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Medicare Rules Make Offsite Organ Recovery Costly

Cheryl Clark, for HealthLeaders Media, March 26, 2014

Gene Ridolfi, director of the Barnes Jewish Hospital's organ transplant program in St. Louis, where the nation's first off-site organ procurement center was built in 2001, says his hospital is among a rare few that allow brain-dead organ donors to go to the St. Louis center for organ recovery, even though "we're well aware that it's costing us money, and it's a significant amount of money."

For any hospital, he says, it "can be" in the millions of dollars depending on how many donors are cared for at any given hospital. Barnes Jewish is taking the loss, Ridolfi says, because "we think it's a better model for multiple reasons."

"Donors are better managed in the OPO than in our ICUs, because that's what they do. And we think in many cases it's better for the families because [the process] happens much quicker.

"And our ICUs (where brain-dead donors are kept until surgery if they are not transported to the OPO center) are near 100% capacity. If we have a brain dead donor, it behooves us to make room for someone we might be able to save, where we have extremely busy operating rooms."

Ridolfi says that surgical procedures to recover organs at Barnes Jewish Hospital "tend to disrupt operating room schedules and delay other cases, so we've recognized all of this as beneficial for us."

Maria Majella Doyle, MD, a liver transplant surgeon at Barnes Jewish Hospital/Washington University, says that when the St. Louis OPO started the off-site recovery center, "no one realized there would be a reimbursement issue." Now, she says, Barnes Jewish and other hospitals "realize how much they're losing, but the system is so streamlined that going back to the way it was is something none of our transplant surgeons would agree to."

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