Strict Rules Proposed for Medicare Compensation in Heart Transplants

Hospitals that want Medicare to pay for heart transplants would have to perform a dozen or more transplants a year and achieve a 73% survival rate under rules proposed by the government Friday.

The rules are “fairly restrictive,” said Otis R. Bowen, secretary of the Health and Human Services Department. Officials expect only 10 hospitals to qualify for reimbursements for transplants, which cost from $100,000 to $200,000.

“We want to select facilities which have the necessary experience and expertise to perform this complex surgery successfully,” Bowen said.

Patients Must Be Screened

The government announced in June that it was reclassifying heart transplants from an experimental procedure to an accepted medical treatment. But it also stipulated that patients must be carefully screened before the government picks up the bill.

About 719 heart transplants were performed in the United States last year, seven times the number performed in 1982.

Federal officials estimate that Medicare will pay for 65 transplants this year, with the number rising to 143 by 1991.

Heart transplants have become almost routine at several university medical centers, including Stanford Medical Center in California and Baylor University College of Medicine in Houston.

Rules May Hinder Hospitals

Several hospitals are scrambling to get into the transplant business, but the proposed Medicare rules published Friday in the Federal Register may make it harder for many to get started.

To get Medicare’s recognition as a heart transplant facility, a hospital would have had to perform transplants on 12 or more patients in each of the two preceding years and 12 patients prior to that, with average survival rates of 73% after one year and 65% after two years.