Equal Work 35Our AMA: (1) shall make its first legislative priority to fix the Medicare payment update problem 36because this is the most immediate means of increasing Medicare payments to physicians in 37rural states and will have the greatest impact; (2) shall seek enactment of legislation directing 38the General Accounting Office to develop and recommend to Congress policy options for 39reducing any unjustified geographic disparities in Medicare physician payment rates and 40improving physician recruitment and retention in underserved rural areas; and (3) shall advocate 41strongly to the current administration and Congress that additional funds must be put into the 42Medicare physician payment system and that continued budget neutrality is not an option. (BOT 43Rep. 14, A-02; Reaffirmation A-06; Reaffirmation I-07; Reaffirmation A-08; Reaffirmed: Sub. 44Res. 810, I-08)

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