Louisville’s only adult organ transplant center is in jeopardy
by Morgan Watkins, Louisville Courier Journal –
The University of Louisville may soon stop providing important medical services at Jewish Hospital — a move that could jeopardize the only adult organ transplant center in the city.
All of the physicians who perform lung, kidney, liver, pancreas, heart and dual organ transplants at Jewish Hospital are employed by U of L, according to the university.
But U of L President Neeli Bendapudi announced in November that the school had begun a process of transitioning certain medical services to University of Louisville Hospital and elsewhere, given “the current uncertainty around” Jewish, which is up for sale.
There are three transplant centers in Kentucky. If U of L transfers some clinical programs to other facilities, that could have a serious impact on the transplant center at Jewish, according to two local doctors.
“If the university is no longer providing the surgeons to do transplants, then there’s nobody to do the transplants at Jewish Hospital. It’s not like you can bring in somebody overnight,” said Dr. Wayne Tuckson, a colorectal surgeon employed by KentuckyOne Health, which owns Jewish.
Negotiations to sell Jewish Hospital to a hedge fund began last December, but KentuckyOne hasn’t announced a deal yet. Some local doctors have speculated that the historic facility, which opened in 1905, is likely to close as its financial losses mount, although the president of Jewish has said a shutdown is not planned.
University leaders have spent months developing contingency plans to move the six U of L clinical programs that are housed at Jewish, university spokesman Gary Mans said.
“The goal is to provide long-term stability to our educational, research and clinical programs in cardiology, cardiovascular and thoracic surgery, motility/gastroenterology, neurosurgery, physical medicine and rehabilitation and solid organ transplant,” he said.
Two major, multimillion-dollar contracts between the university and KentuckyOne are set to expire at the end of this month.
Under those agreements, KentuckyOne agreed to provide a minimum of about $35.6 million to the university for 56 medical resident positions at Jewish Hospital and the Frazier Rehab Institute, as well as for a variety of services performed by U of L employees, including heart and brain surgeries.
For example, KentuckyOne agreed to pay $1.05 million for “cardiovascular surgical services” that university personnel provide to patients at the hospital. Also, U of L physicians serve as medical directors for the lung and liver transplant programs at Jewish.
“An agreement is not required for U of L physicians to practice at Jewish Hospital, and we welcome and encourage their continued service. Our desire and intent is to continue to provide comprehensive services for the community,” KentuckyOne spokesman David McArthur said. “If the university chooses to relocate their physicians to other area hospitals, it will impact the services available at Jewish Hospital.”
McArthur stressed that KentuckyOne is still in “productive discussions” with university officials. And both parties already managed to find common ground concerning the hospital’s role as a training ground for U of L medical residents.
KentuckyOne has agreed to provide funding for 56 residents to work at Jewish Hospital and the Frazier Rehab Institute for six more months, starting Jan. 1.
If U of L pulls out of the hospital, Tuckson said Jewish would stop doing organ transplants as well as certain complex cardiac surgeries — at least for the foreseeable future — because the surgeons who perform them are university faculty members.
But university doctors aren’t the only ones who perform surgeries at Jewish, he said. Other physicians would still be there doing surgical cases, although it would take the hospital a while to recover from U of L’s departure.
“I don’t want to see the University of Louisville leave. I think it’s good that they’re there,” he said. “But if they do decide to leave, I think Jewish Hospital can survive — just in a different form.”
It’s no secret that Jewish Hospital has been struggling financially. Catholic Health Initiatives — KentuckyOne’s parent organization — didn’t provide Jewish-specific data in its latest quarterly report. It did, however, detail the combined performance of Jewish Hospital and St. Mary’s Healthcare, which had operating losses of about $17.7 million for the quarter that ended Sept. 30.
Given the uncertainty about Jewish’s future, Dr. Peter Hasselbacher — a retired U of L medical professor — said it makes sense for the university to make contingency plans.
“Those services are so important,” he said. “Of course, they have to plan for what would be a major divorce.”
Transplants in trouble?
Transplants have been performed at Jewish since 1953, and they still keep the hospital busy today. Jewish did 159 transplants in 2017 alone, and it has over 400 candidates on a waiting list for organs.
“It would be a shame to lose that here in Louisville,” Hasselbacher said of the hospital’s transplant center.
U of L has been making contingency plans for its solid organ transplant program, but shifting such operations from one hospital to another isn’t an easy or quick process, according to Laura Aguiar, principal and managing partner of Transplant Solutions LLC, which works with transplant programs around the country.
Generally speaking, a hospital that wants to start doing transplants probably would need to get a “certificate of need” from their state government and also would have to become a member of the Organ Procurement and Transplantation Network, Aguiar said. Getting Medicare certification is also a priority.
“They have to prove that they have all the necessary services in place to support the program, including physicians and surgeons,” she said.
Transplant programs are expensive, and some hospitals aren’t equipped to — or interested in — running them, Aguiar said. She has seen cases in which a hospital closed its program and no other facility filled the void it left in the community, but she also has seen situations where other hospitals took on that responsibility.
The transplant center at Jewish Hospital is one of three that exist in Kentucky. The others are located at Norton Children’s Hospital in downtown Louisville, which does pediatric procedures, and the University of Kentucky in Lexington.
Officials at UK have said they would be there to help if anything happens to Jewish’s transplant program. When a specialty program closes, issues arise that often create barriers to care for some patients, including travel expenses, said Dr. Thomas Waid, UK HealthCare’s medical director for the organ failure and transplant network.
“UK HealthCare’s mission is to provide access to advanced and complex care for Kentuckians,” Waid said. “We stand ready to continue to partner with the physician community in Louisville to help maintain access to crucial clinical services in a way that best support patients.”
Both Tuckson and Hasselbacher indicated that Jewish would have to evolve if the university yanks its clinical programs.
“Jewish Hospital has billed itself as a high-tech hospital for as long as I’ve been here,” Hasselbacher said. “So what happens when your high-tech programs disappear?”
Tuckson suggested Jewish could become more of a community hospital, taking on fewer patients with complicated medical conditions and focusing on treating more common health problems as opposed to handling highly complex transplant and cardiac cases.
“You’ve got a lot of people who still need gall bladders taken out,” he explained. “You’ve got a lot of people who need their diabetes taken care of.”
Impact on U of L
Breaking away from Jewish wouldn’t just impact the hospital. It would affect the university, too, Hasselbacher said.
The school would lose out on millions of dollars that KentuckyOne pays not only for the services of U of L physicians but also for research efforts at the medical school, he said. (One of the agreements that expires soon says KentuckyOne agreed to pay $520,000 to support neurosurgery-related research and education activities, among other grants.)
Maintaining a presence in local hospitals is important for U of L from an accreditation standpoint, as well.
The Liaison Committee on Medical Education, the accrediting body for M.D.-granting programs, expects accredited medical schools to have sufficient clinical training resources for students, according to Dr. Veronica Catanese, the group’s co-secretary.
Losing a major training site like Jewish wouldn’t put an institution in immediate jeopardy of losing its accreditation, but Catanese said in September that schools in that kind of situation should notify the liaison committee and seek out new clinical opportunities.
Planning ahead, as the university has been doing, is the right move, Hasselbacher said, because failing to do so could have serious consequences.
“I would be highly critical of them if they weren’t,” he said. “That would be administrative malpractice, and it would really put the accreditation of some of their programs in jeopardy.”