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1 AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

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4 Resolution: 211
5 (A-09)
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7Introduced by: Iowa Delegation
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9Subject: Geographic Devaluation of E-Prescribing Payments
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11Referred to: Reference Committee B
12 (Monica C. Wehby, MD, Chair)
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15Whereas, Medicare payments for E-prescribing are 2% of physicians’ Medicare total allowable
16charges; and
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18Whereas, Geographic Practice Cost Index (GPCI) adjustments to physician Medicare fees
19make the differential payments to physicians as high as 30-41%; and
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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
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24Whereas, Vendors do not offer geographic discounts for E-prescribing or other health
25information technology equipment; and
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27Whereas, The physician work effort for E-prescribing is the same in all geographic regions; and
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29Whereas, All physicians should be paid equally for equal work and equal expenses; and
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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
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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
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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)
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46Fiscal Note: Implement accordingly at estimated staff cost of $4,580.
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48Received: 05/06/09

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 3 Resolution: 211 (A-09)
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1RELEVANT AMA POLICY
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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 E-
10prescribing 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)
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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)
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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)
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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)
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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)