Network 9 - ORV Transplant Coalition Quarterly Meeting: 08/27/19 · 2020. 3. 2. · Transplant Centers at Coalition • Summary of how the network is doing regarding access to transplant

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ORV Transplant Coalition

Quarterly Meeting: 08/27/19

Needs Assessment for

Transplant Centers in Coalition

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3

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