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A Tale of Two Liver Transplants: Altruistic Compassion for a Compassionate Altruist

Editor’s Note: Real World Healthcare will be taking a brief hiatus during the month of August. During this time, we’d like to share with you some of the compelling stories we’ve published about patients facing both medical and financial hardships.

 

“Talk about your life changing in an instant,” Helen said, remembering her first diagnosis of acute liver failure. The doctor told her family there was nothing more to be done, and she was given two weeks to live.

Helen Bozzo

Helen Bozzo

Helen Bozzo had spent most of her time being a mother. Her husband, a farmer, worked long hours in the fields in their rural California farm, and early on in their marriage the couple decided that she would stay home to care for their three children. She was the “homeroom mother,” volunteering in classes and with the school’s administration, PTA and athletics department. Helen’s passion was helping others, and not just in the school.

Eventually moving into the town, Helen enjoyed taking others into her home – her children’s friends, her son’s comrades from the Marine Corps – she always had a full house and enjoyed taking these friends in like her family.

“I enjoyed cooking for everyone, reading, knitting and gardening,” she said. “Still things I enjoy doing today, but loving and helping people is my number one pleasure in life.”

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Helen had returned from what she remembers as a great family vacation to Disneyland when she began to get ill quickly. Her doctor had her admitted to her local hospital where, after receiving tests and specialists’ opinions, she was given that shocking diagnosis.

But her family could not accept that. They sought a second opinion, and got Helen an appointment at a local cancer center. Here she was evaluated and admitted to the hospital, where she spent a month undergoing “every test known to man” and waiting desperately for an answer. All that was clear was that her liver and now her kidneys were failing. She was placed on dialysis.

“I was going downhill fast,” Helen recalls.

After much deliberation, Helen’s doctors decided to put her on the transplant list. Eight days later, on April 29, 2007, a suitable liver was available and she had the transplant. Her health began to improve immediately.

More than a third of people on the transplant list die each year waiting for an organ, according to Helen. She would later come to realize just how lucky she was, saying, “The odds of finding a match in such an acute critical case as mine are astronomical,” she said. “The doctors told me later that I was within hours of death.”

For the time being, Helen was in the clear. She had great insurance and her payment plan kept her bills covered. Though she was in debt, she was able to keep her medications coming. Considering how hard her recovery was, that was a very good thing. It took Helen a year to be able to walk again, but she eventually made a full recovery.

For the next four years, things went well for Helen. She became active again, and that meant re-embracing her spirit of altruism. She became active in the organ donor/recipient community, particularly in a liver transplant support group in which she helps others through the process of getting a transplant. She became a California Donate Life Ambassador, speaking at various organizations about the importance of becoming an organ donor. What energy Helen had, she gave to others.

Shortly before her third walk with the American Liver Foundation’s “Walk for Life,” Helen decided she had to see her doctor. She had started feeling tired after a recent road trip with a friend, and now she was feeling worse. To her dismay, the doctor’s test showed some major problems. After ten days of testing in the hospital, her liver was failing again. She was placed on the “Status 1” list in five states, the top of the transplant list.

“It was life or certain death,” Helen said.

Three days later, on September 26, 2011, Helen had her second liver transplant.

Along with this transplant, however, came three expensive new medications that her insurance would not cover. Charging thousands of dollars to her credit card every month, Helen was becoming massively over-extended. She called every agency she could, but no one could help her until she found the HealthWell Foundation. HealthWell is a nationwide non-profit providing financial assistance to insured patients who are still struggling to afford the medications they need (and sponsor of this blog). Helen qualified for a grant that helped cover her copays for her medications.

Now, Helen and her husband are back on their feet. As always, Helen turned her attention to paying it forward to others as soon as she could, donating to the HealthWell Foundation, continuing to support transplant recipients and raising over $25,000 in her walks for research and awareness of liver disease and failure. She spends time with her ever-growing family and her husband, with whom she just celebrated 40 years of marriage. When she’s not helping others or enjoying the love of her family, she still likes to knit, garden and cook, and hopes to see all 50 states one day.

“We are so very thankful to the HealthWell Foundation,” Helen said. “I know of families in our transplant support group that have lost their homes because they were in the same situation we were in. Thankfully we found the HealthWell Foundation in time. The home we had worked so hard for, we were able to keep. The peace of mind in knowing that every month when I went to the pharmacy I would have the money to pay for my medications meant everything to our family. The stress was gone and I could focus on my recovery in peace.”

We at RealWorldHealthCare are thrilled to see patients like Helen in such good places, doing such wonderful things. Please share your thoughts in the comment section.

Patient of the Month: Charles Fazio’s recovery from heart bypass surgery, kidney failure, and financial crisis

Patient of the Month is a new regular feature from Real World Health Care to illustrate the challenges and successes of the American health care system through the experiences of inspiring survivors.

Charles Fazio wasn’t sure how he could survive another health crisis.

Charles Fazio

Charles Fazio

Just three years after his four-way heart bypass surgery, he developed end stage kidney failure. In the worsening economy, he had lost his job as a traffic signal technician in Norfolk, Virginia and had since become too sick to work. On top of his serious health problems, Charles’ financial worries were overwhelming.

“It was like after having all of these other things happen, now I have to deal with this, too,” said Charles. “It was a big shock.”

Charles’ disability benefits had not begun to come in and he had to sell off his possessions to afford his medical expenses. Eventually, he lost his home and found himself homeless for several days.

“One night I stayed in my mom’s nursing home. I went in to visit her and I pretended like I just fell asleep in the chair next to her,” Charles said.

In short, it had been a rough few years, to say the least.

Charles was treated at Sentara Norfolk General Hospital and received dialysis for a year and a half at the Virginia Commonwealth University (VCU) Medical Center. Completing the process for Medicare allowed him to afford his dialysis treatments and living expenses.

Then, one day in 2012, Charles’ regular doctor appointment morphed into an overnight kidney transplant. “I was scared to death,” Charles said. “I didn’t know what to expect. I had read up on everything thoroughly, but when the time comes, you really just have to face it.”

By 4 o’clock the next day, he had a transplant kidney.

Charles continued treatment and testing at the VCU Medical Center after his operation. His recovery went smoothly, but he still required numerous medications and immunosuppressants. Again, he couldn’t afford the copays.

That’s when doctors and social workers introduced Charles to the HealthWell Foundation, a nationwide non-profit providing financial assistance to insured patients who are still struggling to afford the medications they need (and sponsor of this blog).. Charles was given a grant that enabled him to afford his medications.

“The grant I got from [HealthWell] took a lot of worry off of my back, a lot of tension,” Charles said.

With his financial stress reduced, Charles was better able to emotionally cope with his condition. “The help I got from Norfolk General, the VCU and [HealthWell] was the turning point for all of my frustrations, for feeling sorry for myself,” he said.

Now, Charles is doing quite well. At a recent annual check-up with his doctors at the VCU, his blood tests came back looking good. His transplant kidney is holding up well and his medication is stable. “You never know how you’re doing, even though you’re dieting and doing what your doctors are telling you,” he said. “In the back of your mind you’re asking, ‘How am I doing?’ and only a doctor can tell you.”

“But they said I’m doing well, and I feel good too.”

Charles is optimistic that his series of unfortunate events may now be in the past. He is recovering well and doing his best to stay healthy in his eating habits and his lifestyle. “When the weather’s nice, I try to take a walk once a week, and I hold on,” he said.

One step at a time, Charles. We’re all glad you’re here.

Categories: Access to Care, General

Cleveland Clinic’s Value-Based Care Team Improves Patient Wait Times, Saves Costs

Cleveland Clinic CEO and President Toby Cosgrove, MD, believes that the medical center is ready to “lead the charge” in delivering better patient outcomes and faster care, all at a lower cost.

Dr. Toby Cosgrove

Toby Cosgrove, MD

To that end, the Cleveland Clinic has established a Value-Based Care Team, made up of physicians, nurses and other experts who will work together to translate “better, lower cost and faster” into everyday practice. Services are rationalized across the network, with multi-specialty teams using system-wide resources to deliver the right care at the right place for every patient, at the right time with the right cost.

“Value is the centerpiece of Cleveland Clinic’s strategy,” said Associate Chief of Staff for Clinical Integration Development, Dr. David Longworth, who heads the Clinic’s Value-Based Care Steering Committee. “We are focused on two areas. One is to eliminate unnecessary practice variation by developing evidence-based care paths across diseases. The other is comprehensive care coordination to allow patients to move seamlessly through the system so that we reduce unnecessary hospitalizations and ER visits.”

According to Dr. Longworth, the TeamCare model helps to:

  • Increase throughput.
  • Reduce the cost-per-unit of service.
  • Improve patient and provider satisfaction.

“In the past, each physician had one medical assistant who simply roomed the patient and took vitals,” he explained. “All the chart work was done by the physician, often at home in the evenings, adding several hours of work to their day and extra time to the entire process. Now, physicians go home at the end of the day with all their charts closed.”

The TeamCare model helps the Cleveland Clinic improve its Patient Experience ratings in a number of measured metrics, including:

  • 22.8 percent improvement in wait time at clinic.
  • 10.7 percent improvement in wait time in exam room to see provider.
  • 8.9 percent improvement in the time the provider spent with the patient.

While the Value-Based Care Team may be a concept borne of the new world of health care, the Cleveland Clinic has a rich history of improving patient outcomes. In 2000, the Clinic became the first hospital in the U.S. to publish its outcome measures and now publishes outcome books for every department, comparing itself to the best available benchmarks.

The Cleveland Clinic further changed the way it delivers care by developing Institutes to house medical and surgical specialties, working under one Institute leader and one budget. In some Institutes, inpatient and outpatient care are co-located, and Institute leadership is charged with defining what diseases and conditions each Institute cares for, developing a set of shared outcome measures for which the team is jointly accountable. Leaders also identify the skills that need to be brought together to care for patients with the sets of conditions the team treats.

Institutes are given autonomy to pursue different implementation approaches and are expected to share insights with others. For example, the Neurological Institute created a website so that others at the Clinic could learn how it was developing performance measures and decide whether to use a similar approach.

In the case of a primary care pilot program, Value-Based Care relies on a team approach that leads to a higher-efficiency practice style. Responsibilities are shared among two medical assistants and the physician, with each individual functioning to the highest level of their scope.

For each patient visit, a medical assistant brings the patient to a treatment room and obtains vitals and additional medical history information, which they immediately enter into the patient’s electronic medical record. The medical assistant remains in the room during the examination, acting as a real-time transcriber for the doctor’s notes and orders, which are also sent immediately to the physician’s inbox for verification and signature so the assistant can schedule any follow-up tests or procedures before the appointment is complete. At the same time, the physician’s second medical assistant is getting the doctor’s next patient set up in another treatment room.

Value-Based Care also helps the Clinic reduce costs. In fact, in just under a year, the direct cost per patient encounter dropped by 7.5 percent while the number of patient encounters per day increased by 16.4 percent.

The hospital lowers costs in other ways as well, such as avoiding 12,082 lab tests in 2011 and 2012 for a savings of $1.2 million and lowering the cost of lung transplant surgery by 11 percent. Cleveland Clinic also is getting patients into treatment faster, with the total number of same-day visits increasing by 14 percent and the average emergency room door-to-doctor time reduced to 17 minutes.

These strides are helping Cleveland Clinic reach the Top 20 of the University HealthSystem Consortium’s (UHC) quality index, earning UHC’s Rising Star award by improving inpatient centeredness, mortality, equity, efficiency, effectiveness and safety.

The Cleveland Clinic model is a good example of how health systems can develop evidence-based models to generate higher quality care at a lower cost. What are other hospitals and health systems doing to redesign care delivery paths? Let us know what’s working.

Categories: Cost-Savings