Spectrum transplant hopes hinge on decision in Lansing

January 30, 2009
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Spectrum Health’s interest in creating transplant programs for heart and bone marrow for adults hinges on a meeting in Lansing this week.

The Certificate of Need Commission, which is part of the Michigan Department of Community Health, plans to decide on Thursday whether to open for review the state standards covering transplants including heart and bone marrow, as well as lung, heart-lung and liver.

Other than Spectrum Health’s pediatric bone marrow transplant program, heart, lung, liver, pancreas and bone marrow transplants are allowed at a limited number of hospitals, all in Southeast Michigan. Saint Mary’s Health Care in Grand Rapids has one of the busiest kidney transplant programs in the state, but those are not covered by the standards that may be reviewed by the CON Commission.

Spectrum Health spokesman Bruce Rossman said the system’s executives declined to comment. But in letters to CON Commission Chairman Edward B. Goldman, Spectrum Strategic Program Manager Robert A. Meeker argued that it’s unfair for West Michigan patients to be forced to travel to the Detroit area or even beyond for transplant services.

“The concentration of all programs in the same region of the state does not promote access to transplant services for the remainder of the state’s population,” Meeker’s letter stated.

He contended that the standards should be changed to split the state in two and require transplant services be located in each region.

“By making such a change in the transplant standards, the western half of the state would then have access to the much-needed transplant services currently provided only on the eastern side of Michigan,” Meeker continued.

More than 250 Grand Rapids patients have been referred elsewhere for heart transplants over the past 20 years, he noted in the letter. Spectrum’s heart and lung clinic has a caseload of more than 1,000 patients, some from as far away as the Upper Peninsula.

In December, Spectrum Health filed a letter of intent to request a CON for adult bone marrow transplants. The hospital system indicated it would add air filtration and patient monitoring systems to four rooms in Butterworth Hospital to accommodate the patients’ special needs.

Some 144 pediatrics patients, under age 21, have undergone bone marrow transplants at Spectrum Health since the program began in 1998, said Dr. Aly Mageed, pediatric hematology-oncology specialist.

The earliest the CON Commission is likely to consider any changes to the standards is June, Vice Chairperson Norma Hagenow said, and possibly not until September.

“The controversy is getting out front of the action,” she said.

Hagenow said the commission could opt to schedule a public hearing, create a work group for a Michigan Department of Community Health review or create a Standard Advisory Committee for a thorough examination with input from outside experts.

Any attempts to change the standards and expand transplant programs are likely to face scrutiny from Blue Cross Blue Shield of Michigan, the state’s largest health insurer, and the Economic Alliance of Michigan, a business and labor organization that keeps close watch on health care costs.

BCBSM HealthCare Manager Barbara Winston Jackson last fall filed comments opposed to opening standards for bone marrow and heart, lung and liver transplants. Volumes for these programs are stable, she noted. Opening standards for review could create an opportunity to create new programs that would deplete patient supply for existing programs, her letter stated.

While the Economic Alliance filed comments opposing the potential for changes to standards, it has since softened that position, said Dennis McCafferty, director of health policy. After hearing from seven organizations, including Spectrum Health, McCafferty said his organization’s membership may be willing to consider support for a bone marrow transplant program in West Michigan.

“While we’re not yet convinced there is a need for more capacity in the state, based on the information we’ve seen, we think it warrants further investigation,” McCafferty said. “We’re not opposed to this being looked at.”

Spectrum Health has been the state’s leading provider of organs for transplant for the past five years, according to the Gift of Life, Michigan’s organ recovery organization. In 2008, Butterworth Hospital recorded 34 organ donors, while Blodgett Hospital had three.

In their letter to the CON Commission, the eight doctors of West Michigan Cardiothoracic Surgeons said they intend to develop a program at Spectrum Health using ventricular assist devices and “hopefully transplantation in the future.” The doctors practice in Grand Rapids and in Muskegon.

Spectrum board members, local politicians, medical community leaders and financial donors to Grand Rapids hospitals wrote to CON Commission Chairman Edward B. Goldman to express their support for opening the standards to allow transplant programs in Grand Rapids.

Support came from business leaders such as Steelcase Inc. President & CEO James Hackett, politicians including U.S Rep. Peter Hoekstra, health care philanthropists such as Ralph Hauenstein, West Michigan hospital administrators including Mercy Health Partners President & CEO Roger Spoelman, and Spectrum board members including Amway co-founder Richard M. DeVos, who had a heart transplant in England in 1997 at age 71.

Saint Mary’s Health Care did not provide a letter of support because the hospital, a sister organization to Mercy Health Partners in Trinity Health, was not asked to do so, Vice President Micki Benz said.

In Southeast Michigan, several hospitals are interested in adding pancreas and bone marrow transplant services.

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