MUSC could soon begin to offer heart transplants to Medicare patients again

August 10, 2017

Medical University Hospital has re-applied for Medicare approval for its heart transplant program, about 6 months after the federal health insurance program stopped paying for such surgeries due to the hospital’s low volume of heart transplant procedures.

Dr. Pat Cawley, CEO of the Medical University Hospital, told the MUSC Board of Trustees on Thursday that the hospital had completed the 10 transplants necessary this year to secure Medicare funding.

Cawley said in April that MUSC had chosen to appeal Medicare’s decision to cease payments, a process that can take about 18 months. There have been six transplants since mid-April, bringing the year’s total to 10. MUSC had continued to offer the transplants without Medicare funding. Patients paid either out-of-pocket or through private insurance.

Rather than wait for the appeal’s resolution, MUSC has re-applied. Cawley said he expects that application to be approved any day, given the program now has the sufficient volume and a 100 percent survival rate.

“We have the right numbers,” Cawley said.

In the United States, fewer than half of all heart transplants are paid for by private insurance, according to the federal Department of Health and Human Services. Most are paid through public health insurance, either through Medicaid, Medicare or Veterans Affairs.

Medicare’s decision to cease funding was made as of a larger effort to not fund “low volume” centers. Research shows transplant centers with higher volumes have better outcomes.

The Board of Trustees will reconvene on Friday morning, at which time a group of protesters called “Healthcare Workers United” is expected to speak out against a new pay plan that will compensate MUSC doctors based on the number of patients they treat.

“The new pay per patient is a concern for us all,” the group said in a press release.

One of the group’s leaders, longshoreman Leonard Riley, accused the Board of Trustees of ignoring doctors’ concerns.

“Inevitably, patients will pay the highest price,” Riley said.

Some doctors have refused to sign their new contracts. Others have threatened to leave the hospital. MUSC leaders recently extended the deadline for doctors to sign their paperwork to Aug. 15. As of Aug. 4, more than 100 had not yet signed.