1. Benefits of the TFC and Social Worker Relationship Megan Maltby, MSW

2. VCU HF/Transplant

3. “Because donated organs are a severely limited resource, the best potential recipients should be identified. The probability of a good outcome must be highly emphasized to achieve the maximum benefit for all transplants” UNOS Ethics Committee

4. Background
116,829 patients waiting for transplantation. (August , 2017) Of those, 75,572 people are active waiting list candidates.
10-20% all heart, liver, kidney and lung candidates die on the waitlist.
Organ transplantation as a treatment of choice has increased in recent years due to concurrent advances in medical science.
Due to the limited organs available for transplantation, a thorough evaluation of transplant candidates is required to ensure each organ recipient will care for the organ and have the best possible post-transplant outcome.
In addition, there are significant financial and time resources involved in organ transplantation and subsequent care which highlight the importance of identifying appropriate candidates for transplant and ensuring before surgery that such resources are available to patients.

5. Review of the Literature
Shows there are several psychosocial factors known to contribute to poor patient and graft outcomes. They include:
Poor social support/absence of family caregiver
Mental/psychiatric disorders likely to negatively affect post transplant adherence
Self-destructive behavior such as alcohol or substance abuse
A history of poor adherence with medical and mental health treatment
The patient’s inability or unwillingness to comprehend the need for improved adherence
Dysfunctional personality traits and disorders, and
Financial issues which could interfere with post-transplant medication adherence

6. Policy
U.S. Department of Health and Human Services (DHHS) Transplant Center Process Requirements
“Prior to placement on the center’s waitlist, a prospective transplant candidate must receive a psychosocial evaluation”.
Centers for Medicare and Medicaid Services (CMS)
Transplant team: The transplant center must identify a multidisciplinary transplant team and describe the responsibilities of each member of the team
The transplant center must make available social services, furnished by qualified social workers, to transplant patients, living donors, and their families. Definitions for a qualified social worker included:
A qualified social worker is an individual who meets licensing requirements in the state in which he or she practices and
(1) has completed a course of study with specialization in clinical practice and holds a masters degree from a graduate school of social work accredited by the Council on Social Work Education, or,
(2) is working as a social worker in a transplant center as of the effective date of this final rule and has served for at least 2 years as a social worker, 1 year of which was in a transplantation program, and has established a consultative relationship with a social worker who is qualified under § (d)(1).

7. Goals of a Psychosocial Pre-Transplant Evaluation
Promote fairness and equal access to care
Maximize outcomes and use of scarce resources
Ensure that the potential for benefit outweighs risk by identifying factors that may result in non-adherence, morbidity and mortality
Provide information to develop treatment plan for those at high risk
Identify level of cognitive functioning
Address challenges
FINANCIAL
Support
Implement treatment to mitigate risk
Re-evaluate and adjust
Determine needs and help patients understand and cope with daily barriers
medical bills
money
transportation
return to work
Family responsibilities

8. VCU MCS/Cardiac Transplant SW Evaluation
Current family support structure, family history, and current and past family dynamics
Level of education
Employment
Current and past employment
Assessment of patient plans for return to work
Financial implications for transplantation
Insurance coverage
Insurance termination, if applicable
Applying for financial assistance
Patient assistance programs
Social history
ETOH history
Substance abuse
Smoking history
Legal history
Coping skills
Adherence history
Assessment of patient and caregiver understanding of the risks and benefits of transplant

9. The Many Roles of TXP SW
Initial screening and evaluation of patient and caregiver
Comprehensive psychosocial assessment of patient
Help patient/caregiver understand the illness and treatment options, as well as consequences of various treatments or treatment refusal
Help patient/caregiver adjust to hospital admission; possible role changes; exploring emotional/social responses to illness and treatment
Educate patient on the levels of health care (i.e. acute, sub- acute, home care); entitlements; community resources; and advance directives
Facilitate decision making on behalf of patient/caregiver
Educate hospital staff on potential psychosocial issues
Promote communication and collaboration among health care team members
Coordinate patient discharge and continuity of care planning;
Arranging for resources/funds to finance medications, durable medical equipment, and other needed services;
Advocate for patient/caregiver needs in different settings: inpatient, outpatient, home, and in the community
Champion the health care rights of patients through advocacy at the policy level.
Almost are of these roles are tied to some financial obligation or resource

10. Because at the end of the day, what do patients really want to know from the SW….?
How much is this transplant, hospital stay, medications, outpatient costs-what is cost me, the pt. asks?

11. So why is a collaborative relationship between the SW and FC important?

12. UNOS says….
Social workers and financial coordinators collaborate to determine how our patients can best afford the costs of transplantation.
SW have some knowledge about insurance policies and funding but the financial coordinator has detailed knowledge of financial matters and hospital billing methods.

13. I say… SW relies on the patient’s explanation of insurance
FC is able to confirm benefits for the SW
SW can explain in layman’s terms
The SW and FC share information
SW can test compliance- see if patients are actually following through
Truth seeking/finding when patients are not forthcoming or simply confused
Financial codes/assistance
Paying premiums
SW can help patients expedite Medicaid application
FC can provide bills, statements, access to insurance care managers
SW can educate others
SWs can’t help patients without financial knowledge and availability of financial resources
Benefits memo
Medicare info
We validate and support each

14. And Finally…….
Together we work on getting the whole picture

15. Thank You! And special thanks to Tami Topalu for recommending me

16. Shanda Ross, Director, MSN, RN Digestive Diseases & Kidney (DDK); Transplant Omaha, NE

17. Team; Together Everyone Achieves More
Each Team member brings their individual talents
A team’s foundation is formed by a mission and shared values
The Values and mission are the culture of the team
Myth or Fact; there is no I in team? MYTH!
Each Individual brings what is needed for our ENTIRE TEAM TO SUCCEED!!
Your Pt’s count on you to be fully engaged and bring you’re a game

19. The foundation of a Transplant Team
Transplant Teams are considered multidisciplinary
Each Transplant Team member has a responsibility to our pt..'s
The transplant cannot happen without financial clearance
Financial Clearance is a team effort between the TFC and SW
The TFC and The SW work closely together to assure all angles are covered

20. Role of the TFC Work with the Medical Team to obtain demographics
Verify benefits; review the available benefits
Is patient eligible for Transplant
Do they meet criteria for Medical Team/Insurance
Is there a concern for SW or TFC, how can we partner together to get pt. transplanted?
Does the pt. require assistance? Additional coverage, exception to policy, etc.

21. Racing toward the end goal; forming relationships as we go!

22. Communication; As the Expert your Voice Matters
TFC SW
What medical benefits are available, any concerns
If no lodging can we offer any assistance programs; collaboration with SW
Are all medical needs met, any post transplant benefit concerns
Lodging Benefits
Psychosocial Concerns
Support System
Lifestyle
Transportation

23. Chain of Command/Communication; Normal Hours What is That?
Normal Pt coming in for eval; standardized process
Emergent Pt; standardization really counts
Did we capture it all, if not guess who suffers/pays for it?

24. Documentation; Assuring you Tell your Story
Team should have standard process of communication
OTTR and/or EMR
Dot phrases; efficient, set standard
Who is primary contact to send documentation to
What do you need for authorization, is it all there
Your documentation is your word

25. Regulatory and Compliance
UNOS and CMS assures we follow the same standards in each center
Monitor each program to assure safe pt. care
Must be followed or a program/pt.'s are at risk
How do we assure we are in compliance; PSC meetings, who needs to follow up and be sure documentation is in place
FQAPI; is the TFC and SW at the table

26. In the End; This is why we do it!!

27. A-game AKA; Accountability
Each team member is accountable for their role to assure there piece of the puzzle is done
If each team member stays in their lane=Best Patient Care/Satisfaction/Outcomes
Cy Wake man; the tool to utilize to keep your stress to a minimum and assure you are focused on your role as a TFC!

28. Staying your lane assures
You are focused on safe pt. care
You are functioning as a highly reliable and accountable team member
You are managing your energy
You are not stressed out about what you cannot do but on what you can do
Each team member is giving our patients exactly what they need to assure a safe, efficient transplant!!

29. References
The role of the social worker on a transplant team. (2009, October 24). Nephrology News and Issues. Retrieved from

30. Questions/Comments?????