Respiratory Medicine - British Columbia Medical Association

18Appendix FLung Transplant Referrals and RecipientsThis initiative is directed at development of a physician remuneration strategy that willhelp support the delivery of high quality lung transplant services for patients in British Columbiawith enhanced and more timely access and increased opportunity to provide improved quality ofcare for these extremely complex patients.The BC Transplant Lung Transplant Program is an academic program sited at VancouverHospital. This program is one of only five lung transplant programs in Canada and it is broadlyrecognized for its clinical and academic excellence. This program provides access to lungtransplant service and expertise for all British Columbians.Lung transplantation is a complex and labour intensive process, which requires specialexpertise and experience from a multidisciplinary team. The physicians working in the programare highly specialized Respirologists and thoracic surgeons, all on faculty at the University ofBritish Columbia.The Thoracic Surgery Lung Transplant team is led by its Director, Dr. John Yee who issupported by two other members of the Thoracic Surgery Division, Drs. Richard Finley and KenEvans. The Thoracic Surgery Division is currently in the process of recruiting a fourth surgeonwith expertise in lung transplantation. The financial reimbursement for the thoracic surgeons iscovered on a Clinical Academic Service Contract.The current Medical Director of the program (Dr. Robert Levy) was recruited toVancouver from McGill University in 1997 to lead the Vancouver Program initiated anddeveloped by Dr. David Ostrow, who subsequently stepped back to further his work in otherareas. Dr. Jennifer Wilson, a UBC clinical Respirologists, underwent specialized postgraduatetraining in at the University of Alberta and joined the Vancouver Lung Transplant Program asAssociate Director in 2003. Drs. Levy and Wilson currently provide all of the clinical service forthe evaluation of patients referred for lung transplantation from across the province, and lead andprovide clinical care for patients following the transplant. Dr. John Swiston, Medical Director ofthe VGH Pulmonary Hypertension Program, has recently undergone specialized lung transplanttraining in Melbourne, Australia and will be assisting in the lung transplant programcommencing summer 2010.Beyond direct clinical care, assessment and long term management necessitate a largenumber of hours related to assessment meetings with the multidisciplinary transplant team,quality assurance (complications reviews and morbidity/mortality reviews) and communicationwith referring specialists and primary care physicians both before and after transplant.Reimbursement for these activities is through the standard Medical Service Plan fee codes withthe exception of clinical care for the first six weeks post-transplant (reimbursed with a standardblock fee through BC Transplant/PHSA) and on-call service, which is covered by a dedicatedlevel 3 MOCAP.Patients are generally referred by Respirologists and Internists from across BC. Thepatients tend to be younger with severe end-stage disease and with anticipated survival less than2 years with conventional therapies. The majority have cystic fibrosis, obstructive lung disease,pulmonary fibrosis and pulmonary hypertension. These patients tend to be extremely sick and oncomplex medical regimens.Evaluation and care for lung transplant candidates/recipients is complex, specialized andtime-consuming. New patient evaluations generally take 60-75 minutes up front with thepatients, as well as often hours to assemble patient information, communicate with referring