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November 23, 1999 Dear Michigan RPA Member: I am forwarding you this letter to keep you abreast of the exciting news that has been emanating from Washington. As you may have heard, Congress and the Administration have finally concluded negotiations of the Balanced Budget Act (BBA) Refinement legislation that most of organized medicine has been eagerly anticipating. The final package was attached to the omnibus spending bill (remaining appropriations) that passed the House on Wednesday by a vote of 295 - 135. The Senate voted late Friday evening. There was good news for ESRD patients and below you will find what is in the final package that MASI thought was of most interest to RPA. The President is expected to sign the bill before December 2. Composite Rate Provides for a 1.2% increase in the reimbursement rate to dialysis facilities beginning January 1, 2000 and an additional 1.2% increase beginning January 1, 2001 for a total increase of 2.4% over two years. This provision also includes a requirement of MedPAC to study the use of home dialysis services by Medicare beneficiaries. Immunosuppressive Drugs Provides for an extension of the current 36 month limit on coverage of immunosuppressive drugs for persons exhausting their coverage in 2000 - 2005. In each calendar year there will be an extension, specified by the Secretary (as a number of months or partial months), applicable to persons who lose their benefits in that year. The increase for persons who lose benefits in 2000 is a 8 months; the minimum increase for persons exhausting benefits in 2001 is 8 months. Total expenditures are limited to $150 million over that 5 years. Sustainable Growth Rate Makes technical changes to limit oscillations in the annual update to the conversion factor beginning in 2001 by: 1. Requiring that future update adjustment factors be calculated using data measured on a calendar year basis. It also provides that the SGR is calculated on a calendar year basis and requires the Agency for Health Care Policy and Research (AHCPR) to conduct a study on the utilization of physicians services under the fee-for-service program. Separate Billing for Ambulance Services to SNFs Beginning April 1, 2000, provides separate payment for certain ambulance services for beneficiaries needing renal dialysis in a facility outside of the skilled nursing facility (SNF). Remember the RPA is working for you. If you have not paid your national dues, please do so as these remain necessary to allow the important work to continue. Additionally, our local membership fees for 2000 are due and have been drastically reduced to $25.00 per year.
Sincerely,
Robert Provenzano, M.D. President, Michigan Renal Physicians Association
I wanted to take this opportunity to update you on issues pertinent to Michigan members of the RPA. First, several Michigan members were in attendance at the national RPA meeting in Washington, D.C. Overall the meeting was well attended and covered many issues of concern to nephrologists nation-wide. Of major concern to many Michigan nephrologists was the current contracting for Medicaid HMO's and how this will impact their patients and dialysis facilities. I brought this issue up in a physician Reimbursement Subcommittee meeting chaired by Tom Golper, MD. Many aspects of the on going contracting with the HMOs' was discussed including "side-stepping" quality assurance measures, Referrals from PCP's, the nephrologist as the primary care provider to mention a few. The committee agreed that these were serious issues and a working group has been established to address these issues. In addition, the national organization was supportive for the nephrologist serving as the primary care giver for ESRD patients, as it has been shown that cost effective care in chronic disease states is best offered by those specialists trained in those areas. The RPA is also lobbying to apply Medicare dialysis standards to Medicaid federally as to avoid the expense of having each Nephrologist in each state battle with their legislators. I will keep you informed as more information becomes available. The second issue issue concerning many of you is the Indenbaun case. On March 25, 1997, The Michigan Supreme Court denied leave to appeal. The Court of Appeals' holding that "directing or requiring," as used in the Public Health Code, prohibits physicians and other health care licensees from referring patients to another person, place, facility or business in which they have a financial interest, remains the law in Michigan. Michigan State Medical Society is pursing legislation to modify this ruling. The proposed legislation would authorize referrals by health care professionals to entities in which they have a financial interest if the health care professional provides care to the patient at the other facility. If care is not rendered by the referring physician, a number of criteria must be met, including disclosure to the patient, advise regarding alternative facilities, and provisions that the professional not be required to make referrals, that the investment and benefits be unrelated to the volume of referrals, that other individuals be authorized to invest in the facility and other criteria. Ownership in a public corporation and employment by a university, hospital or other health care facility are excluded from the definition of "financial interest." Physician organizations which contract with employers or third-party payors are excluded from the definition of "other facilitiy" to the extent of referrals within the physician organization. This provision is critical to protect referrals within physician organizations that are not deemed to be fully integrated so as to constitute a single business entity. This legislation is being supported by Representatives Kirk Profit (D), Ypsilanti: John Weller (R), Fremont and Senator Dale Shugars (R), Portage. Feel free to contact these supportive legislators and give them your Ideas, opinions and support. Finally, I will be setting up our annual meeting some time in August and will contact you with the details. Please plan to attend.
Sincerely, R.Provenzano, MD President
Dear Members: Febuary 7, 1997 I wanted to take this opportunity to update you on several issues affecting each of us. As you have already heard, the Michigan legislature is in the process of reviewing proposals to award Medicaid-HMO contracts. This has caused a great deal of anxiety in health care circles, particularly among Nephrologists. RPAM has been, and continues to aggressively pursue a "carve out" for our patient population. This concept would prevent primary care providers from disrupting ESRD patients care and would do away with the need for constant referrals and delay or denial of reimbursement for facilities or nephrologists. Initial meetings with our legislators were met with "cool denials", but we have turned up the heat and recruited the support of Michigan State Medical Society, The National Kidney Foundation of Michigan, Network 11, various healthcare systems and patient advocacy groups and a recent meeting I had with the Speaker of the House, Curtis Hertel, resulted to my appointment to the subcommittee reviewing these contracting issues and his personnel support! As mentioned in previous correspondences, a spring RPAM Meeting is anticipated and will be held in mid-March. Details will be forwarded to you when they are finalized. Please plan to attend as this will be an excellent forum to discuss each of your personnel and professional issues so we can deal as effectively with the above mentioned political/healthcare issues as possible. Remember, if you have not paid your dues for 1997, do so as this is the only way to keep this organization moving forward. Also our Web Site (http://home.earthlink.net/~rpam/), has been selected as one of the best Nephrology pages in the country! Check it out! Sincerely, R. Provenzano, MD President |
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