St. Mary’s Medical Center in West Palm Beach, Fla. had no choice but to close down its Pediatric Cardiothoracic Surgery Program in August after an investigation conducted by CNN. It led other hospitals with low volume of congenital heart operations, fewer than 100 per year, to be placed under scrutiny. These hospitals are pressured by more renowned hospitals, such as Johns Hopkins and Texas Children’s Hospital, to cease these risky procedures or shut down their programs because of their success rates. The investigation exposed that these hospitals are non-transparent and sometimes deceptive about mortality rates. Because of this, the existence of their congenital heart health care is threatened.
A Freedom of Information (FOI) inquiry that CNN filed revealed a 12.5 percent death rate at St. Mary’s. This was four times the national average of 3.3 percent. The Society of Thoracic Surgeons estimated children mortality rates, ranging from 1.4 percent to 12.1 percent, in 107 hospitals, including St. Mary’s. Only 47 of these hospitals, which had the highest success rates, were willing to reveal their death rates.
Health care has been more accessible to citizens with the Affordable Care Act; however, due to the heavy influx of new patients, the quality of patient care has been getting worse, according to the Institute of HealthCare Consumerism. The increase in patients can be positive because of higher pay, but for some doctors, it may be more than they can handle. In addition, more patients mean less time. Researchers from Johns Hopkins University and the University of Maryland shadowed doctors to calculate the average time spent with patients. Their assessment showed that less than 10 minutes were devoted to patients.
Urging less prestigious hospitals to stop performing pediatric heart surgery would force these patients to go elsewhere. Optum, a health services firm, created a list of 19 hospitals that they considered “Centers of Excellence.” These hospitals are known to have the best congenital heart disease programs, and are spread throughout the U.S. If hospitals followed suit after St. Mary’s and started to close down their programs, families might have to travel extensively just to have their children treated. Some private insurance companies, such as Aetna, are starting to suggest Optum’s 19 Centers of Excellence to their clients. Although the expenses are covered, this would take a toll on surgeons, because of the volume of patients. The Centers for Disease Control and Prevention approximated 40,000 babies with congenital heart defects per year. The 19 Centers of Excellence could not possibly handle this overwhelming number of patients.
These services are more in demand now than they have been before. Congenital heart defects are one of the leading causes of infant deaths, according to the Children’s Heart Foundation. Approximately 100-200 deaths occur each year because of unrecognized congenital heart defects and more than 25 percent babies need surgery. Despite the large number of babies with congenital heart defects, the number of cardiothoracic surgeons is very limited and continues to decrease.
The American Heart Association predicted a shortage of cardiothoracic surgeons by 2020 because of a lack of well-trained surgeons. Grayson H. Wheatley and Edward B. Diethrich reported in their journal, “How to retrain the cardiothoracic surgeon,” almost 20 percent of graduating cardiothoracic residents did not receive job offers mainly because of outdated training. These residents lacked the skills needed for the constantly evolving field. The Society of Thoracic Surgeons has been urging Congress for provisions in a healthcare reform legislation that would also be advantageous to students studying in specialties such as cardiothoracic surgery. The average cost of attending medical school is around $200,000. Students studying in this field should receive some sort of loan forgiveness or an alternative repayment program that would be less burdensome, especially if retraining becomes a necessity.
There is also a need for strict supervision and improvement of pediatric heart surgery programs that are already running. Hospitals with prestigious congenital heart healthcare should extend aid rather than shutting down poorly performing programs as the National Health Service did in Britain. Hospitals that perform fewer than 100 operations per year will inevitably have less experience and be more prone to making mistakes, resulting in higher death rates. Many of these low-performing hospitals are also understaffed. St. Mary’s, for example, only had one surgeon in charge of pediatric heart surgery. Transferring surgeons instead of transferring dying patients might be a step in strengthening the field across the nation instead of one localized area. So far, the majority of the Centers of Excellence are located in the northeast with very few, or none, in the west. In addition, high-performance hospitals should provide a means for surgeons with less experience to learn. In 2013, St. Mary’s only had 23 operations. There is little room for growth when a surgeon has only 23 procedures, while some others may have more than 100. Extending the programs out to low-volume hospitals to train inexperienced surgeons would ease patient distribution and lower death rates based on incompetency.
Without a doubt, these operations all come down to money. Money should be an incentive, but not the sole reason for maintaining these unsuccessful pediatric heart surgery programs. In a study conducted at Emory University, researchers revealed that one of the riskier procedures, the Norwood, can bring in more than half a million dollars with just one operation. According to Optum, one child with heart defects could be charged more than $5 million over a year. In addition, hospitals with higher mortality rates are more likely to charge over $1 million per case because of extended stays. Even though this may be the case, these low-volume hospitals do not perform enough procedures to greatly benefit from the income, nor are they capable of complex procedures, such as the Norwood. Dr. Roger Mee, a former Cleveland Clinic surgeon, told CNN that doctors are pressured by administrators to keep the money-winning patients at the hospital. Although one surgeon’s mistake may benefit a hospital in terms of money, it does not improve their quality of care and negatively affects their prestige.
All hospitals, regardless of success rate, should be required to reveal mortality rates. This would force hospitals to focus on the quality of their practice rather than the quantity. It could also decrease malpractices. Overall, shutting down unsuccessful pediatric heart surgery programs may prove to be the easiest route, but it would leave families with fewer options and more risks.