Financial and operational stresses at Jewish Hospital likely to be taking a toll on one of the headline partnerships between the Hospital and the University of Louisville. Increasing dependence on Medicaid patients and a blossoming load of uncompensated care may be blocking access for the medically indigent and recipients of color for at least some solid organ transplants such as heart and liver.
Since the middle 1980s when I came to Louisville, Jewish Hospital has branded itself as a high tech “Heart Hospital.” It promotes the early adoption of high-technology. Indeed, a few years ago it received a special designation as a heart hospital in Kentucky from U.S. News & World Report that it would not have received had it not had a cardiac transplant program. In the middle 1990s, the University of Louisville formally shifted the private practice activities of its cardiologists to Jewish Hospital. The transplant surgeons at Jewish, to my knowledge, all have formal University faculty appointments. Jewish Hospital and the University of Kentucky Hospital are the only two hospitals in the state with a Certificate of Need (CON) for adult human solid-organ transplantation. (The University of Louisville does not own this CON for transplant.) Accordingly, this high-profile program is both important for, and a marker of the institutional health of both Louisville institutions.
For this and for other reasons, I have been writing about Kentucky’s transplant programs for the last few years. Most medical schools with a major clinical medical center consider having a transplant program as an important part of their service profile. I became concerned that although in the 1990s through 2010, Jewish Hospital performed the most such organ transplants in Kentucky, that a steadily-growing UK program overtook our own as early as 2010. My academic pride was injured. My concern included that a weakening Jewish Hospital was losing the resources or the will to continue this important program. It is after all an expensive undertaking.
Frankly more troubling to me was additional proof confirming that without high-end medical insurance, transplants were effectively being denied to the poor or uninsured even as their organs were accepted for the use of others. In the early 2000’s, I confirmed that Jewish Hospital would not accept a Medicare patient for transplant. An analysis by me in 2015 confirmed that in Louisville and elsewhere, ones financial or socioeconomic status limited ability to receive a transplant. I termed this practice the “Reverse Robin Hood” approach to of human organ transplantation.” Organs were being harvested from the poor for use by the rich. Harsh words indeed, but compatible with the frankly racist heritage of our medical system here and elsewhere in which the poor or people of color have been segregated to a single hospital that few others seemed willing to use. (I have met older doctors who told me of racially segregated wards in the old Louisville General.)
The future of Louisville’s transplantation program is undoubtedly one of the major issues to be dealt with as KentuckyOne Health and Catholic Health Initiatives (CHI) sell off both of their acute care hospitals and their outpatient medical centers in Louisville. The CON is itself an asset that will be part of the sale of Jewish Hospital – should that hospital be sold or remain as an acute care hospital. I therefore went back into the truly massive collection of data related to transplantation maintained by the United Network for Organ Sharing (UNOS), and its associated Organ Procurement and Transplantation Network. In brief, what I learned is that since 2008, when both programs were doing the same number of transplants overall, that Jewish Hospital is at best treading water and UK is booming. I am concerned that the number of heart transplants done in Louisville is low enough that surgical teams may not be getting enough practice, that the procedures cannot be done cost effectively, or that accreditation may be in jeopardy. In 2016, the last year for which complete data is available, only ten heart transplants were done– none of them to black recipients. I will present and discuss the data below, but I have grave concern about the relationship between socioeconomic class and access to healthcare. I do not know what our Louisville healthcare landscape will look like when the departure of KentuckyOne Health is complete, but perpetuating a dual standard of care would be an anathema to me– and should be to all of us. In all of this, I venture no opinion about the quality of surgical outcomes, nor how traffic flows (or not) through the waiting lists, but data is available that can address those aspects. Continue reading “Louisville’s Human Organ Transplant Program Stagnates As Lexington’s Grows”