HealthyData Blog | Extract Systems

There's more than one letter?

If your letter is from the United Network for Organ Sharing (UNOS), it will most likely be from the UNOS Membership and Professional Standards Committee (MPSC) after it performed a review of your center's data.  The MPSC will have flagged your program due to either functional inactivity (a failure to perform a transplant every 3 months, or in the case of pancreas, one every 6 months) or due to outcomes that are below expected results.  If the issue is a volume issue, you will be asked to document how your center is trying to increase the activity as well as what are your surgeons and physicians are doing to maintain their skills in the operative and medical management of the organs in question.  You will also be asked to justify the turn down codes for the organ offers you have received.  Should the issue be one of outcomes, you will be asked to provide synopses of the cases in question and include an analysis of what led to the below expected outcome results.  In addition, you will likely receive a Transplant Outcomes questionnaire that probes the experience of the surgeons, transplant physicians and administrator at the program as well as the extent of institutional support and commitment both from hospital leadership as well as from ancillary services and multi-disciplinary participation.  An activity log will be provided to assess how many patients are evaluated, listed and transplanted at the center.  Depending upon the situation, MPSC may request follow-up reviews to monitor the program's progress. 

What does the data mean and how can it be used?

Previously we have spoken about the importance of maintaining compliance and having an effective pre-transplant evaluation process to manage the influx of patients from your successful outreach program. Once patients are transplanted you must be persistent in your diligence to ensure successful outcomes. Sometimes, despite optimal efforts, you may experience bad outcomes. If these unfavorable outcomes reach a certain threshold, regulatory agencies will scrutinize your program. Our next series of blogs will discuss the triggers that bring your program under scrutiny, the preliminary inquiries that are made, your options and the transplant System Improvement Agreement (SIA) process.

Tracking data in your transplant care software is a key component of QAPI programs, not only for CMS, but now also with UNOS debating the requirement of QAPI programs. One of the most challenging aspects of transplant program management is ensuring that your Quality Assessment and Process Improvement programs are measuring meaningful and actionable items that lead to program improvement.

In our last post in this series, we talked about the challenges of getting ready for the selection committee meeting. As a transplant coordinator, the selection committee meeting is your opportunity to advocate for your patient that you have been nurturing from the initial evaluation until this upcoming meeting. Now that your patient has completed the pre-transplant evaluation which I covered in the first post in this series, the decision of whether or not to add them to the waiting list must be made.

During the listing meeting, medical information will be shared with members of the multi-disciplinary team, highlighting the key factors that the committee will consider in their decision.

Transplant Evaluation Process Part 3 in a 6 part blog series

Once the transplant evaluation visit has been completed, the required testing and other consults that were ordered or deemed necessary need to be completed. Frequently, this is the most time consuming segment of the evaluation process and where automation can be most useful. First, all the tests and visits must be scheduled. If the program does not facilitate the scheduling process considerable time can be added to the evaluation process. Having block time for common tests such as ultrasounds and cardiac echocardiograms can provide ease of scheduling and access and result in shorter evaluation times. Doing this often permits closer working relationships with the program's consultants which enhances the quality of the consults received and patient experience. During this time, the patient will also have any multi-disciplinary team assessments that were not completed during the evaluation as well as any other specialist consults that were identified during the initial visit.

The Initial Evaluation

The evaluation process is really the lifeline of your program. If not done properly, your program will lack good candidates for transplant or will have insufficient patients to transplant. This is a critical topic! In our first blog of this series, we focused mainly on what happens when a new patient is referred to your program.

What happens once you have the records and are ready to see the patient?

Now that you have established a successful outreach program, you will want to make sure that the transplant evaluation process is as efficient as possible, not only for the patients from your outreach efforts but also those at the home institution. Our next series of blogs will consider some best practices to efficiently complete the work-up process including the intake, record retrieval and initial screening, the education and evaluation visit leading up to the presentation to the multi-disciplinary team meeting and listing decision.

When the new referral is received, the initial contact with the patient is the opportunity to make a lasting first impression on the patient. If the patient is the one making the initial contact, you want to have someone answering the phone who will be able to get important information from the patient including demographics, insurance information, referring physician name and where the patient gets their health care. If a medical release can be obtained at this time, it will greatly accelerate the ability to have the patient medically screened.

You have successfully set up your outreach program and established a strong local presence (please check out my 4 previous posts on this topic). What now? In order to achieve sustainability, you will have pressures to improve efficiencies, reduce costs and demonstrate value. It is important to have in place a methodology by which you track your activity from both a quantitative perspective as well as to be sure that the quality delivered matches the quality of your main program.

In our first three blogs of this series, we discussed how educational outreach can lead to opportunities to facilitate more effective patient care locally and strengthen relationships with referring providers. We have focused on the structure of these efforts; now we will focus on the provision of these services and how to differentiate your efforts from others to ensure your investment pays dividends.

In our first two blogs of this series, we discussed outreach programs beginning with education and facilitating improved patient care in the local community. What happens when the success of these efforts require a more frequent and sustained presence in the local medical community, particularly if the main facility is at a distance and precludes frequent visits by your team? In these cases, it may be beneficial to consider establishing your own brick and mortar facility to provide services to the patients on a routine basis.

While the location need not be fully staffed with all the usual transplant resources, you will want to have, most likely, a coordinator and an administrative assistant present to address patient issues as they arise. In addition, this ensures that the work flow continues in a more timely fashion. Such an arrangement helps to eliminate much of the natural lag time that occurs when tracking results and data for testing ordered by providers who do not have a full time presence in the community.