EMORY TRANSPLANT CENTER Emory Transplant Center 2015 Center-Wide Meeting
Jan 20, 2016
E M O R Y T R A N S P L A N T C E N T E R
Emory Transplant Center
2015 Center-Wide Meeting
E M O R Y T R A N S P L A N T C E N T E R
Emory Transplant Center
• Best place for transplant care
• Best place to work and train
• Leader in Discovery and Innovation
E M O R Y T R A N S P L A N T C E N T E R
Emory Transplant Center Org Chart
E M O R Y T R A N S P L A N T C E N T E R
Dr. James Spivey – Vice Chair of Clinical Affairs, Department of Medicine
Dr. Joe Magliocca – Surgical Director, Liver Transplant
Dr. Ram Subramanian – Medical Director, Liver Transplant
Dr. Samir Parekh – Director of Hepatology, Liver Transplant
Dr. Mandy Ford – Scientific Director ETC
Dr. Rachel Patzer - Director of Health Services Research
Dr. Andrew Adams - Director of Clinical/Translational Research
Dr. Preeti Reshamwala - Assistant Professor of Hepatology, Liver Transplant
Dr. Ray Lynch – Assistant Professor of Surgery, Liver Transplant
Dr. Raul Badell – Assistant Professor of Surgery, Kidney Transplant
New Faculty Assignments and Team Members
E M O R Y T R A N S P L A N T C E N T E R
Cindy Smith, Director of Clinical Operations
Josephine Taganajan, Clinic Nurse Manager
Zina Smith, Office Manager
Caterra Rutledge, Front Desk Supervisor
William Ledford, TFC Supervisor
Sara Feistritzer, Business Manager
Evangeline Rochez, Kidney Program Manager
Leah Baker, Director of Revenue Cycle
New Administrative Assignments and Team Members
E M O R Y T R A N S P L A N T C E N T E R
Lisa Porter – Transplant Financial CounselorMarcy Harvey – Call Center AgentDaphne Byrd – Call Center Agent
Tiae Miller – Administrative AssistantEdie Wise – Lung RN Coordinator
Sandra Fulmore – Liver LPN CoordinatorRonda Westerheid – Liver RN Coordinator Natarsha Jenkins – Liver Medical Secretary
Latoshia Evans – Liver RN CoordinatorHermanda Prioleau – Kidney RN Coordinator
Diedre Thurmon – Clinic LPNEva Suzanne Ramey – Clinic LPN
Robbie Marshall – Clinic LPNTanya Holden - St Joes LPN Fabiya Twahir – St Joes PSC
Keisha Reel-Lacewell – St Joes LPN Suzanna Simonishvili – 7G APP
Kimberly Whitlock – 7G APPYolanda Kimani – 7G APP
Raven Moore – PSC, Front DeskShawn Bell – PSC, Front Desk
New Clinical and Administrative Team Members
E M O R Y T R A N S P L A N T C E N T E R
Fiscal Year (FY) 2015 Financial Performance
P&L FY14 ACTUAL FY15 ACTUAL FY15 BUDGET FY15 Budget Variance
Net Patient Revenue (NPSR)
$14,083,143 $14,622,599 $15,882,537 ($1,259,938)
Operating Expenses
$13,459,496 $13,997,814 $14,638,919 $641,106
Net Operating Income
$623,648 $624,785 $1,243,617 ($618,832)
Net Operating Margin
4.40% 4.30% 7.80% -3.60%
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E M O R Y T R A N S P L A N T C E N T E R
Centers for Excellence• All Emory Transplant Center programs meet the
quality criteria for Transplant Center for Excellence in the following transplant networks:
oAetna, Anthem, Wellpoint, BCBS, Cigna, Lifesource, Coventry, LifeTrac, Humana, & Optum
E M O R Y T R A N S P L A N T C E N T E R
Regulatory and Compliance
• July 13, 2015 – UNOS Membership and Professional Standards Committee (MPSC) notification that all programs remain in good standing with OPTN/ UNOS following on-site survey in January.
• July 20, 2015 – CMS recertification date for Heart, Kidney, Liver, Lung, and Pancreas programs.
E M O R Y T R A N S P L A N T C E N T E R
Clinic Operations Update
New waiting roomNew lab appointment scheduleNew patient rooming process
E M O R Y T R A N S P L A N T C E N T E R
IT Update
• Living Donor Patient and Population Trackers– Patient module provides ability to quickly access a
recipient’s chart and quickly view their donor(s) and status.
– Population tracker provides ability to quickly view ALL donors and their current status.
• Electronic Capture of Provider Billing– Part of “provider optimazation” project, that has
eliminated paper billing forms by capturing diagnoses and charges in EeMR.
E M O R Y T R A N S P L A N T C E N T E R
IT Update
• Lab Order CPOE (computerized physician order entry)
– Developed over 45 protocolized PowerPlans to help create ordering efficiencies.
– ALL programs now use CPOE orders for lab ordering (heart/VAD, liver, lung, renal- donor, eval, waitlist, post, research).
– Eliminated need for personalized charts and chart storage.– Infusion orders stored in infusion center until next wave of
CPOE.
E M O R Y T R A N S P L A N T C E N T E R
The inverse relationship of waiting and satisfaction+
Customer service of challenging patients
FY15 Target FY15 Q4 FY15 Final
92.5 92.8 90.3
Patient Satisfaction
E M O R Y T R A N S P L A N T C E N T E R
Child Health
Brain Health and
Neuroscience
Winship Cancer Institute
Cardiovascular Health
Organ Failure and
Transplantation
Musculo-skeletal
Patient Care Platforms
Research Platforms
Education Platforms
Patient Care Platforms
Research Platforms
Education Platforms
Emory Medicine Skyline
E M O R Y T R A N S P L A N T C E N T E R
Adult Transplant Graft Volumes
278
327292 295 296 284
360384 380
419 429 442469
0
50
100
150
200
250
300
350
400
450
500
FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY 13 FY 14 FY 15
Transplants Liver Kidney/Pancreas Lung Heart
Center Developed
E M O R Y T R A N S P L A N T C E N T E R
Volume Comparison
0
50
100
150
200
250
Emory Piedmont GHS
In-State ComparisonCY 14 Transplants
Liver
Kidney Only
Heart
National Volumes
Program CY 14 Transplants
UCLA 616
UCSF 580
Jackson Mem. 520
NY Pres./Columbia 508
Indiana Univ. 498
Cleveland Clinic 469
Emory Univ. Hosp. 441
• EUH ranked 7th in the nation among all transplant centers
Organ Emory Piedmont GHS
Liver 154 84 -
Kidney only 225 137 75
Heart 29 2 -
E M O R Y T R A N S P L A N T C E N T E R
Leading Indicators & Clinic Visits
Key Indicators FY 2013 FY 2014 FY2015
Referrals 4,658 5123 5098
Evaluations 2,152 1980 2231
Listings 858 803 1158
Transplants 429 442 449
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Clinic Stats FY 2013 FY 2014 FY 2015
Provider Visits 19,353 19,331 22,779
Infusions 5,769 6,252 5,667
Lab 27,823 30,091 29,964
Total 52,945 55,674 58,410
E M O R Y T R A N S P L A N T C E N T E R
Heart Program
E M O R Y T R A N S P L A N T C E N T E R
Heart Program
Source: June 2015 Scientific Registry of Transplant Recipients (www.SRTR.org)
Patient Graft Patient Graft One Year Three Year
Actual
Expected
E M O R Y T R A N S P L A N T C E N T E R
Heart Program - Clinical Innovation and Research
• Heart Failure/VAD:- FIGHT - SECRET - TACTICS-HF - INTERMACS Registry- HeartWare 004-A
• Transplant: - AlloMap Registry- Donor-Derived Cell Free DNA in Association with AlloMap in Heart Transplant Recipients (D-OAR)
• Recently Completed Trials:- ATOMIC-AHF - CHAMPION - EXACT-HF - IMPROVE-HF - ROSE-AHF
E M O R Y T R A N S P L A N T C E N T E R
Heart Program - Clinical Innovation and Research
• NIH grant Right Ventricular Failure after LVAD– Design paper “Rationale and Preliminary Results”
accepted European Heart Journal- Cardiovascular Imaging• Low Prevalence of LV Thrombus in Patients Undergoing VAD
Evaluation (HFSA)• Significant Gender Differences in the Prevalence of Stroke in
EUH VAD Patient Population (HFSA)• Impact of Insurance Status on LVAD Utilization and Health
Outcomes for Patients Listed for Heart Transplantation (ISHLT)
E M O R Y T R A N S P L A N T C E N T E R
Lung Program Volumes FYs 20006-2015
E M O R Y T R A N S P L A N T C E N T E R
Lung Program
Source: June 2015 Scientific Registry of Transplant Recipients (www.SRTR.org)
Patient Graft Patient Graft One Year Three Year
E M O R Y T R A N S P L A N T C E N T E R
Lung Program: Innovation
• Increase patient access– Partnership with HLA lab to move toward virtual
cross matching for all patients
• Active Outreach Program– GTF, CME programs, etc
E M O R Y T R A N S P L A N T C E N T E R
Lung Program: Innovation
• Increase Donor availability– Streamline donor criteria through the Organ
Placement Program
• Post transplant antibody mediated rejection– Novel protocol
E M O R Y T R A N S P L A N T C E N T E R
Lung Program Innovation• Viral respiratory season
– Established program for influenza vaccination of all post patients – 100% compliance in the 2014-15 season
– Enhanced pcr based assay system for early detection of community respiratory viruses
– Emory site of phase IIb study for novel anti-RSV therapy for this flu season
• NIH funded metabolomics study
E M O R Y T R A N S P L A N T C E N T E R
Performance Outcomes
Liver Program
Source: June 2015 Scientific Registry of Transplant Recipients (www.SRTR.org)
E M O R Y T R A N S P L A N T C E N T E R
MARS Research• MARS (Molecular Adsorbent Recirculating System)
is a form of extracorporeal liver support for critically ill patients with liver disease.
• Emory is one of a few select centers in the US that provides this cutting edge technology and has become the referral center for Georgia and the Southeast.
• MARS therapy has successfully treated 50+ critically ill liver patients, including some bridged to liver transplantation over the past four years.
• The successful delivery of this technology has been facilitated by the creation of an ICU and critical care staff that are specifically dedicated to the management of patients with severe liver failure.
E M O R Y T R A N S P L A N T C E N T E R
Liver Perfusion Research
• Perfused 23 pig livers and optimized procedures to improve functional time from 10 to 40 hours over the past year.
• Evaluating opportunity for clinical trial with approved Transmedic investigational device for human liver perfusion.
E M O R Y T R A N S P L A N T C E N T E R
Performance Outcomes
Kidney Program
Source: June 2015 Scientific Registry of Transplant Recipients (www.SRTR.org)
E M O R Y T R A N S P L A N T C E N T E R
• Kidney Living Donor Leadership team - Dr. Nicole Turgeon, Dr. Antonio Guasch, and Sharon Mathews, RN.
• Improved workflows to better manage increasing patient volume:– Patient screening process was consolidated to
expedite patient evaluation process and preserve clinic resources.
– Living donor presentations were expedited by incorporating the interview note into Power Chart.
– Implemented “Electronic Living Donor Questionnaire”, through the Patient Portal
2013 2014 20150
50
100
150
200
250
300
142 140 165
62 69
99
Kidney Living Donor
Kidney Only DD Kidney Only LD
# of
Tra
nspl
ants
E M O R Y T R A N S P L A N T C E N T E R
Emory is the second largest paired donor program in the country, matching 29 paired donor transplants over the past
12 months (member of NKR’s exchange since 2011).
National Kidney Registry
Belatacept Maintains Superior Kidney Function in Transplant Recipients
0 3 6 9 12 15 18 21 24 27 30 33 360
10
20
30
40
50
60
70
80
90 Belatacept MIBelatacept LICyclosporine
Month Post- Kidney Transplant
Mea
n ca
lcul
ated
GFR
(95%
CI)
Kidn
ey F
uncti
on
0 12 24 36 4840
42
44
46
48
50
52
54
56
58
60eGFR of Non-ECD/DCD Tac and On-Treatment Bela 1.0/1.1 Patients
Bela 1.0/1.1
Tac
Month
eGFR
1 mo 2 mo 3 mo 6 mo 9 mo 12 mo 18 mo 24 mo 36 mo 48 moBela(N=82) 82 81 80 77 74 73 70 67 63 0Tac(N=185) 185 185 184 183 182 181 171 176 171 137
E M O R Y T R A N S P L A N T C E N T E RNote: 1As of 8/28/2015, reported on www.optn.org.
Children’s Healthcare of Atlanta Carlos and Marguerite Mason Transplant Center
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Discovery
Translation
Clinical Application
Emory- “Circle of Life”
Discovery
Translation
Application
Needs
E M O R Y T R A N S P L A N T C E N T E R
Basic Research
New Funding and Awards 2014-2015:
Mason Trust Grant for Basic Science Research:• PIs Ford and Adams• Investigating Mechanisms of Belatacept-Resistant Rejection• “Next Generation” Costimulation Blockade in Xenotransplantation
New NIH R01, PIs Ford and Coopersmith:• Investigating T cell coinhibitory signals during infection
Dr. Ford received the AST Basic Science Achievement Award in 2014
Drs. Badell, Ford, and Larsen received a “supplement grant” to an existing R01 to extend studies of T cell alloreactivity
E M O R Y T R A N S P L A N T C E N T E R
Basic Research
Transplant Lab Fellowship Grants 2014-2015:
• Scott Krummey, NIH Fellowship Grant
• Sonia Laurie; NIH Fellowship Grant
• Lindsay Margoles; MD, NIH Fellowship Grant
• William Kitchens; MD, PhD ASTS Fellowship Grant
• Raul Badell, MD; ASTS Fellowship Grant
• Blayne Sayed, MD, PhD; AST Fellowship Grant
• Steven Kim, MD; ASTS Fellowship Grant
Genetically Engineered Donor Organs
• Normally organs from other species are promptly rejected due to key protein differences
• Making Pig Organs more human-like by “Knocking Out” key rejection molecules
• Previous reports average time to rejection 2-3 weeks
• Emory Xeno-Kidney Pilot Experiments- >200 days, longest ever reported
E M O R Y T R A N S P L A N T C E N T E R
Health Services Research
National Institute on Minority Health & Health Disparities R24 (2013-2016): RaDIANT Community Study (PI: Patzer; Co-I’s: Stephen Pastan, Laura Plantinga, Sudeshna Paul, Kimberly Jacob Arriola)
NIH U54 Pilot 2015-1-TCC Pilot Grant: Peer Mentoring for Transplantation (PI: Patzer; Project Lead: Jennifer Gander, PhD, MPH transplant dept. post-doc)
National Institute on Minority Health and Health Disparities R01: The ASCENT (Allocation System Changes for Equity in kidNey Transplantation) Study (PI: Rachel Patzer, Co-I’s: Stephen Pastan, Nicole Turgeon, Cam Escoffery, David Howard).
National Institute of Nursing Research (R21): Transplant Portal for Medication Adherence (PI: Patzer, Co-I’s: Stephen Pastan, Ruth Parker)
Normon S. Coplon Grant (Satellite Healthcare): iChoose Kidney Shared Education Tool (PI: Patzer; Co-I: Stephen Pastan)
E M O R Y T R A N S P L A N T C E N T E R
Health Services Research
NIH U54 Pilot Grant (PI: Alanna Morris; Cardiology. Co-Is: Rachel Patzer; Victoria Phillips, Health Policy & Management)
Bristol Myers Squibb – Transplant Data Mart grant (“Clinical Outcomes Monitoring of Belatacept-treated Kidney Transplant Recipients: a Retrospective Transplant Surveillance Database”), PI: Patzer, Co-I: Andrew Adams
Project ACTS (About Choices in Transplantation and Sharing) II - R01, NIDDK, (PI: Kimberly Jacob Arriola, RSPH; Co-Is: Rachel Patzer, Jennie Perryman)
Health Resources and Services Administration (HRSA) Grant – Web-based Project ACTS (PI: Arriola; Co-Is: Rachel Patzer, Jennie Perryman)
Emory’s University Research Consortium (URC) pilot study: Irritable Bowel Disease, Medication Adherence and Health Literacy (PI: Heba Iskander, GI; Co-I: Rachel Patzer)
E M O R Y T R A N S P L A N T C E N T E R
Clinical ResearchActive Studies = 38• 24 interventional studies (patients are receiving either a study drug, study device, or study
biologic)• 14 studies enrolling new patients• 6 investigator initiated studies by Emory Transplant physicians
Studies opening soon = 19• 17 interventional studies• 10 liver studies• 8 kidney studies• 1 lung study• 11 of these studies will be open by December, increasing our total number of active studies
to 49
Number of interventional studies has almost doubled in past two years. • December 2013 = 22 , December 2015 = 41
Biorepository• 290,000 banked specimens from Emory transplant patients• Largest repository of belatacept-treated patients in the world
E M O R Y T R A N S P L A N T C E N T E R
New fellows:• Elnaz Jafarimehr, MD (Hepatology)• Pradeep Vaitla, MD (Nephrology)• William Kitchens, MD (Surgery)• Denise Lo, MD (Surgery)• Michael Berger, MD (Surgery)• Jordan Mangum, PharmD • Yolanda Kimani, APP Fellow Graduate (start date 10/26/2015)
Med Students, Residents, PhD Students and Post-Doc’s• T32 NIH funding
Education
E M O R Y T R A N S P L A N T C E N T E R
Organ Placement ProgramTransplant Call Center
Mason House 20 Year AnniversaryClinic Front Desk
Transplant Financial Services Phlebotomy
HLA LabTransplant ID
E M O R Y T R A N S P L A N T C E N T E R
Plans: FY 2016
Lung Strategic Plan/Mason Grant Funding
Faculty Recruitment
Expansion of our Program Teams
J Wing
Enhance fQAPI Program
Development of Referral App
E M O R Y T R A N S P L A N T C E N T E R
Conclusion
• Another successful year• YOU make it possible• Challenging years ahead• “We’re all in this together”