Monday Business Briefing: The ‘health care highs and lows’ edition, with more issues at U of L

The xxx website show Dr. Herzig, center, as still director. In fact, Hersig left for UK.

U of L’s Blood and Marrow Transplantation Program website shows Dr. Roger Herzig, center, as director. In fact, Herzig left for UK’s transplant program.

Welcome to the Sept. 8 Monday Business Briefing.

This is your private business intelligence briefing with Insider Louisville staff and contributors vetting tips collected during the past few days, hours and minutes before we post.

As always, we’ve made multiple inquiries on these tips, which come from sources who are not merely insiders, but who have direct knowledge of the deals.

If you’d thought it was too quiet in the medical world, you were right. Several issues are brewing, including possible accreditation problems for yet another piece of the University of Louisville’s medical empire.

U of L’s stem cell transplant program loses director

Recently, Monday Business Briefing started getting email inquires from physician sources asking why we weren’t covering the ongoing changes at the University of Louisville’s Blood & Marrow Transplantation Program at James Graham Brown Cancer Center, part of U of L partner KentuckyOne Health.

Those sources said Dr. Roger Herzig, former director of U of L’s marrow/stem cell transplantation program, left in July to lead the transplant program at the University of Kentucky.

You can see by this graph courtesy of Dr. Peter Hasselbacher at the Kentucky Health Policy Institute that the number of procedures at U of L’s program has decreased while UK’s has increased dramatically between 2008 and 2012, according to a Kentucky Annual Hospital Utilization and Services Report.

bmt-ky-1999-2012Sources tell MBB the Foundation for the Accreditation of Cellular Therapy (FACT) – the accreditation entity for the program – has notified U of L officials the bone marrow transplant program is both under-staffed and has insufficient activity to keep its accreditation.

U of L/KentuckyOne has an 18-month window to resolve the issues, according to our insiders. We tried to interview U of L media people, but their only response was to emphasize the program is not on probation. And it’s not. Let’s make that clear.

But we wanted to ask about Dr. Herzig’s departure, the decrease in staffing and procedures.

FACT standards require a minimum of two experienced physicians. Currently, there is only one physician listed on the Brown Cancer Center’s website, a relatively junior faculty member. There’s also evidence that the tension between U of L and Norton Healthcare is affecting the transplant program.

Norton’s Kosair Childrens Hospital holds the certificate of need for pediatric bone marrow transplantation in Louisville, the only approved pediatric program in Kentucky. Norton Kosair holds its FACT accreditation jointly with the program at University of Louisville Hospital. A hematologist/oncologist from U of L’s Department of Pediatrics is now listed by FACT as the director of the entire U of L bone marrow program.

Here are the relevant point’s from the KHPI website:

• In June 2011, UK and Norton announced a partnership that includes a “cancer program that will share resources, research agendas and clinical trials” as well as a joint transplant clinic that serves to refer patients to Lexington for both solid-organ and bone marrow transplants. Since then, U of L and Norton have ended up in court over who controls the downtown Kosair Children’s Hospital.

• FACT accreditation requires “only those programs that truly function as a single integrated program may apply as one Clinical Program. … This standard means that clinicians accredited together as a Clinical Program must work together in readily demonstrable ways on a daily basis, and have a single director or codirectors (the Program Director(s)), each of whom is responsible for these clinical transplant activities. Programs that include non-contiguous sites must be sites within the same defined network.”

• While only 10 procedures per year are required to maintain FACT accreditation, a major change in leadership and staffing must be reported and automatically triggers a possible re-accreditation site visit.

The KHPI website has a great deal more detail and analysis of this issue. Currently, U of L’s medical school is on probation with its accreditation organization over multiple shortcomings, as is U of L’s continuing education program for docs. The political reality is, neither U of L nor UK have programs that are particularly strong and UK especially sends children to Cincinnati Children’s Hospital, which is consistently ranked among the best in the United States.