Posted on Sat, Nov. 29, 2008
Phila. transplant programs risk losing U.S. fundsBy Josh Goldstein
Inquirer Staff Writer
> The failure to attract enough patients amid heavy competition among Philadelphia-area organ-transplant programs has closed one and put two others at risk.
> The liver program at Hahnemann University Hospital and the storied heart-transplant program at Temple University Hospital are in jeopardy of losing Medicare certification - and government payments - for the high-profile and profitable operations.
> Hahnemann and Temple were among a first wave of transplant hospitals nationwide to face intensified scrutiny of surgical volumes and outcomes from federal regulators. Both have until early May to get their numbers back up, and executives said they expected to do so.
> Lankenau Hospital will shut its five-year-old heart-transplant program next week.
> Organ transplants are one of several areas where the federal Centers for Medicare and Medicaid Services (CMS) has sought use its enormous financial clout to drive quality improvement.
> "In recent years CMS has been more aggressive," said Robert I. Field, chair of the health policy and public health department at the University of the Sciences in Philadelphia.
> "This increased assertiveness has been occurring under a conservative Republican administration and, I think, there is a good chance that the trend will continue or accelerate under the Obama administration," Field said.
> Last year, federal regulators began requiring all transplant programs in the nation to undergo on-site surveys to participate in Medicare and Medicaid. So far, 90 of the nation's 240 transplant hospitals have been scrutinized.
> Hahnemann and Temple were in that first group because of low transplant volumes in their liver and heart programs, respectively. The results of the inspections were recently released by the Pennsylvania Department of Health.
> Temple's heart program - for many years considered among the best in the nation - has failed for nearly three years to reach the federal requirement of 10 transplants in the previous 12 months. So the hospital that performed the region's first heart transplant in 1984 now faces a May deadline to get its numbers up or risk being dropped from Medicare.
> At Hahnemann, the liver program also failed to reach the minimum during any 12-month period between Jan. 1, 2006, and Aug. 31, 2008.
> And Hahnemann's kidney program faces potential termination from Medicare in May because patients died at higher-than-expected rates.
> Leaders at both hospitals said they were confident that their recent addition of new doctors and other changes would enable them to avoid decertification.
> "I think that with our very robust staff, our outreach efforts, and the commitment by the medical school and Hahnemann to provide for the growth of the [liver] program, our future is very bright," said David J. Reich, chief of multi-organ transplantation at Hahnemann.
> Reich added that the worse-than-expected outcomes for kidney transplants was related to several factors, including the program's large number of HIV-infected and other high-risk patients. He said he is confident that the government's consideration of those factors and improved results would prevent termination.
> Temple said it has already resolved the volume problems that caused it to be cited after it was surveyed this summer.
> Temple surgeons in recent months have performed the requisite 10 heart transplants, said Sandy Gomberg, associate hospital director for clinical services. She said she expects the program to grow.
> Despite performing fewer transplants than required, Gomberg said that the program has continued to provide the highest quality of care.
> "Where we want to be is greater than 10 with the same superb outcomes that we have had," she said.
> Ironically, Temple is on the verge of a milestone in heart transplants, with just two more needed to reach 1,000.
> The competition for heart-transplant patients will get a little less intense on Thursday, when Lankenau officially closes the program that was suspended a year ago, when its medical director took a job in Arizona.
> In 2003, Lankenau officials sought to attract a larger portion of the profitable heart-failure market to their suburban hospital. A short time later, Thomas Jefferson University Hospital - like Lankenau, a part of the Jefferson Health System - opened its own heart-transplant program.
> Philadelphia's five adult heart-transplant centers then equaled the number in far more populous Los Angeles.
> "We could have continued to do heart transplants and, I think, we would have done it very well," said Kyle Kramer, vice president of cardiovascular services for Main Line Health, which includes Lankenau. "But you also have to step back and say there are scarce resources," he said. "Are we really serving ourselves and the community in the best way?"
> The Hospital of the University of Pennsylvania, the only local center with programs for all four major organ transplants - heart, liver, kidney and lung - also performed the most of each.
> With many surgical procedures, the more operations a hospital - and each doctor - does, the better the outcomes tend to be.
> Transplants are no different, and Howard M. Nathan, head of the Gift of Life Donor Program, said the regional outlook is good.
> "We continue to increase the number of donors and organs, whereas in other parts of the country the number may be trending the other way," said Nathan, whose organization coordinates the procurement and distribution of organs in the region.
> Still, eight hospitals house 18 remaining adult transplant programs in the region. Children's Hospital of Philadelphia and St. Christopher's Hospital for Children also do transplants.
> So, while the overall number of transplants has remained relatively high, it has not been enough to sustain high volumes everywhere.
> Nonetheless, Nathan said that he would be comfortable at any of them. While he understands the government's focus on ensuring quality in transplants, he believes a one-year snapshot is not enough to fully assess a program.
> "All the data is available to the public," Nathan said. "It is unlike anything else in health care."
>
Transplants in the Region
> The number of liver transplants at Hahnemann and heart transplants at Temple and Lankenau fell below the federal threshold over the last three years.
> Here are the transplant totals for adult programs in 2007.
> Kidney Liver Heart Lung
> Einstein 119 23 -- --
> Hahnemann 85 3 12 --
> Hosp. of U. of Penn. 167 105 54 53
> Lankenau (Wynnewood) 27 -- 3 --
> Lourdes (Camden) 26 8* -- --
> Jefferson 63 47 16 --
> Temple 19 -- 5 35
> * It is not clear from calendar-year data whether Our Lady of Lourdes fell below the rolling 12-month minimum for a sustained period.
> SOURCE: United Network for Organ Sharing
> More information
> For detailed data on every transplant center in the nation, go to
www.ustransplant.org and
www.unos.orgContact staff writer Josh Goldstein at 215-854-4733 or jgoldstein@phillynews.com.
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