1. Rethinking OPO practice in the current healthcare environment

2. 2004- looking back

3. 2004- Collaborative

4. 2004 vs. 2018 What’s changed in healthcare?
Federal Initiatives
Affordable care act
CMS regulation – HCAHPS scores influencing Medicare Reimbursement
Medicare Cost Pressures / growth of Medicaid enrollment
Financial Pressures
Block Reimbursements
Fee for Service Model Phase Outs
Payer mix changes - Increased Medicaid Enrollment; Limited Reimbursement
Demographics
Growing health economy growing as a % of GDP
Aging Population –More Advanced Directives; Move to Palliative Care earlier in the care continuum
Hospital resources/staff
Stretched more than ever- fewer staff, increased turnover
Consolidation of hospitals & responsibilities for upper management
Technology
Information/analytics on-demand
Internet security

5. OPO CHallenges Notable Current Barriers Some are the same as in 2004
Physical/logistical/demographic
Notable Current Barriers
Technological
EMR access & management- getting info when we need it
Internet/ security- are our messages getting through? Is an effective way of communicating?
Turnover & workload of hospital personnel key to CDT
Staff turnover & agency nursing coverage
Workload: not uncommon for CDT’s “key” contacts—upper level RN admin—to oversee 3-4+ departments
One ER/ICU Director:
“I love CDT but I get 100’s of s per day—I don’t have the time to respond.”
Hospital Staff Engagement Challenges
More spot education (effective?)
New employee orientation (15 minutes for the OPO)
Physician engagement – Limited MD availability

6. How do we navigate and adapt?
Revise / Reinvent How the OPO Interacts with Hospital Staff
The Donation Specialist Role – Combine traditional ground-level hospital development and donor family services; Managers increase lead role in high level relations at key hospitals (Combines resources without increasing OPO FTE’s?)
Reduce Reliance on Care Providers – A difficult balance
Mobile/visibility model- position employees—HD, DFS, OPC—to be in the field and respond to hospital needs in a more timely way. Focus field based resources in the field. Mobile operations for day-to-day office duties. Increase on-site evaluation of patient goals of care
Goal: Improve on-demand service delivery vs. current reactive model (“the hospital will call when ready for us.”)
Staff Examples
OPC’s
Traditional: reactive follow approach
Future: referral classification & standard work. Take stress OFF hospitals and place on CDT
HD/DFS
Traditional: standard education and reactive approach to offering donation. “We’re there when scheduled or when the hospital needs us.” CDT found that this led to inconsistency and hospitals “not knowing what to expect.”
Future: Fuse HD & DFS together to form “donation specialists” where HD and DFS are delivered together to provide optimal value to donor families and hospital staff.

7. Record Growth at The University of Vermont Medical Center
Full Time Donation Specialist on site at UVMMC 40 hours a week; qualified for referral evaluations, donation approaches, family support and hospital development activities.
Excellent engagement with critical care team and hospital administration; frequent visibility; real time servicing of hospital needs/issue resolution.
Record donation activity in 2017 vs. 2016
o 89% increase in organs transplanted (28 to 53)
o 78% increase in recovered organ donors (9 to 16)

8. Thoughts?
How can your OPO navigate the changing environment and re-position for long-term success?
Proactive vs. reactive
Responsiveness—on-demand service delivery
Resource management