If the garage that does routine repairs on your car doesn't work on transmissions very often, you'd think twice about going there for a new transmission. How about a hospital that calls itself a transplant center–would you want a new heart or liver or kidney installed in your body at a place that's done the job a handful of times in the past year or two?
Right. Neither would I. Yet many centers do few hearts or lungs or livers. During 2004 and 2005, seven designated adult kidney transplant centers in the United States performed no kidney transplants whatsoever.
Somehow I doubt that government regulators would care to be treated at such places. But hospitals that collect Medicare payments for doing transplants have never had to meet explicit national standards for how many procedures they have to perform and how well they must do them. Don't look for strict criteria for decertifying transplant programs, either. The Organ Procurement and Transplantation Network, a private group that oversees U.S. transplant activity and reports to the federal Department of Health and Human Services, has recommended exactly twice in more than 20 years that a hospital should be deleted from the transplant center rolls.
Thankfully, this state of affairs will change on June 28, when the Centers for Medicare & Medicaid Services will begin holding hospitals designated as Medicare transplant centers to certain standards. The requirements should benefit patients without burdening hospitals.
Newly created standards for the volume of procedures and the quality of outcomes are the most important. It seems reasonable to call for a hospital to perform at least 10 of the more common transplants in 12 months, such as heart and liver, in order to be approved. (There's no volume requirement for rarely done transplants such as heart-lung and pancreas.) Approval lasts three years, during which a hospital will have to average 10 transplants per year to get another three-year thumbs up.
Quality is defined as the number of patient deaths and failed transplanted organs at the one-year mark compared with the results expected when adjusted for patient risk. If there's a sizable unfavorable gap, a transplant center's performance will be considered unacceptable, and its status as a Medicare transplant provider will be in doubt. It seems to me that this is exactly what a reasonable person would want before going under the knife.