RE: Islet Cell Regeneration

[Guest guest]

Hi Everyone

Does anyone know if Islet Cell Regeneration is considered a transplant service?

Our State program for organ recipient is asking me.

Thank you

B

>>> a.Summa@... 08/16/01 08:53AM >>>

Hi Fred,

We, too, are a non-university center here in Orlando, Florida. Ours are

similar to 's- per his notes below. We have several global contracts

which include all aspects of care (eval, waitlist, tx and post). However, we

try to go no longer than 3 months post. (I certainly won't go any more than

6months tops) Some of our contracts DO include physician fees, while some

don't. I find it more beneficial to us NOT to include the physicians' fees,

but in some cases, we are not able to carve that portion out of the

contract.

a

Global Contracts for Transplant

Services @ non-univ-based programs -Reply

Fred,

We are a non-university center and I have some expereince with this

type of issue.

1) We do negotiate for all aspects of care. Eval, waitlist, transplant and

post - including MD. the fact that you can use the Medicare Kidney

Acquisition for eval services does not preclude you from negotiating the

eval services. The regs say that eval services for transplant patients

shoul dbe billed to acqusisiton funds, however if at the time of transplant

the patient has an EGHP primary, you can remove all those bills from the

acqusition fund and bill to private ins. According to our KAF consultatnts,

It really is the policy of the facility that decides what you do at that

point.

Personally I don't recommend taking charges back out of acwquisition.

You have to refile costs reports and make appropaite adjustments. You

can just negotiate the eval out of the contract entirely. Or leave it in and

dont use it.

As far as post services, my average contract is good for one month at

which point the patient retuns to the primary nephrologists care. we can

go up to three months, but I won't agre to anything longer than that.

The typical structure looks like this:

Eval: % off charges

Waitlist: % off charges

Transplant: Case rate, including physicians

Follow-up: % off charges one to three months.

One relaly good contract I have with an HMO looks like this, they contain

the eval and waiting time services at thier facility excluding tissue

typing,

we get the patient on the date of transpaltn and keep them for up to one

month outpt. post transplant for one rate including Physiscians. Works

great for me.

Hope this helps

W. McFall

Manager of Transplant Service

SFMC Honolulu.

>>> 08/15/01 11:21am >>>

Hello Everyone, This is my first post. I am at Good Samaritan Reg.

Med. Ctr. in Phoenix Az. and have some questions regarding global

contracting issues.

We are a non-university-based program doing kidney, pancreas, liver

and BMT transplants. We have the largest kidney and pancreas

transplant programs in Arizona. Because our physicians and other

professional providers are all in private practice, we do not like to

enter into global contracts where we have to reimburse the physicians

and other outside providers out of the global payment we receive. We

are averse to agreeing to these types of arrangements with their four

or five phases of care for up to a year post-tx, etc.

1. For those of you in non-university-based programs, do you accept

the the global reimbursement and phases of care contract structure?

Or do you negotiate just for hospital services and keep the pro fees

a separate item?

2. How do you reconcile this contract structure with the Medicare

Model for reimbursement? These contracts usually require that the

program bill for the evaluation prior to the transplant taking

place. This is antithetical to the Medicare Model and puts the

hospital in violation of HCFA regs.

3. The one-year post-transplant follow-up requirement seems to be

less applicable today than it was 10 years ago given the recent

advances in immunosuppression/anti-rejection therapies. We like to

transition our patients back to their referring nephrologist or PCP

as soon as possible after transplant. Any thoughts on how much

recipient post-transplant follow-up is appropriate and how much is

too much to agree to?

[Guest guest]

Yes ut us

Michele Westfield

> Global Contracts for Transplant

> Services @ non-univ-based programs -Reply

>

>

> Fred,

> We are a non-university center and I have some expereince with this

> type of issue.

> 1) We do negotiate for all aspects of care. Eval, waitlist, transplant and

> post - including MD. the fact that you can use the Medicare Kidney

> Acquisition for eval services does not preclude you from negotiating the

> eval services. The regs say that eval services for transplant patients

> shoul dbe billed to acqusisiton funds, however if at the time of

> transplant

> the patient has an EGHP primary, you can remove all those bills from the

> acqusition fund and bill to private ins. According to our KAF

> consultatnts,

> It really is the policy of the facility that decides what you do at that

> point.

>

>

> Personally I don't recommend taking charges back out of acwquisition.

> You have to refile costs reports and make appropaite adjustments. You

> can just negotiate the eval out of the contract entirely. Or leave it in

> and

> dont use it.

>

> As far as post services, my average contract is good for one month at

> which point the patient retuns to the primary nephrologists care. we can

> go up to three months, but I won't agre to anything longer than that.

>

> The typical structure looks like this:

> Eval: % off charges

> Waitlist: % off charges

> Transplant: Case rate, including physicians

> Follow-up: % off charges one to three months.

>

> One relaly good contract I have with an HMO looks like this, they contain

> the eval and waiting time services at thier facility excluding tissue

> typing,

> we get the patient on the date of transpaltn and keep them for up to one

> month outpt. post transplant for one rate including Physiscians. Works

> great for me.

>

> Hope this helps

> W. McFall

> Manager of Transplant Service

> SFMC Honolulu.

> >>> 08/15/01 11:21am >>>

> Hello Everyone, This is my first post. I am at Good Samaritan Reg.

> Med. Ctr. in Phoenix Az. and have some questions regarding global

> contracting issues.

>

> We are a non-university-based program doing kidney, pancreas, liver

> and BMT transplants. We have the largest kidney and pancreas

> transplant programs in Arizona. Because our physicians and other

> professional providers are all in private practice, we do not like to

> enter into global contracts where we have to reimburse the physicians

> and other outside providers out of the global payment we receive. We

> are averse to agreeing to these types of arrangements with their four

> or five phases of care for up to a year post-tx, etc.

>

> 1. For those of you in non-university-based programs, do you accept

> the the global reimbursement and phases of care contract structure?

> Or do you negotiate just for hospital services and keep the pro fees

> a separate item?

>

> 2. How do you reconcile this contract structure with the Medicare

> Model for reimbursement? These contracts usually require that the

> program bill for the evaluation prior to the transplant taking

> place. This is antithetical to the Medicare Model and puts the

> hospital in violation of HCFA regs.

>

> 3. The one-year post-transplant follow-up requirement seems to be

> less applicable today than it was 10 years ago given the recent

> advances in immunosuppression/anti-rejection therapies. We like to

> transition our patients back to their referring nephrologist or PCP

> as soon as possible after transplant. Any thoughts on how much

> recipient post-transplant follow-up is appropriate and how much is

> too much to agree to?

>

>

>

>

>

>