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Member Letter
Dear Colleagues:
It has been several weeks since out last communication,
and I want to update you on issues as they apply to
nephrologists in the State of Michigan starting with the
most important change first.
Effective retroactively to January 1, 1997 Medicare
claims have been amended, specifically Section 15350-B in
the Medicare Carriers Manual. As opposed to rejections
received in the past, this change will now reimburse
nephrologists for inpatient dialysis on the same day as
evaluation and management. This deletes the previous
statement that evaluation and management services must be
unrelated to the treatment's ESRD. Payment is allowed even
if the admission or consultation is related to the patient's
ESRD. These changes were implemented through the hard work
of our national RPA representatives and by continued
pressure from local affiliates such as ours.
Work continues on the final drafts of the RPA position
paper on Medicaid HMO standards. This is being worked on by
Tom Golper, M.D., Chet M. Amedia, M.D. and myself and
hopefully will be in its final form in the next several
weeks. When complete it will be published on the Michigan
RPA web site.
I would like to commend you on your continued strong
support in our local RPA organization. We currently number
138 nephrologists.
ORGAN DONOR
REGISTRY
You may have heard of upcoming legislation in
Lansing that has been stalled because of infighting in the
Senate. This involves house bills 4039, 4030, 4031, 4620 and
Senate bill 458. These bills are currently stuck in the
Senate Health Policy Committee which is chaired by Senator
Dale Shugars. The outcome of this legislation would
accomplish two things. First, it would enable the State of
Michigan to create an organ donor registry. Driver license
applicants would have the opportunity to specify on their
license their wish to become an organ donor upon their death
and transfer those names to the Transplant Society of
Michigan for entry in an organ donor registry data base. In
addition, it would create funding to pay for education about
organ donation. It is felt that public education is a
necessity in organ donor legislation.
Without public awareness it has been well shown that
increases in donations are unlikely. Other states including
Kentucky where 44% of the people make voluntary $1.00
donations to public education when renewing their licenses
had over a 50% increase in the number of donors with
legislation similar to that requested in Michigan. Currently
this legislation is unopposed in the house but, as
mentioned, is bogged down because of infighting in the
senate. Since Michigan ranks as one of the highest incidence
states of end stage renal disease and is listed as 45th in
the actual numbers of organs donated we are rapidly
approaching a critical situation. Therefore, I would
encourage you to contact your senator and encourage them to
help move this bill along.
Lastly, I would like to schedule a
dinner meeting on February 12, 1998 at 6:30 pm at the Arriva
Restaurant, 14 Mile Road and Van Dyke, so that we
could all get together and share concerns over the last year
and bring up any new issues for the upcoming year. Certainly
with continued acceleration in dialysis unit acquisition by
national chains,formation of IPA'S, MSO'S and DMO'S there
seems to be a lot of anxiety perculating to the surface. A
semi-formal dinner would be an excellent method to help
problem solve any issues that you may have. Please feel free
to R.S.V.P. by calling our office at (313) 886-4256 or using
our E-mail site at the address indicated on this
letterhead.
I continue to encourage your support of the local chapter
and will continue to work closely with our legislators in
Lansing and third party payers to support the positions and
goals of our state's nephrologists.
Yours truly,
Robert Provenzano, MD, FACP
President, RPA
September 16, 1996
Dear RPAM Member:
I am pleased to announce the new RPAM Board of
Directors
elected to a 3 year term this year:
President - Robert Provenzano, MD
Vice-President - Robert Hillyar, DO
Secretary - Elisa Singson, MD
Treasurer - Guan Ganum, MD
As president, I would like to take this opportunity
to
thank you and to update you on current events and
present
new ideas as to how the RPAM can serve us all.
The Michigan Chapter of the RPA was organized in the
1980's and functioned to represent Michigan
nephrologists
interests at a local level. This often revolved
around
reimbursement issues. In our current rapidly changing
environment more varied demands are being addressed
by
organized medicine. Increasing numbers of patients
are
enrolling in managed care programs, physician
relationships
with hospitals are changing as is the status of
specialists.
Nephrologists are banding together in IPA's, MSO's
and
looser associations in an attempt to gain a more
meaningful
representation in contract negotiation and to continue
to
serve their patients. This is leading to a great deal
of
anxiety and confusion.
With these issues in mind I would like to use the RPAM
as
a vehicle to help guide us through these stressful
times.
One of the first issues to be addressed is
communication.
This has always been a difficult issue in a state as
large
and diverse as Michigan. Access to the Upper Peninsula
has
been limited by distance and weather . To help
eliminate
this problem we are in the process of developing a home
page
on the internet. This will allow direct E-Mail to the
officers of RPAM and will have links to all of the
major
nephrology networks (i.e. RPA, ASN ASTP etc.). In
addition,
it will help those of you with modems to communicate
with
each other. I believe this will assist in developing
a
closer working relationship amongst all of us. This
service
will eventually include a news letter and message board
for
local and state wide issue.
Secondly, an update on the Indenbaum case. An Amicus
brief has been filed by MSMS and is currently in the
process
of working its way through the courts. No funding will
be
required from our organization. Funds that had been
collected to assist in legal fees will be applied to
1997
membership dues for those individuals who
contributed.
The new Board of Directors wishes to make the RPAM
responsive to its members in every way possible. Please
do
not hesitate to send your ideas, concerns, criticism
or
questions to us. The Board will be having
teleconferences
every 6 weeks to address ongoing issues. Pertinent
information will be communicated to you initially by
letter
then, hopefully, by E-Mail or available on the Internet
home
page.
Lastly, annual dues have not been collected for 2
years
and our funding is at an all time low! In order to meet
the
expectations of the membership funding is essential.
Dues
for 1997 are $250.00 except for those individuals
applying
their contribution to the legal fund. (you will be
individually notified). Please mail dues by October
15,
1996.
Please feel free to fax us with any questions or use
my
E-Mail address until our home page is created
(<provenzano@earthlink.net>).
Sincerely,
R.Provenzano
Robert Provenzano, MD FACP
President
Renal Physicians Association of Michigan
Dear Members: November 23,
1996
Many exciting events have transpired over the past
several weeks and I wanted to take this opportunity
to
update you.
First, the Renal Physician Association of Michigan
now
has an Internet Home page!
(http://home.earthlink.net/~rpam/) This will allow
for
quicker more efficient communication among all of
Michigan's
Nephrologists. We are constantly adding to this site
and
encourage your input. Currently there are sections for
local
and national issues, a classified section, opinion
sections
and transplant area. In addition the page has links to
many
other web sites of interest to nephrologists. I encourage
to
use it!!
Secondly, I had the opportunity to meet with Robert
Smedes, CEO of the Medical Services Administration of
Michigan. Also present at the meeting were
representatives
from the Michigan Branch of NKF, representatives from
Greenfield Healthcare (HFH), St. John Dialysis Network
and
patient advocates.
Several Issues were addressed. There has been great
concern amongst many of you as to reimbursement of
services
rendered to Medicaid patients who present without
prior
referral. This becomes a difficult situation since
the
patient is often not interested in seeking a referral,
nor
is the primary care physician able to see the patient in
a
timely fashion to provide the referral. This too
often
results in confusion and anger on the part of the
patient
& Nephrologist alike.
Also, support and requests to allow the Nephrologist
to
be retained as the patients (those with ESRD) primary
physician was addressed.
After a lengthily discussion, Mr. Smedes and his
staff
indicated that they would be receptive to and
strongly
supportive of specialists retaining their primary
care
rights but prefaced his statement by adding that the
State
of Michigan is not in a position to dictate to HMO's
who
must be their PCP's.
Mr. Smedes also indicated that he would review
non-payment due to no referral cases and put in place
a
"patient broker" to assist is alleviating this problem
and
other referral issues.
Certainly much more dialogue will be necessary to
resolve
these issues and I will continue to encourage each of you
to
keep me informed of your concerns. I also encourage you
to
pressure your local HMO's and hospital networks to
demand
that you have the right to maintain your status as
primary
care givers to patients with ESRD.
No one of us operates in a vacuum and it will take a
concerted effort by us all to accomplish these ends.
Lastly, only a VERY small percentage of you have paid
your 1997 dues. If we are to remain a force to be
reckoned
with we must have funding. In a time when HMO's IPA's,
MSO's
and hospital networks are diluting you voice and
influence I
think this a reasonable amount. ($250 for those of you
who
don't know).
This and all other RPAM communications will be
archived
on the home page.
Have a happy and safe holiday season!
Sincerely,
R. Provenzano, MD,FACP
President, RPA of Michigan
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