Medicare is actually cutting funding for a historic heart-transplant program

“which has far-reaching ramifications beyond just the heart transplant program,” said Alexander Aussi, a San Antonio-based transplant consultant who has closely followed the situation at St. Luke’s.

Losing Medicare is actually not unprecedented, however rarely has such a severe sanction been levied against a transplant program of St. Luke’s prominence. Some of the earth’s first heart transplants were performed at the hospital inside 1960s as well as ’70s. Since the heart transplant program was formally established in 1982, only a handful of hospitals inside nation have performed more. as well as, along with its research affiliate, the Texas Heart Institute, St. Luke’s has been credited with numerous advancements inside development of mechanical heart pumps right now routinely used to keep patients alive until they can receive a transplant.

“I expect they recover coming from which,” Aussi said. “which is actually one of those marquee programs which’s going to remain inside history books when which comes to innovation. … We all have a vested interest in which succeeding.”

Medicare first raised concerns about the heart transplant program during an inspection in December. At the time, an unidentified St. Luke’s transplant physician told a CMS inspector which the hospital had hired a consultant to determine what led to poor outcomes in 2015. The physician “explained which issues were identified with the major issue being surgical technique with one of the heart transplant surgeons, who was no longer practicing,” inspectors wrote.

St. Luke’s officials have declined to say which surgeon was being blamed for poor outcomes.

In a more detailed written response to regulators a few weeks later, the hospital’s CEO, Gay Nord, detailed actions the hospital was taking to improve outcomes. In 2015, Nord wrote, the hospital hired “an international leader in heart transplantation” as the heart program’s brand-new surgical director. The brand-new surgeon, she wrote, had “led another renowned heart transplant program to national prominence.”

The physician St. Luke’s had hired, Dr. Jeffrey Morgan, came coming from Henry Ford Hospital in Detroit, whose heart program was smaller than St. Luke’s. Morgan was not its director as well as had only been the lead surgeon on 18 heart transplants inside previous a few years.

St. Luke’s officials say the heart transplant program’s one-year survival rate improved upon in 2016 as well as 2017 under Morgan’s leadership. however multiple heart transplant recipients have suffered unusual complications since 2016, the ProPublica as well as Chronicle investigation found, including two who had major veins stitched closed during surgery, according to numerous sources. Another patient’s heart transplant failed which year after operating-room equipment malfunctioned during a key stage of surgery.

Once Medicare cuts off funding, the program could face an uphill fight if the hospital wishes to regain federal approval, said Laura Aguiar, an Arizona-based transplant consultant who has spent years helping programs navigate regulations.

In most cases, Aguiar said, a program seeking Medicare approval must perform 10 transplants as well as follow those patients for a year to demonstrate which has the proper medical as well as administrative infrastructure in place to support a safe transplant program.

“The challenge is actually going to be finding 10 patients they can transplant who have coverage,” Aguiar said, noting which Medicaid as well as most private insurance companies won’t pay for heart transplants at programs which don’t have Medicare approval. “Otherwise, the hospital will have to make a decision to absorb those costs.”

Mike Hixenbaugh is actually an investigative reporter at the Houston Chronicle. Email him at mike.hixenbaugh@chron.com as well as follow him on Twitter at
@Mike_Hixenbaugh
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