Sutter Memorial Hospital Could Lose Heart Transplant Program

Some health insurers are declining to cover heart transplants at Sutter Memorial Hospital because of low program volumes, the Sacramento Bee reports.

Sutter Memorial's transplant program has performed 99 procedures since 1989, averaging six procedures per year. However, in the last four years, the number of transplants has decreased to an average of five or fewer annually.

Because of the low volume of transplants, insurance companies, such as PacifiCare Health Systems, have removed the hospital from their lists of preferred facilities where plan members can receive heart transplants. Sutter Memorial officials say that continued decreases in program volumes could lead Medi-Cal and Medicare to stop reimbursing for heart transplants at the facility, a development that could force the program to shut down.

In addition, the Bee reports that improved medications to prevent heart failure have contributed to a nationwide decrease in the need for heart transplants. For example, the number of heart transplants in California decreased from 285 in 1990 to 265 in 2004, a 22.1% decrease when adjusted for population growth.

Roger Evans, a health economist in Minnesota who consults for the United Network for Organ Sharing, said that health insurers increasingly have the ability to terminate small transplant programs because they "buy into the hypothesis that the more you do, the better you do it, so they use a minimum volume requirement and an outcome requirement."

Despite a low number of transplants, records show that only 21 of the 99 patients who have undergone heart transplants at the facility since 1989 have died, Kelley Jaeger-Jackson, director of the transplant and outpatient heart specialty clinic at Sutter, said.

However, Dr. Sam Ho, chief medical officer at PacifiCare, said, "I think most people, when they put themselves at such tremendous medical risk, would much prefer to go to a facility with more experience than to one that doesn't" (Griffith, Sacramento Bee, 3/12).