The Health Resources and Services Administration (HRSA) Best Practices Evaluation, conducted in 2007, states that transplant programs should meet the following six criteria:
①Institutional vision and commitment
-- “Hospitals cannot dabble in organ transplantation. They must commit to it fully and provide the resources and support necessary.”
②Dedicated transplant team
-- Attracting & retaining dynamic, dedicated and skilled specialists who consistently function as a team.
-- Collegial and nonhierarchical team provides the best care.
③Aggressive clinical style
-- For the care of patients before, during & after transplant is central to making best use of organs that are chronically in short supply.
④Patient- and family-centered care
-- Organize care around needs of patients and families, instead of around the needs of the institution.
-- Streamlining processes to reduce paperwork burden on patients; increasing educational opportunities for patients and families about lifelong care of the transplant; creating comfortable spaces in the hospital that do not isolate the patient from his/her family.
-- Rigorously detailed accounting of program finances, sound financial management, and excellent payer relations.
-- Leading centers consistently conduct improvement-oriented performance reviews based on protocols, data-driven quality control methods, innovation, and research.
The chart above shows the number of adult abdominal organ transplants for all the centers in New England through October of 2008. I am going to go out on a limb here and assert that a substantial number of these programs would not meet the HRSA criteria. I do not say this to insult anybody, but objective observers throughout the country would surely reach the same conclusion.
We hear over and over again from state officials and insurance company executives that they want to rationalize health care in the state, increase efficiency, reduce costs, and make it more patient-centered. Question: When are the state regulators and/or insurance companies going to step in and shut down some of these programs?