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Renal Transplant Re-structuring Business Plan Proposal Confidential: Strategic Planning Problem Statement The current Lee Health model of providing single organ transplantation services is not sustainable. Despite a two year effort the following barrers stil exist: Some referring nephrologists do not refer patients to the local program for evaluation. Due to historical issues, they send all their patients to Tampa General 2. Transplant volume: a. 17 Cadaveric transplants from March 20, 2017 to Sept. 30, 2017 (7 months of data) b. 16 Cadaveric transplants from October 1, 2017 to 7/10/2018, (9.5 months of data) c. FY 2018 budget = 35 transplants; 55% below budget, close to the end of the fiscal year, d. Program is falling short of financial targets fe. Program is cost reportable to CMS; pre-transplant expenses are reimbursable. £. Current Statistics: WaitLst: 64 Active; 37 Inactive The program continues to face human resource issues. 4, tis difficult to compete regionally for organ offers with such a small waitlist. Large multi-organ centers receive the lion’s share of the organ offers, especially with kidney/pancreas patients who have a higher UNOS priority 5. Itis not uncommon for the OPO (Lifelink) to pass on kidney only donor recoveries due to the resource allocation it takes to send a recovery team for kidney only vs, sending a team to recover multiple organs. This further decreases the organ pool a small community based program is dependent upon. Problem Summary: 1. Small number of patients on waitlst . 2. Program is falling short of financial targets. 3. Inability to secure stable referral source from local referring nephrologists, 4, Inability to complete for viable organ offers with large centers to the north and east. 5. Interpersonal relationships and human resource issues continue to hamstring the program, Proje ription: (Provide on overall description of the effort; whot is the project, why was it requested included future stote . Permanently close the Transplant Institute at Lee Health, transition program to Tampa General. TGH re-opens the program in Fort Myers as a satellite program. Operational control remains with TGH, Pre-transplant evaluation continues in Fort Myers, surgical care Is delivered at Tampa General, patient transitions for post-transplant follow-up in the Fort Myers satellite clinic. Toit either employs the needed staff members (those not needed wil fall under the Lee Health reorganization policies) or employees remain under Lee Health and Lee and TGH initiate a professional services agreement (PSA) to cover the cost of salary and benefits Renal Transplant Re-structuring Business Plan Proposal Confidential: Strategic Planning Overview of Practice Scope: (Describe current state History: The renal transplant cadaveric program re-opened March 20, 2017 after more than a yearlong closure due to a living donor operative death, The Living Donor program remains closed, and will require a new UNOS application to re-open. ‘This program has a long history of issues, a patient death, and fractured relationships with private practice surgeons and nephrologists. The program has also been challenged by limited medical staff support as well. Lee Health provides single organ kidney transplantation services at Gulfcoast Medical Center. This location is a hospital OP department, and bills both facility and professional fees. The in-patient service is covered 24/7 by a group of Advanced Providers, Since re-opening, the program has successfully completed 34 transplants, with 100% graft and patient survival to date, ‘The program is voluntarily inactivating on August 16, 2018 due to the departure of a surgeon, and the pending personal leave of the primary surgeon and program director. Staffing 1 Program Director and Primary Surgeon (going on personal leave early September 2018) 1 Surgeon (departing no later than October 15, 2018) 1 Transplant Nephrologist and Medical Director 1 Transplant Nephrologist 5 Advanced Providers- providing in-patient coverage 24/7. Requirement of UNOS to re-open the program, staffis present even if no patients are currently admitted. 4 Transplant Coordinators: broken down into the following; Living donor, Waitlist, Pre-transplant, Post-transplant 1 Transplant Administrator 11 Office Manager 4.C3Rs 1MA 2 Dietitians: 1 full time; one PRN 2 Social Workers: 1 Fulltime; 1 PRN 1 Financial Coordinator 1 Data Coordinator Please see attached listing of staff members; DOH and pay rates. Renal Transplant Re-structuring Business Plan Proposal Confidential: Strategic Planning All revenue and expenses are attributed to TGH. Medicare Cost Report will be under the TGH program as will he SRTR data. TGH leases the office space currently housing the program at FMV and can also lease the furnishings, including ‘computers, equipment and supplies if desired Potentially named, "Tampa General Hospital Transplant Institute at Lee Health”. Consider co-branding needs Future State Lee Health ceases to operate a transplant program. The FLER designation with UNOS Is inactivated; the cost report is reconciled for calendar year 2018 with CMS. Current staff, physicians, and advanced providers transition to Tampa General employees or are reimbursed under a PSA with TGH and Lee Health Patient flow: pre-transplant evaluation occurs in Fort Myers, pre-transplant testing is done locally, transplantation is performed in Tampa, patient returns to be followed in Fort Myers post-transplant. Patients now have access to living and paired donation. Potential for additional organs, such as pancreas and liver in the future? Summary of request and other comments: (How does this initiative fit into the LPG Strategic Plan): Project team needs to begin working though these issues, goal to transition the program to TGH ASAP; not later than December 2018. Program is inactivating August 16", 2018 due to surgeon availability. Work is underway to transition patients on the waitist to Tampa General