Virtual Kidney Transplantation Evaluation Program Ensures Equity and Access for Patients

MUSC Health's kidney transplant program, which was among those severely impacted by COVID-19, wasted no time finding a solution to closed ambulatory clinics and limited patient access: The team adopted a virtual platform for evaluating potential patients.

"We had an urgent need to develop a COVID-19 compliant process to maintain access to kidney transplantation,” says Vinaya Rao, MD, MUSC 's Transplant Nephrology medical director.

Within days, in late March, the team had implemented a pre-transplant virtual platform.

Aided by federal policy changes that allowed Medicare reimbursements for virtual visits, the swift action meant that MUSC Health's transplant evaluation process would not be disrupted.

They recently described their rollout and virtual evaluation platform in an online video and article that was published by the Journal of the American College of Surgeons.

Vinayak S. Rohan, M.D., an assistant professor of surgery and lead study author, says the platform allowed the team to give continuous access to patients in the kidney transplantation program even in the midst of a pandemic that restricted access to the hospital.

"We can provide access to kidney transplantation even for patients who have difficulty getting to the transplant center because of where they live or who have difficulties due to their socioeconomic status,'' he says.

Their study "Maintaining Equity and Access: Successful Implementation of a Virtual Kidney Transplantation Evaluation" was published online by the Journal of the American College of Surgeons in advance of print. According to their article, between April and September, 176 transplantations were performed.

Of the 1,148 patients who were referred for transplantation, 930 underwent virtual evaluation and 282 were placed on the waitlist. In the same period in 2019, 177 transplantations were performed. Of 1,639 patients referred, 880 were evaluated and 308 were wait-listed.

Nicole Pilch, Pharm.D, MUSC's director of quality and safety operations, says the numbers are encouraging and that the virtual visits have added a layer of convenience and cost-effectiveness for patients and efficiency for the operations team. The platform is also HIPAA compliant, and no special software is needed.

"COVID-19 has added so many challenges to our way of life, particularly for elderly, minority, and rural populations who must travel for medical care,'' she says. "The ability to have virtual visits from home and avoid the inconvenience of a long drive and the expense of an overnight stay in Charleston is a huge advantage for our patients. We can conduct interviews with patients in the comfort of their own home.”

Dr. Rao says because physical space at MUSC is limited, the virtual platform allows physicians to see more patients, thus increasing the number of patients in the transplant evaluation process.
Using a telehealth platform, the transplant team schedules two virtual visits and one in-person visit. Before the first visit, a coordinator or clinical nurse calls the patient to ensure the patient has the technical set-up or a smartphone and the know-how to participate.

"The nurse coordinators serve as an intrinsic part of the virtual platform and navigate the patient through the transplant process,'' says Natalie Wessels, transplant regulatory coordinator, and pre-transplant kidney coordinator.

The visit covers the patient's medical history, risks associated with the transplant process, and any patient risk factors that could impact the process and outcome.

A second virtual visit, two weeks later with an advanced practice provider, recaps the first visit and outlines needed lab tests for the patient to have locally.

Once the initial testing is completed, the third visit, an in-person visit at MUSC Health, is scheduled to ensure the patient understands the entire transplant process, including its risks, benefits, and alternatives to transplant.

The patient's case is then submitted to the selection committee, which comprises representatives from surgery, nephrology, infectious disease, pharmacy, along with a financial coordinator, social worker, and a transplant coordinator.

The most notable outcome in the virtual process is the shortened time between a patient's in-person visit and being listed for transplant, Dr. Rao says.

Nurse coordinators such as Michelle McQueeney, kidney transplant coordinator, efficiently move patients from referral to final evaluation visit. Often patients are presented to the selection committee within 14 days of their final evaluation visit.

"The shortened time is also a key advantage because it gives us the opportunity to see and evaluate the patient in real-time closer to the time of being listed,” says McQueeney.

While COVID-19 was the impetus for transitioning to a virtual platform, the change has the potential to diminish socioeconomic barriers that have historically led to disparities for African American, elderly and rural residents.

The expanded use of smartphones and Medicare's temporary funding for telehealth services have had a significant impact on health care.

For these and other reasons, Dr. Rao says the team is optimistic that the platform will become the established practice for kidney transplant evaluation and be even more widely used in the future.

"The transplant program is a flagship program for the system, and MUSC has invested significant resources in the pretransplant kidney program to be sure patients can get through this process as quickly and safely as possible so they get the benefits of transplant,” she says.

"We're hoping that the virtual program will continue to be funded by Medicare, and if it is, we anticipate that other third-party payors will follow suit.”

Find out more about the MUSC Health Kidney Transplant Program.