The decision to consolidate two kidney/pancreas transplant programs within the same healthcare system and within a 10 mile radius, was a pro-active approach in an era of healthcare reform to maintain the highest quality of patient care, achieve efficient operations and cost savings without compromising access. The plan moved all services to the larger volume facility while maintaining satellite services for pre and post care at the smaller inner-city facility. Prior to consolidation, these programs were operationalized under common administrative and surgical teams which was increasingly inefficient and burdensome. There were many considerations- regulatory compliance, patient notification, revenue/cost, patient access, staffing, quality standards and outcomes.

Feasibility plans were developed and projected the impact on both facilities and the system. A transition taskforce was formed of clinical, financial and administrative disciplines. Members took responsibility for researching issues and creating detailed action plans.

By tackling each issue in a methodical, step-wise fashion, the taskforce stayed focused. Reporting mechanisms tracked progress and re-aligned priorities/issues.

There were significant financial implications. Overall expenses were reduced/avoided by approximately $2.1 million. The reduction is attributed to capital/operational cost that would have been required for the continuance of the smaller program. There was no system increase in staffing or operational expenses.

Patient access was not compromised due to public transportation accessibility and 60% of the smaller center's patients with Medicaid and transportation assistance.

To date patients evaluated increased 12%. Total system transplant volume is down by 15%– primarily due to decreased donor organ procurement since consolidation and a 22% reduction of candidates determined no longer suitable for transplantation after re-evaluation. 8% of the patients transferred from the smaller center have been transplanted. Patient and graft survival and other quality metrics (Readmits, Return to OR, Infections, Adverse Events, etc.), remain at or above expected benchmarks.

Programs will need to evaluate the efficacy of consolidation as healthcare economics evolve and larger healthcare systems are formed. Our experience leads to the conclusion that successful consolidation of transplant programs can occur with proper planning, anticipation of economic/political impact, and a carefully thought out plan for implementation and continuous evaluation.

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