The Sutter Heart Transplant Program gets recertified after an eight-month legal battle

Oct 22 2009

Larry Clymer's heart was just plum wearing out. The 60-year-old Rocklin resident needed a heart transplant, and a temporary machine was implanted in his abdomen to keep his heart beating until the right heart was identified.

Then, in February, Clymer received more devastating news. The federal Centers for Medicare and Medicaid Services (CMS) canceled Sutter Medical Center, Sacramento's contract for its Heart Transplant Program. That meant Clymer would need to get his transplant at a Bay Area hospital and would have to live in San Francisco for at least six weeks until he was well enough to return home. Then he'd be required to make regular visits to that hospital's transplant clinic for the rest of his life.

"Not only was Larry's situation physically and mentally draining," said Larry's wife, Abbie, "but it now also threatened to drain us financially. We faced losing everything we have."

However, the news just improved for Clymer and other Northern California heart patients. After an eight-month battle that first played itself out in the courts and then took a major, positive turn outside of court thanks in large part to Congresswoman Doris Matsui, D-Sacramento, CMS reviewed Sutter Medical Center's Heart Transplant Program and certified it anew.

"The Sutter Heart Transplant Program is a critical component of our region's health care system, and I am extremely pleased that by working together we have been able to keep the program in Sacramento," Congresswoman Matsui said. "As the only heart transplant program in the Valley, its location provides unfettered access for individuals in our communities to get the care they need - when they need it."

The 20-year-old Sacramento program that has transplanted 117 heart patients and produced some of the best success rates in the nation will now be able to transplant Clymer and other Medicare patients after the program's own life was threatened due to the CMS decertification in February. Heart transplant patients have come from Chico, Redding, Marysville, Stockton, Modesto, Reno and many other cities in California and Nevada.

CMS decertified the Sutter Heart Transplant Program because it did not meet its volume criteria of 10 annually. The decision was based solely on volume and did not take into account the excellent outcomes the program has historically had. The survival rate for Sutter Medical Center, Sacramento transplant recipients is 98 percent after one year and 90 percent after five years, compared with the national averages of 90 percent after one year and 75 percent after five.

For the past three years, Sutter Medical Center worked closely with state and federal governments to increase the program's volume. In 2007, Sutter Medical Center started a ventricular assist device program that includes a full range of devices to help extend patients' lives until they can receive a heart transplant. Clymer's machine is a HeartMate, a left ventricular assist device that does the pumping for the heart.

This CMS decertification only affected those patients who have Medicare as their primary insurance, and four Medicare patients on the heart transplant list were transferred to programs in the Bay Area. During the eight months, one patient was transplanted at California Pacific Medical Center.

While not all heart transplants are paid through Medicare, the decision by CMS put the entire program in jeopardy because insurance companies usually look for a hospital's Medicare certification in their own approval processes. Since the CMS decertification, Medi-Cal and private insurances worked with Sutter Medical Center on a patient-by-patient basis, and six patients have been transplanted so far this year at its Sutter Memorial Hospital campus.

Sutter Medical Center leadership took the decertification issue to the courts but determined that directly working with CMS to resolve this issue was better for patients and the community. With help from Matsui, CMS agreed to evaluate the current program for certification based on the hospital's efforts to grow the program and its excellent survival rates.

"Our positive outcomes are due in part to our successful team approach, including dedicated surgeons, cardiologists, nurses, transplant coordinators, and a very active post-heart transplant clinic," said Sutter Medical Center, Sacramento CEO Tom Gagen. "We have the sixth largest open-heart program in California, and this allows our surgeons to maintain competency and excellent outcomes in transplants and all other complex surgeries."

Sutter Medical Center, Sacramento also provides kidney, pancreas and bone marrow transplants. Those programs were not affected by the February CMS decision.

SOURCE Sutter Medical Center, Sacramento