The federal government has notified four more heart transplant programs, including one in California, that their federal funding may be pulled because they performed too few transplants in recent years to remain proficient.
Slated to lose their Medicare certification in 30 days are programs at Sutter Memorial Hospital in Sacramento, Hartford Hospital in Connecticut, Washington Hospital Center in Washington, D.C., and BryanLGH Medical Center East in Lincoln, Neb.
The relatively uncommon actions by the U.S. Centers for Medicare and Medicaid Services come after a Times investigation found that a fifth of the 236 federally funded heart, liver and lung transplant centers had subpar patient survival rates or performed too few operations to ensure competency. (Experts generally agree that the more a program performs specialized procedures, the sharper its performance.)
Since the newspaper's June report, the Medicare agency has been reviewing the performance of programs nationwide.
In November, the government said it would revoke funding for two other heart programs identified by The Times: those at Wake Forest University Baptist Medical Center in North Carolina and Montefiore Medical Center in New York. The heart program at St. Louis University Hospital, faced with a loss of funding, agreed to withdraw from Medicare.
Wake Forest and Montefiore were subsequently given extra time to make changes to meet Medicare standards.
Medicare's latest actions, made public Wednesday, show the "continued effort on behalf of the agency to make sure we're getting the best care we possibly can for Medicare beneficiaries," said Herb Kuhn, the agency's acting deputy administrator.
Articles in The Times over the last year have exposed excessive deaths at individual programs and lapses in oversight that have allowed subpar programs to continue operating. The articles have prompted investigations ordered by Sen. Charles E. Grassley (R-Iowa), now ranking minority member of the Senate Finance Committee.
In a statement Wednesday, Grassley said he is "heartened that the Medicare agency is taking action."
Some experts have suggested that there may be too many transplant centers in the U.S.
Each program notified this week performed fewer than 12 surgeries last year, the minimum set by the federal government, although all said they meet Medicare's survival thresholds.
Each program can maintain its certification if it submits an acceptable corrective plan, the letters said. Such a plan must include an explanation of why the program failed to meet Medicare standards in the first place, as well as short-term and long-term measures to ensure that it complies with the government's standards.
Without the Medicare agency's approval, it can be difficult for a transplant center to secure private insurance contracts or even stay open.
All four programs have said they will submit corrective plans, which will probably head off a loss of funding, at least temporarily.
For its report in June, The Times examined the total number of transplants performed in 2005 by each Medicare-approved center, as well as survival statistics made public in January 2006 by government-funded transplant researchers.
All of the information is available on the websites of the United Network for Organ Sharing and the Scientific Registry of Transplant Recipients.
Hartford Hospital spokeswoman Lee Monroe said the heart program there has already taken steps to help it meet Medicare standards, including hiring a new director to oversee heart-failure patients and encouraging local cardiologists to refer their patients there.
Dr. Janis Orlowski, chief medical officer at Washington Hospital Center, said her hospital also has hired a new physician to oversee its heart-failure program, including transplants. Two more specialists were also added to the staff.
A BryanLGH official said his program had never met the government's volume standard. "It's never been an issue till now," said Eric Hoesing, the hospital's director of cardiac and vascular services.
"I fully support quality patient care. I fully support good outcomes," he said. "But volumes are not the only indicator."
For its part, Sutter said it would soon begin offering heart devices that help keep patients alive while awaiting transplants, which should make it less likely that they will seek treatment elsewhere.
"Nobody wants to go to San Francisco or Los Angeles for a heart transplant from this area," said Dr. Douglas Schuch, the heart transplant program's surgical director. "It's just too much of a burden for them."
For previous coverage of organ transplants in The Times, please see www.latimes.com/transplants.