Dr. Sivappiriyai Veluppillai, DDS

521 Parnassus Ave, San Francisco, CA 94143

When I was training as a general surgeon, I operated on everything but the chest. I was curious to find out what was on the other side of the diaphragm. The chest seemed like such a fascinating almost spiritual cavity.

I consider UCSF to be the Harvard of the West Coast. I came to UCSF in 2004 from Boston, where I had been training at Brigham Women and Childrens Hospital. UCSF is the ideal institution. It has excellent basic science research, clinical research and patient care expertise that have achieved national recognition.

Lung transplant is all about teamwork and we have a truly spectacular team. Every person in the program pulmonologists, nursing staff, pre-op and post-operative coordinators, respiratory therapist, physical therapist, pharmacy staff and surgeons is top-notch.

We also work very closely with patients to prepare them for transplant. That includes educating them about what to expect before, during and after surgery. By preparing our patients for what's to come, we can alleviate a lot of their anxiety.

We don't shy away from high-risk patients and, it's true, we have been very fortunate to still have the best outcomes. I've had people who we were doing CPR on and then successfully transplanted and are now several years out. The majority of transplant programs would not take those patients, but I've had good success with them. Our success boils down to our aggressive perioperative management as well as long-term comprehensive monitoring. Again, it's all about teamwork.

Restoring a person's ability to breathe is one of the most satisfying parts of my job. When I meet them, they are hanging on for dear life. After transplant, they send me photos, postcards from vacations where they are skiing, rock climbing, surfing, jogging and biking. Lung transplant patients are keenly aware that they've been given a second chance at life, and they don't want to waste a single second.

Lung transplants used to be performed on a first-come, first-served basis but we realized that the people who needed transplants most urgently (the sickest) were the least likely to survive the wait. Now the system is designed so that the sickest patients go to the front of the line because they stand to benefit the most. Since making that change, the number of patients who die while waiting for a transplant has declined.

Donated organs are a very precious resource. Each donor and recipient is very carefully considered and selected by the transplant team. We need to balance the needs of the recipient with the wishes of the donors family during what is usually a very painful time. The family wants the gift to be put to the best possible use.It's up to the transplant team to help discern who will benefit the most from this organ. We weigh each case from a scientific and ethical point of view. It's never an easy decision, but the complexity of each case is one of the things that makes organ transplant surgery so rewarding.

At UCSF Health, we collaborate with the best providers throughout Northern California to extend our mission Caring, Healing, Teaching and Discovering beyond our walls and into the communities of the patients and families we serve.

UCSF doctors work directly with our affiliate providers, sharing best practices and the latest innovations in treatment and technology. Like UCSF, these experienced independent providers are committed to improving the quality of care for all Californians and are deeply invested in their community. We help them identify and develop services that can be delivered locally, whether by building a cancer center or establishing a pediatric ICU.

The collaboration between UCSF and our affiliates is a two-way street, bringing together expertise and resources from both sides. What does this mean for you? If you're a patient, you're more likely to get excellent medical care for a serious condition without traveling great distances.

If you need a referral to UCSF for treatment, our affiliations can smooth the way at a stressful time. We coordinate closely with your physician to make sure you receive the best care at home and at UCSF.

This document lists the gross charge for all services and items that would potentially be provided to UCSF Medical Center patients, insurers and guarantors. This list represents line-item charges for many different elements of the care we provide, such as the surgery itself, as well as hospital rooms and special facilities (e.g., operating rooms), supplies, devices, procedures, tests and medications.

We have also provided our self-pay pricing along with any fixed payer-specific negotiated charges. Please note that UCSF provides many complex services, which are reimbursed at a variable rate. This means that the reimbursement is dependent on many factors: the length of stay, medications and supplies provided with the service, and other variable factors.

The charges hospitals are required to post on this list may not reflect what you will actually pay. Your doctor and care team will determine what services and treatments are necessary. Your individual out-of-pocket costs will be impacted by insurance plan coverage, co-pays and deductibles, if any, as well as by the wide range of services provided and other variables that affect costs so our list should not be used to estimate the actual final cost you will incur.

UCSF Medical Center and UCSF Benioff Childrens Hospital San Francisco (BCHSF) are tertiary and quaternary care providers serving the greater San Francisco Bay Area, Northern California, Central Valley and beyond. We care for patients who suffer from the most acute medical conditions, which often require costly treatments. UCSF is among the largest Medicaid providers in Northern California and is San Franciscos largest provider of hospital care for Medicaid patients. More than 26 percent of our total patient services are provided to Medicaid patients.

Neither UCSF Medical Center nor UCSF Benioff Childrens Hospital San Francisco receives operating funds from either the state of California or the University of California system. As self-supporting institutions, UCSF Medical Center and BCHSF rely heavily on other funding sources, including savings generated from participation in the 340B Drug Pricing Program, to offset the losses incurred in caring for Medicaid patients and to fund programs that care for vulnerable and underserved populations.

Patients who come to UCSF Medical Center and UCSF Benioff Childrens Hospital San Francisco for care often have overlapping vulnerabilities financial, psychosocial and geographic. UCSF stretches its scarce resources by leveraging access to discounted outpatient drugs and savings generated from our 340B program to support these areas of need, particularly uncompensated care for our pediatric and cancer patients.

  • Ensure Medicaid and uninsured patients can access specialty clinics that provide lifesaving treatments such as organ transplants, complex cancer care, immunological care (including bone marrow transplants),neurological and neurosurgical care, cardiovascular care and cardiothoracic surgery.
  • Provide specialized care for thousands of children with life-challenging medical conditions, such as cancer, organ failure, genetic diseases, heart defects and epilepsy. Roughly half of these children are covered by Medicaid.
  • A 10-year-old girl from a remote area of Northern California was diagnosed with severe ulcerative colitis. Despite their best efforts, her family was unable to find a provider in their community who would accept their insurance because it didn't adequately reimburse for the infusions she needed. The 340B savings allowed UCSF Benioff Childrens Hospital to absorb the financial losses associated with the bi-monthly infusions required to control her disease. The outcome is a 10-year-old who excels academically and participates in soccer after school.
  • A 21-year-old student at a local college was diagnosed with acute leukemia. The medical team determined his best course of treatment was an expensive, non-formulary oral drug. Despite UCSF Medical Center assisting him to sign up for Medicaid, his plan did not initially cover the drug. However, access to 340B pricing and savings generated from participating in the program enabled UCSF Medical Center to cover the cost of his first month of therapy. This allowed him to begin healing while appealing, and he ultimately received ongoing coverage for this therapy. Without 340B savings, this talented young man would likely have first received, and failed, an inferior therapy before being allowed to use the more effective drug.
  • UCSF Benioff Childrens Hospital also provides care for many low-income patients who struggle to find adequate care for serious or rare diseases in their communities. UCSF Medical Center pioneered fetal surgery to help repair the spinal cord defects associated with spina bifida. Children who undergo the surgery are significantly more likely to walk independently and have better motor function than those who don't, without the medical and public health costs historically associated with these birth defects. This treatment is not available in most communities and pregnant women come from all over the West Coast for treatment at BCHSF. 340B savings enable UCSF Benioff Childrens Hospital to provide financial assistance to these patients.
  • 340B savings also allow UCSF Medical Center to provide vital medical services to vulnerable patient populations closer to their homes. UCSF Medical Center has a very large solid organ transplant program that includes kidney and liver transplants. Our patients from Californias Central Valley must make the four-hour drive to UCSF Medical Center for their transplants. To improve outcomes, UCSF Medical Center now provides pre- and post-transplant care to these patients in Fresno. Sending our clinicians to Fresno enables close follow-up for patients who reside in that medically underserved area. 340B savings again make it possible to stretch our dollars, help absorb the costs of this service and provide improved outcomes for patients.
  • At UCSF Medical Center, we are deeply committed to our missionto care, heal, teach and discover. Our missionis central to everything we do. In the face of declining reimbursements over the past years, UCSF Medical Center has resisted reducing mission-critical services and has instead utilized funding from the 340B program to expand these services.

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