Ohio River Valley

Transplant Coalition

February 27, 2019

2

Agenda

1. ESRD Network Role and Transplant Coalition

Charter – Vicky Cash, Executive Director

2. Introductions

3. CMS Transplant initiatives Update – Vicky

Cash, Executive Director

4. Transplant Coalition Overview – Dr. Anne

Huml – Coalition Chair

5. Next Steps

3

Network Role

and Charter

4

18 ESRD Networks

5

IPRO ESRD Network 2017 Service

Areas(2017 Network Annual Reports)

IPRO

ESRD Program

127,224ESRD Patients

1,831Dialysis Facilities

47Transplant Centers

Network 9IN, KY, OH

Network 6GA, NC, SC

Network 1CT, MA, ME, NH, RI, VT

NW2

NY

NW1

p. 6

IPRO ESRD Network of the

Ohio River Valley:

Network 9

Network 9IN, KY, OH

33,703ESRD Patients

634Dialysis Providers

14Transplant Centers

Network Role

• Funded by the Centers for Medicare and Medicaid Services (CMS) to improve the quality of care for individuals with end stage renal disease (ESRD)

• Work with patients, family members/care partners, providers, transplant centers and other stakeholders to promote patient and family centered care

• Secure commitments to promote collaboration among all ESRD partners

• Support access to appropriate care for all ESRD patients

• Promote best practices related to clinical care, data collection and quality improvement techniques

• Improve patient safety

• Assist with emergency preparedness and disaster relief for the ESRD population

p. 7

8

Transplant Coalition Charter

• Understand mechanisms and practices around challenging issues that transplant centers, ESRD facilities, and patients face

• Support sharing of processes and practices across the region for centers and institutions to gain a better understanding of their own practices based upon the practices of other institutions

• Develop best practices to spread throughout the region.

• Identify specific interventions that can be developed to overcome barriers.

• Collaborate with other coalitions to create a nationwide framework focused on improving transplantation rates in ESRD.

9

National and Network Waitlist Statistics

National Average

• 113, 886 Patients currently on the kidney transplant waitlist(Jan.2019)

• 713,562 ESRD patients (USRDS 2016)

• 15.3% % of Prevalent dialysis patients wait-listed (USRDS 2016).

Network Average

• 4184 Patients currently on kidney transplant list

• 33703 ESRD patients (Dec.2018)

• 12.41 % Rate of dialysis population active on the transplant list

• Ohio 2266/ 17824 12.7%

• Kentucky 766/ 6055 12.6%

• Indiana 1152/ 9824 11.7%

Victoria Cash, MBA, BSN, RN

IPRO ESRD Network of Ohio River Valley

Executive Director

216-755-3051

vcash@nw9.esrd.net3201 Enterprise Pkwy, Beachwood, Ohio 44122

Phone: (216) 593 - 0001 Fax: (216) 593 – 0101

Introductions:

Anne Huml, MD, MS

Coalition Chairperson

Transplant Nephrologist

216-778-4061

ahuml@metrohealth.org

3201 Enterprise Pkwy, Beachwood, Ohio 44122

Phone: (216) 593 - 0001 Fax: (216) 593 – 0101

• Established over 10 years ago

• The Center has three long-term goals:

1. Create a durable academic-community partnership

to develop innovative interventions that achieve

measurable reductions in health disparities in the

Greater Cleveland area

2. Promote successful intervention strategies that can

be replicated in other regions.

3. Train a new generation of health activists committed

to eliminating health disparities.

• Past Projects:

� Addressing phosphorus additives in food

� Examining organ donor consent

� Understanding social context of hypertension

Coalition’s Academic Partnership

Coalition Representation:

Your Name:

The Organization or ESRD Modality:

Your Role/ ESRD Vintage☺:

Transplant Center Representation

Indiana

Lutheran Hospital of Indiana

IU Health Kidney Transplant Center

St. Vincent Hospital and Transplant Services

Kentucky

Jewish Hospital Renal Transplant

University of Kentucky Medical Center - Transplant Department

Ohio

University Medical Center Toledo

Christ Hospital- Transplant

The Ohio State University Wexner Medical Center- Transplant

University of Cincinnati Medical Center- UC Health

University Hospitals of Cleveland

Cleveland Clinic Hospital

Childrens Hospitals

Norton Childrens Hospital (Kosar Childrens)

Nationwide Childrens Hospital

Cincinnati Childrens- Transplant

ESRD Providers

Indiana

Incenter HD Providers

Home Program Providers

Kentucky

Incenter HD Providers

Home Program Providers

Ohio

Incenter HD Providers

Home Program Providers

Patient Representatives:

IN, KY, OH

Other Stakeholders:

CMS : Focus

on Transplant

CMS Focus On Transplant

• 2019: Increase percent of prevalent in-center hemodialysis patients

on the waitlist by 2% over the past five year’s natural trend.

• Raise overall percent of patients on the waitlist for kidney transplant

to 30% by 2023

• Lower organ discard rates.

• Increase use of high KDPI organs

• Reduce disparity in transplant

CMS program changes to support initiative

• Removal of 1 year survival rating as a quality measure in transplant

(proposed, date to be adopted eminent)

• Initiation of quality payment incentive goal to increase prevalent

patients on waitlist for all ESRD facilities starting in 2020

• Focus on measurement and reporting of kidney discard rates.

• Patient education campaign aimed at use of KDPI organs

• Network quality programs aimed at increasing PPW by 2% in 30% of

population for three years of the five year contract

16

Improved Transplant Coordination

National Goal: By 2023 to increase the percentage of ESRD patients on

the transplant waitlist to 30% from the 2016 national average of 18.5%

Network Scope and Goal:

• Work with 30% of the facilities in the Network service area with the lowest

demonstrated 5 year natural trend = 190 clinics/ 10,450 patients

• To improve the rate of patients on the transplant waitlist by 2 percentage

points over the natural trend

• Usually wait list 16 patients/month will now need to wait list 35/month.

Additional 19 patient per month to meet goal.

• Assist with the navigation of the 7 identified steps to transplant, promote

patient engagement, and involvement.

5 year natural trend= number of patients referred/ average census in the

QIA facilities October 2013 through October 2018

Coalition

Overview

The Model for Our Work

Examining Referral Rates across Georgia Dialysis Facilities

308 Georgia Dialysis Facilities, 2005-2011

1. Patzer RE…Pastan SO et al, JAMA 2015 2. Patzer RE…Pastan SO et al, JASN 2017

• In Georgia overall, limited proportion of dialysis patients referred for kidney transplant evaluation during this time period

• Substantial variability in referral among dialysis facilities (Range: 0% to 75%)1

• Led to several dialysis facility quality improvement projects / pragmatic randomized trials that led to increased transplant access (e.g., RaDIANT)2

Contributions of the Coalition

For Patients

Contributions of the Coalition

ESRD Providers and Facilities

Kidney Transplant Toolkit (To be released in 1-2 mo.) Table of Contents

o Introduction

o Selecting Patients to be Referred to a Transplant Center and the Transplant Evaluation

o Deceased Donor Transplantation, The Kidney Transplant Operation, and Transplant Complications

o Living Kidney Donation

o Educating Dialysis Patients Optimally About Transplantation and Living Donation

o Financial Toolkit for Dialysis Centers

o The Role of the Dialysis Unit Beyond Education: Successful Care Coordination to Achieve Success in Transplant

o Resources

Emory University

Medical University

of South Carolina

Augusta University

Piedmont

Transplant Institute

Wake Forest

Baptist Medical

CenterUNC Transplant

Vidant Medical

CenterCarolinas Medical

Center

Duke University

GASC NC

Patient-Level Pre-Transplant Data Registry – Collected Fields

Patient Name Referred Transplant Center

Referral Date

Patient DOB Preemptive Referral Evaluation Start Date

Patient SSN Dialysis Start Date Evaluation

Completion Date

Patient Race Dialysis Facility Name Waitlisting Date

Patient Sex Dialysis Facility Address Referring Physician Info

Patient Address Dialysis Facility CCN Referring Staff Info

Patient Insurance *BOLD indicates required field

Contributions of the Coalition

Regional Transplant Center Collaboration

ESRD Network

Coordinating Center

Transplant centers

submit patient-level

Excel file via a

Secured Filed Transfer

Protocol

Invitation

For OUR Coalition

IDEAS, IDEAS, IDEAS

• Please complete the electronic survey to understand directions of our coalition

• Opportunity to present and discuss challenges of stakeholders in getting patients to transplant

• Share best practices

• Understand best meeting scenarios

• Additional pertinent comments

• Expansion of coalition membership

SAVE THE DATE: IN PERSON COALITION

MEETING

APRIL 25, 2019**