Heart Transplant Funding Threatened: Abbott Northwestern Defends Program After Federal Warning
By Jeremy Olson, Pioneer Press, St. Paul, Minn.
Jul. 4–MINNEAPOLIS — Abbott Northwestern Hospital has 30 days to prove it can correct deficiencies in its heart transplant program or risk losing federal funding, according to a warning letter that Medicare sent Friday to the Minneapolis hospital.
While Abbott officials said they will submit an improvement plan, they stressed that their deficiency was the number of procedures done each year and not the outcomes of the patients.
“Our outcome and our quality is as good as anybody’s,” said Dr. Kevin Graham, president of Abbott’s Minneapolis Heart Institute.
The U.S. Centers for Medicare and Medicaid Services has intensified its focus in the past year on the quality of the nation’s heart transplant programs and issued warning letters to 18 hospitals. The lack of official Medicare support can effectively shut down transplant programs, partly because of the loss of federal revenue and partly because it makes it hard to secure contracts with private insurers.
Two hospitals in Texas and Indiana also have the next month to respond to Medicare warning letters. In the past year, nine other transplant programs have decided to operate without federal money, five have submitted correction plans to Medicare and one has had its federal funding pulled.
Abbott’s correction plan must show that the hospital will have adequate staffing and commitment from its leadership to continue its heart transplant program, according to the Medicare warning letter.
Abbott performed eight transplants in 2005 and five in 2006, according to the United Network for Organ Sharing. Medicare’s threshold for proficiency is 12 transplants per year, though the federal program is considering cutting that rate to 10.
Minnesota’s two other transplant centers exceeded that volume: Mayo Clinic averaged 27 transplants during the past two years while the University of Minnesota averaged 30.
Mayo and the University of Minnesota also had one-year survival rates for adults that were above expectations when considering the varying conditions of their patients, according to the Scientific Registry for Transplant Recipients, which tracked outcomes from 2003 through June 2005. Abbott’s one-year survival rate of 87.5 percent (14 of 16 patients survived one year) fell slightly below what was expected for that time period. However, the rate was better than the Medicare standard, which is a one-year survival rate of 73 percent.
Abbott’s data isn’t as reliable, though, because of the hospital’s low volume. Had one more patient survived, Abbott would have been well above its expected rate.
An Abbott spokesman also said new data released later this month will show Abbott’s survival rate exceeds 90 percent and is equivalent to its expected rate.
Anywhere from 40 to 70 heart transplants take place in Minnesota every year. Abbott was the leading heart transplant center in the late 1980s and early ’90s, but its volume started dropping in the late 1990s as volumes at Mayo and the University of Minnesota increased. Abbott hasn’t performed more than 10 heart transplants annually since 1998.
Abbott has a national reputation as a top center for cardiac care, creating a Level 1 system for rapid treatment of heart attack patients that has been copied by hospitals across the nation. Graham said the hospital’s ability to treat heart attacks and provide advanced cardiac care has “taken bread off our table” by keeping patients healthy and preventing them from needing transplants.
Nationally, the number of heart transplants appears to have peaked: The 2,192 transplants in the U.S. last year were well below the record 2,362 transplants in 1995.
Exactly how Abbott will increase its transplant volume in a shrinking market is unclear, but Graham said the hospital has some strategies, including reconnecting with hospitals that refer patients for transplants.
Given the dwindling number of transplants, one suggestion is to close down the low-volume centers in the U.S. and allow the busier centers to build on their expertise. Graham disagreed.
When Abbott doctors evaluate patients with complex cardiac conditions, he said, they need to have all treatment options, including transplants, at their disposal.
Jeremy Olson can be reached at jolson@pioneerpress.com or 651-228-5583.
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