Network 9 - ORV Transplant Coalition Quarterly Meeting: 08/27/19 · 2020. 3. 2. · Transplant...
Transcript of Network 9 - ORV Transplant Coalition Quarterly Meeting: 08/27/19 · 2020. 3. 2. · Transplant...
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ORV Transplant Coalition
Quarterly Meeting: 08/27/19
Needs Assessment for
Transplant Centers in Coalition
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One-on-One Needs Assessments
Transplant Centers at Coalition
• Summary of how the network is doing regarding access to transplant (WL rates
and rank, number of transplants by state)
• Goals and progress of transplant coalition
• Semi-structured discussion about protocols, best practices, waitlist management,
and ideas for coalition
• Follow-up 20 minute survey
• Scheduled with approximately 2/3 of transplant centers
• Compare results to other regions (via coalition), guide future work
Collaboration Across
Coalitions
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Collect data on early
transplant steps
-Conduct quality
improvement projects &
interventions to improve
access to early transplant
steps
-Reduce inequities in
transplant access
-Develop new quality
metrics to improve
transplant rates
Need for NATIONAL Data Collection on ALL Transplant Steps
Pre-ESRD Nephrolog
y Care ESRD Education Referral
Evaluation Start
Evaluation
Complete Waitlist Transplant
Step 2 Step 3 Step 4 Step 5 Step 1 Step 6
48.2%
Agreement with
claims1
1. Kim JASN 2012; 23(6)
2. Salter JASN 2014; 25(12)
= Well recorded in
national surveillance
data
= Measured in data,
but validity may be
questionable
= Not measured in
national surveillance
data
56.2%
provider/patient
agreement2
Step 7
Although significant variation in rates of kidney
transplant exists across United States dialysis
facilities, rates of transplant referral and start of
an evaluation at a transplant center remains
unknown
Emory
University Medical
University of
South Carolina
Augusta
University
Piedmont
Transplant
Institute
Wake Forest
Baptist Medical
Center UNC Transplant
Vidant Medical
Center Carolinas
Medical Center
Duke University
GA SC NC
Patient-Level Pre-Transplant Data Registry – Collected Fields
Patient Name 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
Pre-Transplant Data Registry, 2012-2016 – Data Collection Methods
ESRD Network 6
Coordinating
Center
Transplant centers
submit patient-level
Excel file via a
Secured Filed
Transfer Protocol
ESRD Network
Coordinating Center
• ESRD Networks across U.S.
support data collection effort, and
will serve as data coordinating
centers
• Receipt of transplant center data file
through REDCap
• Perform additional quality checks
for:
• Missing values
• Field validation errors
• Incorrect values
• Backfills missing fields with
CROWNWeb-supplied data and
denominator of all ESRD patients
• Creates a data file with selected
fields to submit to the United States
Data Systems (USRDS) for linkage
to national surveillance data
FINAL PATIENT
LEVEL DATA
Updated Transplant
Center Data File
*ESRD Network 6 continues to collect these
data from all 9 transplant centers semi-annually
De-identified
data sent to
Emory for
analysis
Example: Dynamic Transplant Center Reports to help with Outreach Efforts
Example Quality Metrics
How many referrals per year?
How many referrals convert to evaluation start? waitlisting?
Average time from ESRD start to referral
Basic demographics of referral patients (including comorbidities)
Number of dialysis facilities that refer to that transplant center & median/range of 1-year referral rate for that facility
Frequently Asked Questions by Transplant Centers What do I need to do to commit to doing this?
• Right now, all we need is a letter of support that states you are willing to be a “champion” for your center and committed to participating.
• If funding is received, this would require a bi-annual data pull that we expect would take ~2 hours of IT time the first time it is set up, and minimal effort thereafter.
What will it cost my transplant center to participate?
• There are no direct costs at this time, and we do not anticipate a cost for participating. Our funding in the past has supported the data coordinating center, and we expect future funding would support this expansion.
What information needs to be shared with the data coordinating center?
• Patient identifiers (e.g., social security number, DOB), date of referral from a dialysis facility to a transplant center, and start of the transplant evaluation date
I’m worried about the legal/regulatory issues with sending patient data – will we need to sign data use agreements with the data coordinating center?
• ESRD Networks, as part of their CMS conditions of participation, have legal oversight of kidney patient data in your respective region, and they already have identifiers for patients with kidney disease. So no additional data use agreements are necessary if your ESRD Network is supporting the effort.
What is the benefit of participating?
• See next slide
Benefits for participating transplant centers
Participate in important quality improvement work to increase rates of kidney transplantation
Participate in research efforts to better understand the variation in early transplant access steps
• For those interested in research, they could be involved in various research publications as co-authors or acknowledgments (depending on level of participation)
• Access to USRDS-tx center linked data, with a signed data use agreement
• Single IRB supported/paid for by Emory University
Center-specific transplant center reports on data not collected via UNOS, USRDS, or other surveillance registries that may help transplant centers with outreach efforts to dialysis facilities
Linkage of data with other transplant center data to benchmark transplant access metrics
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Upcoming Meetings/Reminders
2019
ORV Transplant Coalition Quarterly Meeting
November 13th – Option for in Person Meeting Indianapolis ?
***Please complete survey to show your interest in Webex versus In Person
All Transplant Materials Available on Website
https://network9.esrd.ipro.org/transplant-coalition/
Preparing for the
Onslaught
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National Transplant Program Growth
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Advancing American Kidney Health 07/10/19 Executive Order: Advancing American Kidney Health • President Trump, Secretary Azar, Administrator Verma, Director Boehler
• Reduce the development of ESRD by 25% by 2030 • 80% of incident ESRD patients receive home dialysis or a
preemptive kidney transplant by 2025 • Standardize organ procurement procedures to double the
number of kidneys available for transplant by 2030 • Removing financial barriers for living kidney donors • Encourage the development of the artificial kidney
• Restructuring payment models to incentivize kidney
disease prevention, home dialysis and transplantation
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Advancing American Kidney Health
Future Initiatives to Improve Access and Quality Innovation Center’s New Kidney Care Models
• Mandatory:
• End-Stage Renal Disease Treatment Choices (ETC) Model – Proposed
Rule
• Voluntary:
• Kidney Care First (KFC) Model Base year 2020 + 5 years
• Nephrology practices capitated payment adjust based on outcomes
• Comprehensive Kidney Care Contracting (CKCC) Models Base year + 3
• Nephrology practices, Transplant Centers, ESRD facilities
• Risk adjusted with cost saving sharing. Risk based on model
o Graduated – lowest risk
o Professional
o Global – highest risk
Goal 2: Improve Access to and Quality of Person-Centered Treatment Options
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Advancing American Kidney Health
ESRD Treatment Choices (ETC) Model - Mandatory
• 1/1/2020 – 6/30/2026 • Participants: ~ 50% dialysis facilities (QIP) and “Managing
Clinicians” (MIPS) across the US using “randomly selected” Hospital Referral Regions
• Exclusion of facilities census 11/132 months/ Providers with - low volumes of ESRD
• Risk adjustment - Uses the methodology of the Percentage of Prevalent Patients
Waitlisted (PPPW) from the ESRD Quality Incentive Program (QIP) except over 75 years
old, in skilled nursing facility, or on hospice
• Kidney dialysis education extended to CKD5 and ESRD
• Payment:
• Home Dialysis Payment Adjustment ( HDPA) 1st adjustment (+) on “certain” home
dialysis claims decreasing 1/1/20-12/31/22
• Adjustment first year 3% increase 2% 2nd year 1% 3rd/last year
• Performance Payment Adjustment (PPA) 2nd adjustment (+/-) to PPS rate & MCP based
on home dialysis utilization rate & transplant rate (kidney & KP) increasing over time
(1/1/21-6/30/26)
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Advancing American Kidney Health
Goal 3: Increase Access to Kidney Transplants
OBJECTIVE 1. Increase the utilization of available organs from deceased donors by
increasing organ recovery and reducing the organ discard rate
OBJECTIVE 2. Increase the number of living donors by removing disincentives to donation
and ensuring appropriate financial support
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Advancing American Kidney Health
Goal 3: Increase Access to Kidney Transplants
Future Initiatives to Improve Deceased Donation
• Revising the guidelines to reducing risk of HIV, HBV, and HCV
transmission while preserving high-quality organs
• Organizing a workshop to discuss use of HCV+ donor organs in
recipients who do not have HCV
• Testing accelerated placement of kidneys at high risk for discard
• Reviewing the OPO conditions for coverage and proposing changes
to the standards used to evaluate OPOs
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Advancing American Kidney Health
Goal 3: Increase Access to Kidney Transplants
Future Initiatives to Improve Living Donation
• Expanding reimbursement of travel and other expenses related to
living organ donation
• Considering also providing reimbursement for lost wages for donors
• Using findings from two ongoing HRSA studies to inform these
decisions
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How Do We Prepare?
Thoughts and Ideas
• How will you manage increasing referrals to your center?
• What would help you to better manage those referrals?
• What may some potential benefits or risks associated with the pressure to refer?
• How can we educate ESRD facilities and patients to ensure success?
• Are you changing any practices to be prepared?
• Are the Living donor incentives sufficient to help increase donation?
• Has your center/ OPO taken any steps to improve organ utilization?
Supporting
Regulatory Changes
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Removal of One Year Graft Survival CoP
09/20/18 Published Proposed Rule:
We propose to remove the requirements at § 482.82 that require transplant centers to
submit clinical experience, outcomes, and other data in order to obtain Medicare re-
approval.
Transplant centers will still be required to comply with the CoPs at §§ 482.72 through
482.104 and the data submission, clinical experience, and outcome requirements for
initial Medicare approval under § 482.80.
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ESRD QIP Measure
Measure starting 2020 payment period 2022
Percentage of Prevalent Patients Waitlisted (PPPW) Clinical Measure
Aim : Effective communication and coordination
“…shared accountability between dialysis facilities and transplant centers.”
• Percentage of patients at each facility annually who were on the kidney or
kidney-pancreas waitlist
• Denominator: CROWNWeb (risk adjustment, exclusions – SNF, Hospice,
age > 75)
• Numerator: OPTN
• MAP – conditional support (need to incentivize education, lack of control,
social risk adjustment), need for NQF endorsement
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Network Transplant Waitlist report
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Transplant Report – Transplant Center