A crusade by the wife of a former hospital administrator appears to have paid off for a Kansas hospital, which won Medicare approval of its heart transplant program even though it didn't meet all federal standards.
Last November, 637-bed St. Francis Regional Medical Center in Wichita, Kan., became the first hospital in the state at which Medicare will pay for heart transplants.
Medicare asks hospitals to meet several standards for heart or liver transplants. Its approval process, in effect since 1987, is meant to ensure that hospitals can perform the difficult procedures. It's rare, but not unheard of, for Medicare to grant exceptions to the standards, a Medicare official said.
St. Francis fell short of Medicare's requirement that a hospital perform at least 12 heart transplants for three consecutive years. St. Francis met the minimum last year and in 1991 but performed only seven transplants in 1992, said Marsha Richardson, its cardiac transplant coordinator.
HCFA's approval of St. Francis followed a vigorous campaign by a Kansas resident, Lisa Stevens John, whose husband, Dru, 40, needs both a new heart and a new kidney.
St. Francis applied for approval several months before Ms. John contacted newspapers, members of Congress and state legislators on its behalf, Ms. Richardson said. It also had applied four years ago, but wasn't approved.
Exemplary survival rates at St. Francis justify the exception, said Robert Wren, director of HCFA's office of coverage and eligibility. "In no case has pressure, political or otherwise, had anything to do with approval," Mr. Wren said. "It's a quality issue."
Managers at St. Francis agree. So do Ms. John and the legislators who answered her cry for aid. St. Francis, they said, would have won approval on its own-eventually.
"(The Johns) did make a big impact," said Cindy Hagerty, St. Francis' cardiac transplant manager. "But it wasn't just them. We had a lot of patients calling and writing. And the endeavors that came from this office! That application was not easy."
Medicare approval of the St. Francis program means that Mr. John can receive a transplant 80 miles from his home in St. John, Kan. Otherwise, he would have been forced to travel 250 miles to Kansas City, Mo., for surgery at the nearest authorized facility.
Such journeys can't always be made during the time in which an organ is available, Ms. John said. The distance also makes it more difficult for families to be near patients. Travel adds to the cost of heart transplants, which already are extremely costly. The transplant, drugs and other healthcare expenses typically cost $150,000 in the first year after the procedure.
For St. Francis, Medicare approval means it eventually could perform more heart transplants, a profitable enterprise. One reason is that the more people who are on its waiting list, the more likely a donor organ will match one of the potential recipients, Ms. Hagerty said.
Mr. John's kidneys failed nine years ago. He left his job as administrator and controller at 232-bed Eastwood Hospital and Medical Center, now Vista Hills Medical Center, in El Paso, Texas. In 1989, he moved to St. John to be near his parents. Last year, he had triple-bypass surgery to repair a heart damaged by years of dialysis.
In August, Mr. John was told that he would need a double transplant. Ms. John, the editor of a small weekly newspaper, began her campaign.
"I feel that St. Francis would have gotten there on its own accord," she said. "But what if it didn't? And what if we didn't do anything?"
Her campaign included letters to 122 Kansas newspapers. The letters, titled "Medicare's significant omission," asked why Kansas had no Medicare-approved facility, while other states had several.
Ms. John also wrote Kansas legislators, several of whom said they contacted HCFA to learn the status of St. Francis' application. In late October, first lady Hillary Rodham Clinton and lawmakers met in Kansas City, Mo., to talk about healthcare reform in a public forum. There, Ms. John pleaded her case to Sen. Nancy Landon Kassebaum (R-Kan.).
"I think that was the turning point," Ms. John said. "We are very, very grateful for everything they did do. I would say they pulled strings."
The healthcare aide to Ms. Kassebaum disagreed with that conclusion.
"HCFA's wheels had been going pretty slowly," said Jane Williams, the aide. "Our office was able to move the process along a bit. But it was very much informational."
As of late last week, Mr. John was on St. Francis' waiting list for transplant organs.