Part One Of Three
Once you are diagnosed as a candidate for heart transplantation, it is only natural to wonder what the best heart transplant centers are. In a perfect world, we could identify the best heart transplant hospitals and choose the center where we had the best chance of a successful outcome. In the real world, our health insurance carriers pretty much determine where we can receive the transplant, the pre-transplant care and the best post-transplant care. In the business of heart transplantation, there are many factors that the prospective recipient needs to consider. These considerations are financial, practical, and personal and are based on the patient’s knowledge of the industry and a specific center or physician.
My home base is Albany, New York. Before I entered into end stage, congestive heart failure, Albany Medical Center was performing very successful heart transplants. Unfortunately, the heart transplant surgeon was creatively interpreting the OPTN and UNOS guidelines and the program was closed.
That left me in a position where I needed a heart transplant but there was no transplant center in my health plan’s theater of coverage. Under the Capital District Physician’s Health Plan (CDPHP) coverage, this afforded me the opportunity to select a transplant center outside the immediate area. The hospital had to be qualified as a “Center of Excellence.” It is this availability that allowed me to originally list at Columbia Presbyterian in New York and later at Tampa General, both Centers of Excellence for my carrier.
I remember asking my Albany cardiologist where he recommended I go. What was interesting was his spur of the moment analysis of the best center for me.
- One that the insurance carrier covered.
- A center where heart transplants were done very regularly and not one or two per year.
- A center where the geographical location fit my support network.
As I mentioned, I was fortunate to have CDPHP coverage and their strong prescription coverage. This is one very client-based insurance carrier. When I listened to the war stories other patients told me, I thank my lucky stars for CDPHP and their transplant coordination program. I was never disappointed by the sincere and valuable advice the CDPHP coaches provided.
You may not be as lucky as I was. However, you must open a line of communication with your carrier. It is your responsibility to make a contact and work with that contact to make sure you are within the bounds of your coverage. This is one thing that you can do for yourself. Dealing with the carrier yourself will make sure you get all the information you need to make decisions. Of course, you should be completely up to speed on your coverage, but in these critical times, you want to know the parameters of your coverage.
As far as your support network, circumstances can change as you move through the wait list. People’s lives are happening. The real life people in you support network have lives that are ever-changing. They move, they become pregnant, their children require more time. They lose their job. Anything can happen.
In my case, I was out of network and out of my base camp. You may not want to admit it, but you will need help before the transplant and after. In most heart transplant centers, you are required to be within one-half hour of the center for the first thirty days and sometimes longer. Tampa General wanted 24/7 care for at least 60 days. I was fortunate enough to find a flat on Davis Island within walking distance of TGH.
However, my bride had a business to run and family situations that required her presence. Fortunately, there is a direct flight from ALB to TPA. After taking slightly more than two years to get the call, my support group did not resemble my original network. My son left Fort Lauderdale for a position in New Hampshire. However, my new friends and neighbors who lived in the magical Merasol on Davis Island and “the scout” Suzanne were there at crunch time.
Each year, US News Health evaluates all the hospitals in the US based upon a comprehensive set of elements and by specialty.
Since the heart transplant, I have been asked to evaluate the three hospitals where I received cardiology care and more complicated care before and after the transplant. I have measured this question carefully. This is not an area of my expertise but certainly within my experience. In researching transplant hospitals, I found the 2011 US News Health report that ranks hospitals every year.
In part 2 of my post, I will discuss the results of their findings. What I liked about this report is that it established indisputable criteria for the rankings. Neither location nor cost played a role in the evaluations. The formula used by US News puts forth an objective rating for each heart transplant center. The US News Health scoring of each center deploys quantitative figures to rank the centers.
- Reputation with specialists = 32.5 percent.
- Survival = 32.65 percent.
- Patient safety = 5 percent.
- Patient volume and Nursing care = 30 percent.
In each category, the transplant hospital was assigned a value between 0 and 100.
Reputation and Specialists – This analysis consists of computing the percentage of board-certified physicians in cardiology, transplant surgery and other fields, including psychiatry and rehabilitation programs, connected to transplantation and recovery.
Survival – This is strictly a quantitative analysis of the rate of inpatient fatalities in the specialty area, in this case heart transplantation, within 30 days of discharge compared to the expected rate after adjusting the patient’s age, the severity of illness and other risks. A score of ten, means the center is in the top 10 percent in the nation.
Success in Keeping Patients Safe – This component is a reflection of how well the center manages six harmful medical events. Transplant hospitals in the top 25 percent score 3 points. Hospitals that score in the mid 50 percent score 2 points and the bottom 25 percent score 1 point.
Patient Volume – This component is based upon the number of Medicare patients treated in the specialty area in 2007, 2008 and 2009.
Nurse Staffing – This component is determined by the balance between registered nurses, bot for inpatient and outpatient care, and the daily number of patients treated. Inpatient RNs carry more clout because the needs of inpatients are more demanding. Temporary and nurses hired through an agency are not considered in the equation.
US News applies a few other important criteria to their ranking program.
- Advanced technologies within the specialty area.
- Patient services or services needed in the specialty field.
- Trauma center includes designation as a state-certified Level 1 or Level 2 trauma center.
- Intensivists for hospitals that provide a minimum of at least one intensive care unit and a physician with a specialty in ICU treatment.
- Transplant accreditation
- Diabetes and Endocrinology departments and their scores.
It is interesting to think about these criteria as you consider where to receive a heart transplant. As mentioned, there are other considerations. So, in this three part series, part 2 will reveal which heart transplant centers scored best according to the standards US News Health used. In part 3, I will add my own, practical insight about what I would look for in a transplant center today.