Area units line up for heart transplant group

March 22, 2009
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A Michigan Department of Community Health committee will have six months to study organ transplants in the state and decide whether there is room for one more heart transplant program — and if so, whether it should be in West Michigan.

Norma Hagenow, vice chairperson of MDCH’s Certificate of Need Commission, said she plans to make appointments to a Standards Advisory Committee within a few days following Thursday’s commission meeting in Lansing. The task falls to Hagenow because Ed Goldman, chairman of the CON Commission, is an attorney for the University of Michigan Health Systems, which is one of three Michigan sites offering heart transplants, and has recused himself.

Among the applicants for the heart, lung and liver Standards Advisory Committee from the West Michigan area are Dr. Tim Bunchman, Dr. Michael Dickinson, Dr. John Fox, Dr. Robert Hooker Jr., Dr. Lawrence Robson, Dr. Luis Tomatis, Warner, Norcross & Judd lawyer and former Grand Rapids Mayor John Logie, Mary Marks, Mercy Health Partners President & CEO Roger Spoelman and Spectrum Health Hospitals President Matt VanVranken. Applications were due March 12.

Spectrum Health last year pushed the MDCH for a review of standards for heart and adult bone marrow transplants, arguing that it’s unfair to expect residents of West Michigan to travel to the Detroit area for those services. West Michigan business, medical and political leaders, including Hooker, last fall submitted dozens of letters to the MDCH in support of Spectrum’s quest.

Also this week, the CON Commission is expected to choose a level of review for bone marrow transplant standards. Spectrum Health already has filed a request to initiate adult bone marrow transplants, a service it already provides for children.

The SAC committee will have six months to review six Michigan standards covering heart/lung and liver transplants, Hagenow said. SAC members will be asked to:

Determine whether continued regulation is necessary.

Consider establishing a needs-based methodology to determine when new heart/lung transplantation services are necessary.

Recommend a way to regulate the number of heart/lung transplant programs in the state.

Determine whether the cap on heart-lung transplant programs should be continued or amended.

Determine whether the existing cap methodology should be altered to modify the number of programs, or the planning area designation rules changed or standards for comparative review changed.

Recommend changes for outdated and inconsistent language.

Hagenow said the committee must consist of two-thirds experts such as doctors or administrators of heart transplant programs. She said she is reviewing résumés and curricula vitae to ensure that those members “truly are an expert in the field” and “whether they have a cat in the fight” to promote objectivity.

“They don’t even have to come from the state,” she said.

Other representation must come from consumers, health care purchasers such as employers, and payors such as health insurance companies, Hagenow said.

Hagenow added that her own criteria include appointing no more than one person from any one medical organization, no one with a CON application in process for the transplant services under question, no consultants for establishing heart transplant services, and a geographic distribution from around the state.

She said she hoped to limit the number of members to 12, although some committees have been as large as 24 or 30 people. She didn’t know how many applications had been submitted, and the MDCH said the applications are still being reviewed.

Heart transplants currently are available in the state at Henry Ford Hospital, the University of Michigan Health System and Children’s Hospital of Michigan. Another half-dozen programs are located in Chicago.

Heart transplants are performed at 124 locations in the U.S., according to a list from the United Network for Organ Sharing. The first human-to-human heart transplant occurred in 1967 in South Africa. But modern advances in invasive cardiology and pharmaceutical treatments ensure that heart transplants a rare event.

“They are not commonly done procedures,” said Dr. James Byrne, chief medical officer for Priority Health. “They are very complex, very intensive, very costly, and should be performed at a center that does enough volume to justify evidence that they have the expertise to do this.”

Byrne said Priority Health, like other health coverage providers, works with a network of major transplant centers around the country, “particularly those who have a high volume of cases and good quality scores,” he said.

“We looked for, of course, the most comprehensive network, and the transplant networks are able to negotiate discounts at the transplant centers, so they help us on the cost side, as well. By virtue of bringing a lot of covered lives to a contract, these networks are able to generate some pretty good contracts and discounts at the centers,” Byrne added.

The Centers for Medicare and Medicaid Services last year lowered the standard for transplant centers’ eligibility for federal reimbursement from 12 heart transplant procedures per year to 10. But a 2008 study by Johns Hopkins heart surgeons urged that the standard be raised to 14, which their study showed to be a high enough volume to consistently show higher survival rates and lower rates of complication.

“Our national health care system has to rethink which hospitals should do heart transplants, and in consultation with their physicians, patients need to review these surgical volumes to see for themselves which hospitals have teams operating at their peak skill level,” said senior study investigator Dr. John Conte, a Johns Hopkins cardiac surgeon.

Byrne said a national database containing such data is available for review by patients referred for transplants.

The study said that of the more than 100 heart transplant centers in the U.S., a dozen perform more than 20 heart transplants each year and fewer than 10 do more than 30.

The MDCH CON section already has established a workgroup to look at pancreas transplant standards, which has been a hot topic among hospitals in southeastern Michigan.

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