Raising the ante in L.A.'s competitive world of heart transplants, Cedars-Sinai Medical Center plans to open a clinic this November that hospital officials hope will boost its share of the transplant business.
Dubbed a "heart failure clinic," the $500,000 outpatient facility is designed to improve the treatment and diagnosis of critical cardiac patients. In turn, some of these patients may become candidates for transplant.
Transplant programs are no small consideration for major L.A. hospitals. While six area facilities perform heart transplants, industry officials say Cedars clearly seeks a bigger share of the market, which is currently dominated by nearby UCLA Medical Center.
UCLA, which pioneered the heart failure clinic concept 14 years ago to help cut the costs of dealing with heart failure patients, performed 102 transplants last year more than any other U.S. hospital and more than all other L.A. County hospitals combined.
"We operate in a competitive market," said John Edelston, president of Health Pro, a health care consulting firm based in Woodland Hills. "The hospitals have to be competitive to stay in business, and having a high-profile specialty like heart transplant is good for public relations. It brings more patients into the hospital for other things."
Cedars-Sinai doesn't dispute the P.R. value of the new clinic.
"It will let the community know we are a center of excellence," said Dr. Americo Simonini, director of the heart failure clinic. "It will elevate our stature in the community. There are people who might think that it is better to just have one center in Los Angeles for heart transplants. But if you take all of the patients and refer them to one center, then it limits the patient's ability to have choice."
Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center, which oversees the UCLA Clinical Heart Failure Program, said Cedars' new effort is no surprise given the rivalry between the two Westside hospitals. But he does not see the clinic as a threat.
"I think the fact that they want to start a heart failure program is further validation of the winning formula at UCLA," said Fonarow. "Our program has such a strong relationship with our referring physicians, it won't impact us. The overall impact will be that it will improve care in Los Angeles. Two or three centers of excellence is potentially worthwhile."
But Dr. Michele Hamilton, co-director of the UCLA Clinical Heart Failure Program, said the competition doesn't benefit heart failure patients.
"Six heart transplant programs in Los Angeles is a vast waste of resources," Hamilton said. "It takes a huge amount of resources to perform a heart transplant. Programs that only do a few transplants a year cannot expect to have the same knowledge. If you just had a few transplant centers you could provide an even higher quality of care with a lower overall expense."
Indeed, a heart transplant can cost anywhere from $100,000 to $150,000, without complications, and up to $1 million with a case that requires months of hospitalization.
Over the past 10 years, Los Angeles has emerged as the nation's largest heart transplant center. Last year, more transplants were performed in L.A. 183 than anywhere in the country, according to the United Network for Organ Sharing, a non-profit organization that keeps the nation's donor list.
The large urban population, the massive freeway infrastructure and resulting traffic fatalities and all those medical centers contribute to the high numbers.
"We have more donors and more deaths," said Eric Marton, executive director of the UCLA Clinical Heart Failure Program. "It is the nature of living in a large urban population that derives donors. Typically, all of our work comes from local hearts. It is quite unusual to travel long distances for a heart."
More than 4,000 people are waiting for heart transplants in Southern California, according to UNOS. The average wait for a heart transplant for critically ill patients is about two weeks. Less critical patients can wait up to a year, UNOS said, and 20 percent of the patients die waiting for a heart donor.
In addition to Cedars and UCLA, transplant operations are performed by Loma Linda Medical Center, St. Vincent Medical Center, USC-University Hospital and Children's Hospital of Los Angeles.
Health care analysts say that a heart transplant program is the most prestigious specialty a hospital can offer. And prestige programs bring in more patients, who in turn bring in more revenue to the hospital.
"Everybody wants prestige, that is why everyone is competing to make their program the most successful," said Steve Valentine, a health care consultant with the Camden Group in El Segundo. "It also will indirectly bring added revenue to the hospital."
Simonini defends Cedars' decision to start a heart failure clinic, saying that the hospital is already treating heart patients and that the clinic will help cut costs and improve care.
With a clinic, he said, the average number of admissions can be cut in half or more because the patients are closely monitored by cardiac specialists on an outpatient basis.
Heart failure occurs when the heart does not pump enough blood for the body to function properly. In mild cases, it can be treated through medication, but in severe cases it requires a transplant.
At the new Cedars clinic, heart failure patients will have on-call access to specialists 24-hours a day. And since research is being conducted at the clinic, patients will have access to the latest drugs and procedures.
"Many patients can be managed more efficiently," said P.K. Shaw, director of cardiology for Cedars. "And considering heart failure takes up one-third of the hospital's budget, it is very important to reduce costs wherever it is possible."
Cedars' center will have 5 full-time physicians on staff and more than 100 affiliated cardiologists. The goal is to bring 35 to 40 new heart failure patients into the clinic annually. The clinic will also be involved with cardiac research and clinical trials.
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