1. Improving the accuracy of geographic adjustment factors Section 1848(e)(1)(D) of the Social Security Act ( 42 U.S.C. 1395w–4(e)(1)(D) ) is amended to read as follows: (D) Use of accurate data (i) In general In establishing indices and index values under this paragraph, the Secretary shall use the most recent data available relating to practice expenses, malpractice expenses, and physician work effort in each fee schedule area. (ii) Practice expense and work indices In establishing indices and index values under clause (i) or (iii) of subparagraph (A), the Secretary shall— (I) use the most recent market data available on physician wages, or if available, actual cost data for physician labor