Spectrum Health Heart Transplant Program Earns CMS Recognition

The Spectrum Health heart transplant program reached another milestone this week when it received Medicare certification.

The Center for Medicare Services (CMS), issued formal certification this week. They conducted an onsite quality review of the program in January, evaluating procedures, care, standards and outcomes. In addition to meeting CMS’ quality standards, the certification allows Spectrum Health to receive Medicare reimbursement for heart transplants.

The certification was given without citations, meaning the CMS review found no issues with Spectrum Health’s transplant program that required correction.

“To receive Medicare approval without citation is a significant accomplishment for any heart transplant program. However, this is quite remarkable considering our program is not even two years old.” said Michael Dickinson, MD, medical director of Spectrum Health’s heart failure program. “It’s a direct reflection of the commitment to excellence shared by everyone in our program.”

The transplant program requested a CMS review in July of 2011, after Spectrum Health’s 10th transplant. CMS requires a program perform 10 transplants before requesting review. Fifteen transplants had been performed by the time CMS visited in mid-January but the total is now 17. Spectrum Health performed its first transplant in November of 2010.

Another benefit of the Medicare certification is that the transplant program will receive better reimbursement from commercial health insurers. Most commercial insurers wait until a heart transplant program receives Medicare approval before paying for transplants.

Spectrum Health is a not-for-profit health system in West Michigan offering a full continuum of care through the Spectrum Health Hospital Group, which is comprised of nine hospitals including Helen DeVos Children’s Hospital, a state of the art children’s hospital that opened in January 2011, and 190 service sites; the Spectrum Health Medical Group and West Michigan Heart, physician groups totaling more than 600 providers; and Priority Health, a health plan with 625,000 members. Spectrum Health is West Michigan’s largest employer with more than 18,000 employees. The organization provided $176.5 million in community benefit during its 2011 fiscal year.