EMORY TRANSPLANT CENTER 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

2015 Center-Wide Meeting


Emory Transplant Center

• Best place for transplant care

• Best place to work and train

• Leader in Discovery and Innovation


Emory Transplant Center Org Chart


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


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


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


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%

7


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


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.


Clinic Operations Update

New waiting roomNew lab appointment scheduleNew patient rooming process


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.


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.


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


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


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


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 -


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

17

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


Heart Program


Heart Program

Source: June 2015 Scientific Registry of Transplant Recipients (www.SRTR.org)

Patient Graft Patient Graft One Year Three Year

Actual

Expected


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


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)


Lung Program Volumes FYs 20006-2015


Lung Program


Patient Graft Patient Graft One Year Three Year


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


Lung Program: Innovation

• Increase Donor availability– Streamline donor criteria through the Organ

Placement Program

• Post transplant antibody mediated rejection– Novel protocol


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


Performance Outcomes

Liver Program



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.


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.


Performance Outcomes

Kidney Program



• 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


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

81

Discovery

Translation

Clinical Application

Emory- “Circle of Life”

Discovery

Translation

Application

Needs


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


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


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)


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)


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


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


Organ Placement ProgramTransplant Call Center

Mason House 20 Year AnniversaryClinic Front Desk

Transplant Financial Services Phlebotomy

HLA LabTransplant ID


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


Conclusion

• Another successful year• YOU make it possible• Challenging years ahead• “We’re all in this together”

EMORY TRANSPLANT CENTER Emory Transplant Center 2015 Center-Wide Meeting.

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