Hospital Is Given Reprieve

Program Was Facing Loss of Certification

Federal regulators will not withdraw approval or Medicare funding from Washington Hospital Center's 20-year-old heart transplant program, as threatened, while the hospital tries to rebound from a decline in surgeries that has dropped it well below the government's standard.

The hospital learned this week that the Centers for Medicare & Medicaid Services had signed off on a comprehensive plan of corrections, some already implemented, others still ahead.

Heart transplant Chairman Leslie Miller and Chief Medical Officer Janis Orlowski said they were pleased more than surprised by the agency's decision. "We were anticipating that this would be approved," said Miller, an internationally known cardiologist who was recruited in 2006 to turn the program around.

The potential federal action, announced in January, could have left the immediate Washington area with one cardiac transplant program. It followed a national review of more than three dozen heart, liver and lung transplant programs that repeatedly fell short of the number of operations considered necessary to maintain surgical skills -- or, in some cases, that failed to meet the criteria for patient survival rates.

The area's other heart transplant center, at Inova Fairfax Hospital, also came under scrutiny but has never been given a deadline for improvement.

Both programs have had too few operations to meet government standards in recent years. In 2006, Washington Hospital Center performed five transplants and Inova seven. The federal threshold is 12.

This year, Washington Hospital Center transplanted three hearts through May and Inova four.

The District facility responded immediately to the potential decertification of its program. Additional cardiac coordinators were hired, joining another cardiologist specializing in heart failure, and a heart failure clinic was expanded to increase the number of patients who could be seen. The transplant team includes five surgeons.

"It was a very well-articulated plan, a very detailed plan, and it was very clear that the heart transplant program at Washington Hospital Center had the support of the administration," said Laurence Wilson, a director of the Center for Medicare Management.

The hospital is looking at opening a satellite clinic in Maryland or Virginia and having its doctors travel to other offices to evaluate patients. "The world is changing, and I think we need to be out in other regions," Miller said.

According to administrators, the institution has invested several million dollars in strengthening its program. The goal for 2007 is to double the number of transplants done last year. As of Tuesday, eight people were on its waiting list for a new heart.

"There was never an issue with quality," Orlowski stressed. "This had to do with volume."

The connection between transplant quantity and patient outcome is not definitive, but studies generally indicate that more procedures increase operating skills and lead to better results.

With numerous centers across the country still out of compliance, Wilson predicted yesterday that more enforcement actions will be taken. A Nebraska hospital is the only heart program to be decertified since the crackdown began. That move does not force a facility to stop transplantation. However, decertification cuts off reimbursement through Medicare and usually discourages private insurers from extending coverage.

Despite the shortcomings in its heart transplant numbers, which a decade ago stood at 13, Washington Hospital Center has one of the country's largest cardiovascular programs. In a city with acute rates of heart disease, hypertension and related problems, it expects to treat as many as 1,500 patients for heart failure this year. More than 90 percent of them are expected to be black.

"That's a population we are committed to serving," Orlowski said. "If anything, those numbers are not going down, they're going up."