Medicare Compliance & Reimbursement

OIG calls for an overhaul of centers' centrification process.

Heads up, heart transplant centers.
     
Changes in the way the Centers for Medicare & Medicaid Services deals with you may be in the works -- and may be long overdue. If the HHS Office of Inspector General gets its way, effective immediately, CMS will be keeping closer tabs on centers' performance criteria for volume and survival rates. 

Medicare-approved heart transplant centers have not had performance or recertification criteria revamped since 1987. And in a final inspection report of 90 centers, the OIG pointed out several oversight deficiencies that put at risk CMS' ability to take action against errant facilities.
     
The report, titled "Medicare-Approved Heart Transplant Centers" (OEI-01-02-00520) found that half of the centers studied had gone below Medicare's minimum required volume of 12 transplants per year at least once, and 76 percent had dipped below the minimum first year survival rate at least once -- some for years on end. And while centers' performance criteria has been plummeting in recent years, CMS has likewise fallen behind in collecting data and updating its criteria. In a Jan. 20 letter to Acting Principal Deputy Inspector General Dana Corrigan, former CMS Administrator Dennis Smith pointed out that there were problems with the OIG's data because the survival criteria used in the evaluation did not take into consideration whether each center's patient mix was high or low risk.
           
However, Smith agreed that existing standards are outdated -- and therefore do not reflect the quality of organ transplantation in Medicare approved centers.
           
Don't be surprised if CMS starts moving to tighten controls. It's under pressure now to develop new standards for ongoing performance and recertification, new guidelines for enforcement actions against under-achieving centers, as well as improved exchange of volume and survival rate data.
           
To read the report, go to http://oig.hhs.gov/oei/reports/oei-01-02-00520.pdf.
           
Lesson Learned: Heart transplant centers can expect modernized performance criteria for survival and volume rates in the foreseeable future.