USC analysis finds dialysis firms overcharge largest Medicare Advantage plans

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Largest Medicare Advantage Plans Pay Big Markups for Dialysis

Story Headline: Largest Medicare Advantage Plans Pay Big Markups for Dialysis

DEK: Large dialysis chains charge Medicare Advantage plans 27% more than the traditional, fee-for-service Medicare program.

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Large dialysis chains charge Medicare Advantage plans 27% more for dialysis services compared with what they charge the traditional, fee-for-service Medicare program, according to a new USC analysis.

“The dialysis industry is heavily consolidated and two large national chains are the dominant provider in most communities,” said Eugene Lin, a clinical fellow at the USC Schaeffer Center and an assistant professor of nephrology at the Keck School of Medicine of USC. “As a result, these chains can wield their market power by forcing insurers to pay high prices. We’ve seen evidence of this in the commercial market, and now we are seeing the same thing in Medicare Advantage.”

The study, by researchers at the USC Schaeffer Center for Health Policy & Economics, appears in the August 2022 issue of Health Affairs. The researchers found:

  • Two large providers dominate the dialysis market and use their leverage to negotiate Medicare Advantage payments that are significantly higher than what traditional Medicare pays.
  • High markups could increase patients’ out-of-pocket spending and impact the financial viability of these plans.
  • Researchers expect to see an increase in dialysis patients covered by Medicare Advantage. Prior to a change of rules in 2021, most dialysis patients were enrolled under traditional Medicare.
  • Policymakers should address market consolidation among dialysis providers.

Medicare Advantage Poised to Have a Growing Segment of Dialysis Patients

Chronic kidney disease, when the kidneys have an impaired ability to filter toxins out of blood, affects more than 15% of U.S. adults. In the most advanced stages of the disease, patients must receive dialysis regularly or have a kidney transplant.

Historically, patients with kidney failure could receive coverage for dialysis through enrolling in traditional Medicare, regardless of age, but they were generally prohibited from enrolling in Medicare Advantage after initiating dialysis. The 21st Century Cures Act lifted those regulations prohibiting Medicare Advantage enrollment starting in 2021 and early reports indicate a significant shift towards these plans.

Medicare Advantage plans are private health plans that beneficiaries can enroll in as an alternative to traditional Medicare. Enrollment in these plans has grown considerably in recent years because these plans tend to be easier for patients to navigate and often include more robust, additional benefits.

Prior to the regulatory change, patients who were already enrolled in a Medicare Advantage plan upon initiating dialysis were permitted to stay in that plan. Lin and his colleagues studied prices paid for dialysis services among these patients by analyzing data from three large insurers representing almost half of the Medicare Advantage market.

Compared with what traditional Medicare would have paid, Medicare Advantage plans paid 27% more for the median price of outpatient dialysis treatment.

“Our findings stand in sharp contrast to other areas we have previously studied–like physician services–where Medicare Advantage plans tend to pay providers rates that are very similar to traditional Medicare,” said Erin Trish, co-director of the USC Schaeffer Center and associate professor at the USC School of Pharmacy. “These high prices increase costs for Medicare Advantage plans and beneficiaries, especially as more patients receiving dialysis choose to enroll in Medicare Advantage.”

Large Dialysis Chains Supply Three-Quarters of all Dialysis Services in the U.S.

Over the last decade, the dialysis industry has consolidated considerably. Two large dialysis organizations supply more than three-quarters of all dialysis treatments in the U.S. More than a quarter of patients live in counties where one or both large dialysis organizations own all the facilities.

“In an interesting twist, providers can charge more in the Medicare Advantage market by being in network. If a patient goes to an out-of-network provider, the provider is prohibited from charging more than traditional Medicare,” said Erin Duffy, research scientist at the USC Schaeffer Center. “But when there are only one or two providers in a market, the insurance company loses any potential leverage to negotiate lower payments.”

Markups charged by large dialysis organizations were 31% higher than traditional Medicare. Markups to regional chains were 20% higher, markups to independently owned facilities were 12% higher and prices charged at hospital-based facilities were on par with Medicare rates. In contrast, out-of-network treatments at these facilities were on-par with what is paid to Medicare.

Though out-of-network dialysis treatments were cheaper for the plan, beneficiaries paid slightly more out-of-pocket and those with high spending paid quite a bit more annually.

Given that more patients on dialysis are expected to switch to a Medicare Advantage plan, this increase in dialysis spending may have downstream consequences including higher premiums or reduced benefits, write the authors. The researchers argue that policymakers should consider broad reforms to increase market competition.

Bich Ly of the USC Schaeffer Center also coauthored this paper. This research was supported by a grant from Arnold Ventures and the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) (KO8 DK118213).

Largest Medicare Advantage Plans Pay Big Markups for Dialysis

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Methodist Hospital of Southern California joins Keck Medicine of USC as USC Arcadia Hospital

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https://news.keckmedicine.org/methodist-hospital-of-southern-california-joins-keck-medicine-of-usc-as-usc-arcadia-hospital/

Story Headline and Deck – USC News *

Methodist Hospital of Southern California joins Keck Medicine of USC as USC Arcadia Hospital

Affiliation will offer the San Gabriel Valley community expanded access to health care

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LOS ANGELES — Keck Medicine of USC announces that Methodist Hospital of Southern California in Arcadia is now part of Keck Medicine, and will be known as USC Arcadia Hospital. The affiliation was finalized on July 1.

“We are very fortunate to have found a complementary partner in USC Arcadia Hospital,” said Rod Hanners, CEO of Keck Medicine. “Its strength as a long-standing community hospital coupled with our academic health system will secure the legacy of both organizations and better meet the health care needs of the San Gabriel Valley community.”

The affiliation brings residents of the San Gabriel Valley greater access to Keck Medicine’s specialized care, research and breakthrough technology. Keck Medicine offers world-class care for both routine and highly complex cases, and is nationally ranked in 12 specialties by U.S. News & World Report.

USC Arcadia Hospital also complements existing multispecialty outpatient services Keck Medicine currently offers in Arcadia.

“Our hospital will be stronger as part of Keck Medicine of USC,” said Dan Ausman, president and CEO of USC Arcadia Hospital. “The partnership brings our community expanded access to a full range of physician specialties, technology and clinical services that will benefit our patients, employees and physicians.”

Over the coming years, Keck Medicine will invest in USC Arcadia Hospital’s equipment, infrastructure and services. The areas of focus include expanded neurosciences, cardiac care and oncology services.
Additionally, the health system will develop academic and training relationships for USC residents and fellows at USC Arcadia Hospital.

Keck Medicine has a history of successful collaborations with regional hospitals and health enterprises, improving access to academic medicine in local communities.

With this affiliation, Keck Medicine now has two community hospitals in the northeast area of Los Angeles. USC Arcadia Hospital joins USC Verdugo Hills Hospital, which serves La Ca?ada Flintridge, Glendale and the greater Foothills community.

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From Student to Patient: How Keck Medicine of USC Brought Me Back to Life

At 30 years old, I sat coloring in bed. It was all I could do.

Deep blues, daffodil yellows and emerald greens filled the ink-stained outlines in my coloring book. I strained to stay in the lines as my world spun on a perpetual leftward tilt. It was early February 2021 in North Carolina, and I had been sick with long COVID-19 for nearly three months. I was deteriorating fast: I’d lost 20 pounds, I barely slept, I had severe and constant vertigo, and I could only speak in a slow, drunk-like drawl.

Life looked vastly different from when I graduated from the USC Annenberg School for Communication and Journalism and the USC Dornsife College of Letters, Arts and Sciences with a double bachelor’s degree in journalism and political science at the top of my class in May 2020. Back then, I was on the fast track to a dream career in journalism–one that I’d gone back to school for in my mid-20s to pursue as a first-generation transfer student.

Now it took all the mental energy I could muster to simply color inside the lines.

The adult coloring book–a very adult coloring book, featuring flowery curse words–arrived two days before, along with a box of colored pencils and a handwritten letter from Christina Bellantoni, my former journalism professor and mentor at Annenberg. Bellantoni was one of three people outside my family who knew what was happening to me. A smile crept across my face from time to time as I colored in offensive words that summed up how I felt about this illness.

“Coloring is supposed to be good for brain healing,” she had written. “I was told that USC is starting a post-COVID clinic. We can try to get you in.”

The idea of USC’s post-COVID clinic offered me and my family something we had scarcely dared to feel that winter: hope. We let that sliver of hope buoy us from the cold and sterile North Carolina exam rooms of “I don’t know” toward the possible spaces of “I can help.”

Two weeks later, my husband, Jerry, drove us across the country in an SUV newly purchased for the trip. Jerry pulled out of the suburban North Carolina neighborhood and went across the expansive bridges of the Mississippi River, the flatlands of West Texas, the red-dirt canyons of southeast New Mexico, and then, finally, the palms, dry heat and gridlock of Southern California.

A couple of weeks later, I was accepted as a patient at what would become the COVID Recovery Clinic at Keck Medicine of USC.

‘Long COVID seems to be a thing’

Dr. Caitlin McAuley recalls that early in the COVID-19 pandemic–around June 2020–she began seeing patients who weren’t getting better after COVID infections had ended.

“People were starting to acknowledge, ‘Hey, long COVID seems to be a thing,'” says McAuley, a physician and clinical assistant professor of family medicine at the Keck School of Medicine of USC. “It seems to be more complicated–something we need to have a specialty clinic for.”

In response, Keck Medicine set up a post-COVID outpatient clinic in December 2020 to treat and study the unusual symptoms that can follow a COVID infection. Jehni Robinson, chair of the Department of Family Medicine at the School of Medicine, appointed McAuley to oversee it and treat patients. The outpatient clinic was the precursor to the launch of the COVID Recovery Clinic, which officially opened in 2022.

Keck Medicine set up a post-COVID outpatient clinic in December 2020 to treat and study the unusual symptoms that can follow a COVID infection.

“The funny thing is, at first, the Family Medicine department put a general email for participation in the clinic out, and I think a lot of Keck staff were hesitant because it was something new, and we weren’t used to it,” McAuley says. But while most doctors shied away from diving into a new post-viral illness because of its unfamiliarity and workload, McAuley leaned into the challenge.

Operated through two of Keck’s departments, pulmonology and primary care, the clinic is located at Keck’s medical campus in East Los Angeles. There, McAuley sees COVID patients once a week.

The clinic offers a targeted approach to symptom management through referral. Its staff of six– a family medicine physician, physical therapist, social worker, respiratory therapist, pulmonologist and nurse–evaluates patients before sending them to various Keck specialists.

Patient demand and the waitlist for the clinic have ebbed and flowed with surges in COVID cases, which tend to spike about a month after cases rise. Its approach to treatment also evolves as doctors learn more about the illness’s impact on patients’ lives and livelihoods. The clinic now offers an anti-inflammatory diet protocol-eating foods known the reduce inflammation in the body such as tomatoes, leafy greens, berries and fish, and avoiding sugar, bread, pasta and fried food. A social worker also informs patients at appointments about potential disability programs and other social service options available to them.

McAuley says she’s noticed patterns: Some symptoms cluster together. Loss of taste and smell, for example, tend to go with neurological symptoms such as cognitive dysfunction, chronic headaches, insomnia, dizziness and sensory issues. Respiratory symptoms, such as prolonged cough, shortness of breath and severe fatigue, are present in some patients. Some patients present three or four of these “clusters,” she says.

She’s seen some patients’ symptoms improve after getting a COVID-19 vaccine, and some studies have shown antihistamines can also be helpful. But there are no proven treatments for long COVID yet. As with most medical research, that will take time and money.

Good on paper

In April 2021, I signed in for my first appointment at the clinic. My nurse Cindy Ho and I walked back and forth through the hallway while a machine and pulse oximeter measured my vitals.

One foot in front of the other, I pushed forward. My muscles were tired and achy, and I craved to lay down, but the oximeter showed nothing out of the ordinary. For the nth time, I was withering away and yet told I looked “good” on paper. Then I met with McAuley. She asked plenty of probing questions striving to understand my experience and symptoms.

I was withering away and yet told I looked “good” on paper.

Morgan Stephens

Next was a meeting with a social worker. I was impressed that the clinic understood that long-haulers were in dire straits. Many are too sick to work and see doctors constantly–a recipe for financial ruin in the United States.

Since my symptoms were primarily neurological, the clinic referred me to a neurologist, an occupational therapist and a physical therapist. Finally, we had a plan to tackle my illness from various specialists to get me functional again.

Ashley Halle, an associate professor of clinical occupational therapy at USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, worked with me on pacing and rest.

Since the pandemic started, Halle has seen a steady flow of long COVID patients. Demand is cyclical, depending on the latest surge in cases. Her work focuses on meeting patients’ needs and goals to get them back to being functional. Her department has seen dozens of long COVID patients. Symptoms, she says, include fatigue, mental health symptoms like depression, anxiety, suicidality and cognitive symptoms like brain fog and concentration problems.

“It’s really about partnering with them, [noting] where they are right now in their lives, and where they want to see themselves in the future,” Halle says, “then coming up with a plan on how we can get them to that place of wellness, recovery, and their new normal.”

Planning for life with long COVID

Healing from long COVID looks different for everyone.

I knew I was getting better when my world widened beyond surviving each day to planning for life–an actual life–with long COVID.

I started earning victories with small tasks like pouring my own coffee, making a meal, or taking a short walk. Some patients return to their pre-COVID selves, while others can become disabled for months–with gradations in between.

As I worked with the Keck clinic team, our focus turned to ensure that I would be OK when resting. The agitation and anxiety accompanying my neurological symptoms made me feel as if I was always in “fight or flight” mode.

“Let’s call them ‘brain breaks,'” Halle said during one of our sessions. This meant no phones or computers, no problem-solving and no tasks, so my brain would have 10 minutes to simply rest.

Halle and I met over Zoom to discuss my capacity, triggers and pacing. We started tracking my migraines on an app.

After a month of working together, I told her that we’d accumulated enough small victories that I was ready to go for a big win: I would try going back to work at CNN. I was terrified, but I needed to see what I was cognitively and physically capable of. I quickly found that five days a week was too exhausting–plus, I needed time for my doctor’s appointments. I sometimes had multiple appointments a week with different specialists.

But I was able to work again. A year after being treated, I felt good enough to close my long COVID chapter. I started seeing my doctors less, eventually stopping my weekly appointments. I’d made it to the other side. Nearly two years after graduating, I’d achieved another rite of passage through USC.

Helping other long-haulers

Today, I’m back in North Carolina. The stifling silence and sadness I once associated with the place have given way to laughter, long walks in nature, full nights of sleep, and work after a nearly two-year hiatus. We’re looking to buy a house in Washington, D.C., a city I love and initially dreamed of working in after I graduated.

McAuley wants the COVID Recovery Clinic to serve as a model that can help other long-haulers like me.

“I hope we can work on education and spread this toward our primary care population because it will be hard for everyone to get into these kinds of clinics,” said McAuley. “As we learn more and better therapies, people can go to their regular doctors for [long COVID].”

When people ask how I got better, I realize there’s no one answer: Many factors combined into that big push back to the land of the living. But I know that my alma mater took me in as a shadow of who I was and walked with me as I slowly stitched myself back together, piece by piece, treatment by treatment, until I resembled myself again.

That’s more than what a “medical center” does. It’s what a family does.

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President Folt outlines ‘moonshots’ including computer, health sciences initiatives

President Carol L. Folt has outlined an ambitious agenda for USC, featuring four “moonshots” that include a dramatic investment in the “Frontiers of Computing” and expansion of the university’s health sciences efforts.

In the first of two State of the University speeches, Folt outlined what she called “USC Futures” – a plan that focuses on making USC the top choice for students, faculty and staff who seek purpose-driven work and establishing the university as the international standard-bearer for collaborative learning and discovery.

“That is the future,” she told the crowd of faculty and staff members gathered in Bovard Auditorium on April 14.

The speech was Folt’s first in-person State of the University address since she came to USC in July 2019; the 2020 and 2021 speeches were delivered online because of the COVID-19 pandemic.

USC Futures consists of four major initiatives: Frontiers of Computing; the health sciences expansion; making USC the destination for the best and brightest change agents; and continued investment in USC Athletics.

“If we do these well, we will put USC on a path to even greater leadership and success in the next five to 10 years,” she said.

Transforming health sciences

The university’s health sciences work — including research, medical training and clinical practice — makes up about half of the university’s people and resources, Folt noted, adding that USC’s health programs already are recognized for excellence and innovation. Keck Medicine of USC treats the most complex and, often, most critically ill patients. Children’s Hospital Los Angeles — staffed by USC physicians — is the only top five children’s hospital in the nation whose patients are predominantly insured by government programs such as Medi-Cal.

No other university has this constellation of resources and schools and breadth that we have here to create a healthier society for the future.

The transformation will expand health sciences work across the university, including not only the health-related schools but also the architecture, business, cinema, communication and journalism, engineering, and public policy schools, as well as the USC Dornsife College of Letters, Arts and Sciences.

“No other university has this constellation of resources and schools and breadth that we have here to create a healthier society for the future,” she said.

Accelerating advanced computing

The president also introduced Frontiers of Computing, an initiative to accelerate advanced computing and its impact on the world.

USC will use a $261 million gift from the Lord Foundation to build on its already strong presence in the computing and high-tech innovation spaces, she said.

Like health sciences, this project will also build on USC’s unique strength, breadth, location and scale.

She noted that Los Angeles’ tech industry is already the fourth largest in the United States and that USC must be at the center of this innovative ecosystem. USC will do this by collaborating with education and industry partners and increasing its existing presence in Silicon Beach, home to more than 500 tech and startup companies.

“They need talent,” she said. “The potential here is mind-boggling.”

Making USC the destination

A third moonshot, “USC Competes,” is designed to make the university a national leader in accessibility, affordability and debt reduction and attract the top students in every field. The university is actively raising funds to increase scholarships and aid.

Folt noted that USC’s largest feeder school is the Foshay Learning Center, a public high school near the University Park Campus. “That’s a real point of pride to us,” she said.

The university also must continue to invest in faculty and staff to ensure that it recruits and retains “the best of the best.”

Importance of athletics to the Trojan Family

Folt also underscored the importance of athletics, noting that the university’s sports programs, student athletes and coaches bring together students, alumni and the community in ways that nothing else does.

She added that sports and related enterprises are among the fastest-growing areas of commerce, media and job generation. USC-hosted athletic events bring an estimated $400 million in revenue to local neighborhoods, she said.

“Our goal in athletics aligns with our emphasis on building the right kind of culture across USC,” she said, “a culture that puts high ethics and strong values at the core of everything we do — in the classroom, on the playing field, in the laboratory, everywhere.”

A time of change and challenge

Folt opened her speech with her thoughts on two historic events in the past two weeks: the conferring of posthumous degrees on USC’s Nisei students — the Trojans of Japanese ancestry who were removed from school and sent to detention centers during World War II — and the dedication of the Dr. Joseph Medicine Crow Center for International and Public Affairs. The building had been named for a previous university president who espoused racist views, sympathized with Nazis and promoted eugenics.

A university doesn’t get to rewrite its history, but we do have the power to telegraph to the world who we are and what we aspire to be, now and in the future.

“A university doesn’t get to rewrite its history, but we do have the power to telegraph to the world who we are and what we aspire to be, now and in the future,” she said.

She noted the university’s continued focus on sustainability and repeated the university’s commitment to achieving carbon neutrality by 2025, adding that 17,000 students had enrolled in sustainability-related courses last year.

She again thanked all faculty, staff and students for their perseverance during the pandemic, and while she celebrated the fact that “We are back!” she noted that the pandemic isn’t over and encouraged everyone to continue to maintain COVID-19 safety protocols.

‘A hot place’

Folt noted that the number of applications to USC remains strong: Graduate and professional applications are up nearly 350% over 20 years and undergraduate applications are up nearly 150%.

“This is a hot place to come to,” she said. “A lot of people want to be here.”

She noted the success of the Trojans who are already here:

  • USC’s research grants increased significantly, despite the pandemic.
  • The university is in the top 20 for federal research dollars.
  • For the first time, the university joined the “billion-dollar club” for external research funding.

And she pointed out other Trojan wins over the past year: four Oscars, 17 Emmys, 13 Grammys, seven Fulbright scholarships and 21 medals at the Tokyo Olympics.

During a question-and-answer session after the speech, Folt noted that new policies on remote and hybrid work for USC employees would be forthcoming. Developing those policies has been challenging given the range of jobs within the university, she said, but it’s also an opportunity for the university to make other changes, including reducing the number of private offices or parking.

“There will be a big difference,” she said.

When asked to talk about what today’s students are looking for, she described them as purpose-driven, practical and ambitious: “Everyone,” she said, “has a big dream.”

She also described them as impatient — perhaps because they have only four years here.

“If you don’t have impatience,” she said, “you’re not going to make any change.”

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Living Donor Program From Keck Medicine of USC is a Win-Win

To save her brother’s life, Elizabeth is getting in shape.

The 38-year-old Kern County, California, resident, whose last name is not being used to ensure the family’s privacy, changed her cooking and her workout routines and has dropped 32 pounds since September 2020. Keck Medicine of USC physicians told her she would be an ideal kidney donor for her older brother–if it weren’t for her weight, which put her out of range to donate safely.

Her transformation was aided by a donor wellness program launched last year by the USC Transplant Institute. Transplant surgeons realized that as many as a third of living donors were turned away because they didn’t meet the necessary health requirements. The donor wellness program aims to solve two problems: increase the pool of available living donors while also improving the donor’s own health and well-being.

The program is one part of the university’s effort to improve organ transplant outcomes. From helping potential donors get healthy to examining racial disparities to protecting patients from COVID-19, Keck Medicine physicians are searching for more and better ways to keep both donors and recipients healthy and active.

A game plan for success

Elizabeth’s journey began because she wanted to help her brother, who had been on dialysis for several years. He is the third of the six siblings; Elizabeth is the fifth.

The siblings agreed Elizabeth was the best candidate. For one thing, she had one child, a teenage daughter, and didn’t plan to have more.

But USC’s transplant coordinators told her that she would have to lose at least 20 pounds to qualify as a viable donor. She dieted and worked out as many as five times a week, but after a year, lab tests showed she was still 10 pounds over the target weight.

That’s when Elizabeth was introduced to Susan Kim, a nurse and clinical nutrition and wellness manager. Kim headed up the newly launched donor wellness program, and Elizabeth became one of its first participants. Kim knew she was already working out and counting calories, so she started talking about nutrition.

For example, Elizabeth liked to snack on flavored yogurt. Kim advised her to look at the label and see how much added sugar it had. The numbers startled her. “I was like, ‘Wait, I was eating this?'”

Kim suggested she switch to plain Greek yogurt and add fresh fruit. “Less sugar, less calories, but you get the same result,” Elizabeth says. “Small changes like that.”

The small changes added up, and the pounds started to drop off.

When demand exceeds supply

Elizabeth’s success is part of the vision of the living donor program–an initiative born of frustration.

Southern California is one of the most difficult places in the nation to live if you need a new liver or kidney.

Aaron Ahearn

Southern California is one of the most difficult places in the nation to live if you need a new liver or kidney, says Aaron Ahearn, associate director of the liver transplantation program at Keck Medicine of USC. That’s partly because of good trends: A healthier population means fewer people collapsing and dying of heart attacks or strokes, which frees up organs for donation. On the other hand, the large metro area also includes many residents whose health is declining, often the result of living for decades in impoverished and underserved neighborhoods. “You essentially have to be in the ICU in multi-organ failure before you can get a liver transplant,” Ahearn says.

One solution to this dilemma is living organ donor transplantation. Keck Medicine has one of the few living donor programs in Southern California, but surgeons were turning away about 30% of candidates.

“We realized it was a problem on both sides,” he says. “The donors were at higher risk of developing their own diseases due to the health consequences of being overweight. And the recipients were in desperate need of an organ. This was an opportunity to improve everyone’s health.”

Saving lives and saving money

It turned out that not only was a donor wellness program “good karma,” as Ahearn puts it, but it also made good financial sense. If a patient couldn’t get a living donor transplant, she would have to wait until she was deathly ill to get one from a deceased donor. The cost of caring for her in the ICU while she awaited that transplant and later recovered was greater than offering free services to potential living donors, he says.

Besides nutrition counseling, the donor wellness program offers participants personalized meal plans and help with time and stress management from occupational therapists. A welcome packet includes a bathroom scale, a blood pressure monitor and a step-tracking watch. “You want to make it all as easy as possible, as manageable as possible,” Kim says.

Addressing health inequities

Keck Medicine also took a hard look at its own team and began examining its own structural biases.

After news reports of racial disparities in kidney transplants, Jim Kim, a surgeon at Keck Medicine specializing in organ transplants, worked with his team to review how they calculated kidney function for patients.

We no longer use equations that take race into account.

Susan Kim

They were surprised to realize that the equations they used contained racial biases. These were the same equations used for decades around the country, but Black patients didn’t qualify for transplants until they were at a more advanced state of kidney disease than white patients, he says.

Keck Medicine decided to eliminate those calculations from its system. “We’ve rectified that,” Kim says. “We’re no longer using any of these equations that take race into account.”

Taking Cover From COVID

The coronavirus threw a wrench into the transplant program when it landed in the U.S. in 2020, particularly when a bad COVID-19 wave hit Southern California in November and December of that year.

Ahearn started getting calls from transplant patients who tested positive. Because their immune systems were suppressed, they had a high mortality rate. “We realized COVID was devastating for our recipients, and we needed to do something to retard disease progression,” he says.

Ahearn and his team built a system on the fly. The kidney and liver transplant programs set up regular telemedicine visits, sent patients pulse oximeters to measure oxygen levels and heart rates and provided monoclonal antibody infusions to fight the first signs of disease.

As a result, coronavirus hospitalizations for USC transplant recipients dropped from 54% to 35%, and deaths dropped to zero in a two-month period for transplant patients who received monoclonal antibody infusions.

“It was really important that our transplant patients be educated that their risk is different than the general population,” Ahearn says, “but there are things they could do to reduce their risk, so they needed to communicate with us.”

A Diet Overhaul

They asked me when would I be available to do the transplant. I told them, whenever my brother is ready, I’ll be ready.

Elizabeth

Communication has also been key for Elizabeth’s success. Regular telemedicine visits with Susan Kim helped the potential donor overhaul her diet and lose 12 more pounds. She’s now a fan of lentils and brown rice, vegetables and nuts. Her daughter has also embraced the changes to their meals, and her sisters-in-law ask her to share her new recipes. “This is a new lifestyle for me,” she says.

She is hopeful that at her next appointment, the transplant team will give her the green light to proceed with the donation.

“I just want to make my brother feel better,” she says. “They [the transplant team] asked me when would I be available to do the transplant. I told them, whenever my brother is ready, I’ll be ready.”

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