Lawmakers intervene in bid to retain transplant services

Nevada's only kidney transplant program might have a lifeline.

Rep. Jon Porter, R-Nev., said Wednesday he has had productive conversations twice in two days with Centers for Medicare and Medicaid Services, the agency that informed University Medical Center that certification for its transplant center is being revoked effective Dec. 3.

Porter said in one of his conversations with CMS, he received assurance that the investigation of UMC's transplant program would be re-examined.

"The acting director has committed to me that CMS will review the whole investigation to ensure it was handled appropriately,'' Porter said. "I have made it clear to CMS that this is a critical program for Nevadans.''

Porter, along with Reps. Shelley Berkley, D-Nev., and Dean Heller, R-Nev., sent a letter to CMS urging the federal health agency to reconsider its decision to decertify the transplant program.

Porter met with Kerry Weems, CMS' acting administrator, on Tuesday in Las Vegas. He spoke with CMS officials again Wednesday while back in Washington.

David Cherry, a spokesman for Berkley, said the congresswoman is scheduled to meet with CMS officials sometime today. It was unclear whether Heller would be speaking with CMS.

Porter said "key areas" that concern CMS about the state's transplant program were discussed. Those concerns center around the federal agency's belief that UMC is not meeting minimum required patient survival outcomes.

According to health surveys in March and August, the transplant center's death rate for kidney transplant recipients was significantly higher than its expected death rate, based on federal standards.

According to CMS officials, when the March survey was conducted, it was noted that five patients had died within a year of their kidney transplants. The same statistic was noted again in the hospital's August survey.

The expected death rate for that time period, taking a number of factors into account such as the patient volume and age of patients, would be 1.81, according to CMS.

Kathy Silver, the hospital's chief executive officer, says her understanding is that UMC's expected death rate should be 4.8.

Using that calculation, Silver said UMC would be well within the federal guidelines.

"It doesn't work that way,'' Silver said referring to the calculations CMS used to come up with the expected death rate.

Thomas Hamilton, director of CMS' Survey and Certification Group, says UMC is referring to a calculation method that is used for transplant centers that are new. This higher threshold, he said, helps new programs with a low volume of transplant patients get easier entry into the Medicare transplant program. Nevada's transplant center isn't one of the new programs, he said.

"You can't just pluck a number out of a data set that you don't like. ...That's manipulating the data. The real issue here is whether or not the transplant center has an effectively functional program that provides acceptable levels of quality of care,'' Hamilton said. "To that end, we've offered them an opportunity to voluntarily withdraw and request reinstatement as soon as they have an effectively functioning program. ... We look forward to that day.''

Unless lawmakers can dissuade CMS from decertifying the transplant program, UMC plans to voluntarily withdraw its transplant program out of Medicare. Since Medicare pays for nearly 100 percent of the costs of transplants at the hospital, the program will be lost.

If the hospital chooses to re-open the program, it would have to undergo recertification, which could take years. Either way, the move leaves more than 200 people awaiting kidney transplants in Nevada in limbo. Their option would be to travel at least 300 miles to an out-of-state facility.

Silver, who said there will be a conference call today between UMC and CMS officials, praised the state's congressional delegation for its help.

"We're cautiously optimistic,'' she said about UMC's transplant program staying operational. "We have at least go them (CMS) to take a step back and take a look at maybe something was overlooked. That's all we're asking for.''

Contact reporter Annette Wells at awells@reviewjournal.com or 702-383-0283.