Montefiore's Kinkhabwala is looking to make improvements to the transplant program by growing its number of living donors. "We want a higher ratio of living donors, because recipients of live donors generally have better outcomes," he says. "We can transplant them quickly and the outcomes are more reliable."
Kinkhabwala says national benchmarks show that about 50% of kidney donations nationally are living donors. "At our program, it's only about 20%, so we have a long way to go to get to at least the national average for living donation, and part of that is our demographic." One way Montefiore is addressing this issue is by going outside of its service area to other parts of the state to attract patients who may have more living donors, he says.
Success key No. 5: Focus on long-term, coordinated care
Montefiore performed 39 liver transplants in 2015 and 46 the year before, according to OPTN data. Kinkhabwala notes that liver transplant volumes need to be between 50 and 70 to maintain a high-quality ranking. Growing the program is a challenge given the competition in New York for transplant services as well as clinical advancements.
"In the downstate area, there are four or five doing liver transplants, so there are a lot of hospitals that are competing for the same patients," says Kinkhabwala. He adds that better treatments for hepatitis C also make it less likely that liver transplantation will be a growth area down the road.
Still, the plan is to grow the program by taking a more expansive approach to the service line, explains Kinkhabwala. "It's more accurate to call it an organ failure service line." With that approach in mind, Montefiore is developing a model of care similar to an ACO for its liver programs, treating all liver conditions, regardless of transplant need, including hepatitis and liver cancer.
"We want to provide all of the services in the health system that eventually, like a pyramid, may lead to transplant." This broader approach also helps other service lines, such as oncology. Regardless of disease stage, "we're taking care of them holistically for life, and we'll actively manage everything in their care, whether that's a psychiatric problem, or if someone with cirrhosis is an alcoholic, then it's our job to get them intervention for alcohol dependency. That is very unique in healthcare," says Kinkhabwala.
Still, despite these efforts, he says there is pressure on revenue in heavy managed care regions because larger insurers demand transplant centers to become centers of excellence. "Those centers of excellence are really vehicles to negotiate lower rates," Kinkhabwala adds. Ultimately, he says, "there's a tremendous halo effect, and there's an elevation of the case mix index for the hospital as a result of the transplant program, which is important for overall reimbursement."