Insurer drops UW Hospital transplant program

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Insurer drops UW Hospital transplant program

By DAVID WAHLBERG 608-252-6125
dwahlberg@madison . com

A major insurance company has removed UW Hospital from its list of approved kidney transplant centers because of low success rates among transplant recipients.

The move by Minnesota-based OptumHealth marks the first time any insurer has delisted any UW Hospital transplant program, said hospital spokesman Aaron Conklin. The company pays for about 16 percent of transplants at the hospital, making it the second largest payer after the federal health plan Medicare, Conklin said.

Dr. Hans Sollinger, chairman of the hospital's division of transplantation, said many of the hospital's kidney transplant recipients were older, had unexpected medical conditions or were receiving their second transplants during the period assessed by OptumHealth. Those factors put the patients at higher risk for unsuccessful transplants, he said.

Sollinger said the hospital is more aggressive than many in transplanting patients quickly.

"We're saving lives of people on the waiting list," he said. OptumHealth's action "doesn't necessarily mean the program isn't treating the patients well."

OptumHealth removed Froedtert Hospital in Milwaukee from its pancreas transplant program list last month, also because of low success rates, said Mike Donnell, Froedtert's director of transplant services.

Donnell, who used to work for a division of what is now OptumHealth, said the insurer periodically delists programs to encourage better success rates and to keep its costs low.

"It's a leverage thing for them," he said. "They're too big a player not to play with."

Sollinger and Donnell said other reputable hospitals around the country also have been delisted.

Dale Kurschner, a spokesman for OptumHealth, said it's rare for the company to remove a program from its list. But he said UW Hospital performs well overall.

"We see this as a temporary blip in an otherwise excellent program," he said.
A major insurance company has removed UW Hospital from its list of approved kidney transplant centers because of low success rates among transplant recipients.

Other transplant issues

UW Hospital's removal from the list, in September, follows problems with the hospital's lung and heart transplant programs, reported this year by the Wisconsin State Journal.

In some recent years, fewer of those organs have been taken from donors at UW Hospital and transplanted into patients there or sent elsewhere than at most transplant centers. That means patients who could have received transplants didn't, doctors in other states said. Hospital officials say they are working to improve the situation.

With the kidney program — the largest of the hospital's transplant services — the issue is the success rate for the 725 patients who received transplants from January 2005 to June 2007.

A year after surgery, transplanted kidneys were working in 89.78 percent of the patients, compared to an expected rate of 92.30 percent and a national average of 92.56 percent, according to the United Network for Organ Sharing, which oversees transplant programs.

That means about 75 of the patients at UW Hospital died or needed another transplant or kidney dialysis.

OptumHealth said it would stop referring patients to UW Hospital for kidney transplants. The company said that the 80 or so patients insured by the company who were on the hospital's kidney waiting list at the time could continue to pursue transplants there, according to information provided by the hospital. Other patients would have to seek transplants elsewhere, though OptumHealth would consider individual requests to go to UW Hospital.

More than 500 patients are on the waiting list for kidneys at UW Hospital, where about 300 kidney transplants are performed each year.

UW Hospital's appeal

When new transplant data is released in January, OptumHealth will consider putting UW Hospital back on its list, according to the hospital.

Another insurer, Humana, has said it also might remove UW Hospital from its list of approved kidney transplant centers if the hospital's statistics don't improve in January, according to a memo the hospital sent to patients in September.

OptumHealth initially removed UW Hospital's pancreas transplant program from its list as well, according to the hospital. After the hospital appealed, the company reinstated the hospital's programs for pancreas transplants, kidney-pancreas transplants and kidney-liver transplants. Only transplants involving just kidneys remain off the list.

Sollinger, the transplant division chairman, said insurance companies shouldn't make decisions based on the data because some hospitals don't report it as thoroughly as UW Hospital does.

He said UW Hospital barely dropped below the cutoff for delisting by OptumHealth and expects to be reinstated in January. Donnell said Froedtert also expects to be returned to the pancreas transplant list then.

Sollinger said half of the patients on UW Hospital's waiting list get transplants within 13 months, compared to the national average of 41 months. More than 10 percent of patients on waiting lists die each year, so UW Hospital has saved lives by providing transplants quickly, he said.

"It all comes down to how aggressive you are with donors and with people on the waiting list," he said.

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