The federal Medicare program is moving forward with plans to cut off funding for heart transplants at Baylor St. Luke’s Medical Center, putting the once-renowned Houston program at risk of closure after an unusually high rate of its patients died in recent years.

In a letter to the hospital Monday, the Centers for Medicare and Medicaid Services gave St. Luke’s until the end of the day Tuesday to notify Medicare beneficiaries awaiting hearts that the program would no longer be allowed to bill the federal health plan for their care beginning Aug. 17. It also directed St. Luke’s to assist any patients on its heart waiting list who wish to transfer to another hospital.

St. Luke’s can still appeal the ruling before an administrative law judge, but that would not stop the termination of funding next month. In a statement Tuesday, a St. Luke’s spokeswoman said the hospital has not yet decided if it will appeal before the Sept. 14 deadline set by Medicare. She said the hospital would notify patients and help any who wish to transfer, as required.

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“Our unwavering focus is always to ensure our patients receive the best possible medical care, and in ways that reflect our core values of reverence, integrity, compassion, and excellence,” the statement said.

CMS first notified the hospital last month of the agency’s intention to terminate funding. The decision came just weeks after an investigation by the Houston Chronicle and ProPublica found that the program lost several top doctors and performed an outsized number of heart transplants resulting in deaths in recent years.

Those declines came in the years after St. Luke’s was purchased by Catholic Health Initiatives, a Denver-based nonprofit chain burdened with billions of dollars in debt, and after the hospital entered into a joint operating agreement with its affiliate Baylor College of Medicine.

Losing Medicare's seal of approval threatens the program's viability, experts say, depriving it of an essential source of funding. About a third of the 88 patients awaiting a heart at St. Luke's are Medicare and Medicaid beneficiaries, but the termination could lead private insurance companies to follow suit. That could force all of the patients on the program's waiting list to either pay out of pocket or, more likely, transfer to another hospital.

Hospital leaders have not said whether they plan to shut down the program after Medicare funding ends, or if they will attempt to keep it going with depleted resources. Medicare’s action does not affect patients awaiting kidney, liver or lung transplants at St. Luke’s.

Other hospitals nearby

For weeks, officials at St. Luke’s and Baylor have defended the program, saying they made improvements following a string of patient deaths in 2015. But the Chronicle and ProPublica investigation revealed that multiple St. Luke’s doctors raised concerns since then, specifically about errors during operations and serious surgical complications after Dr. Jeffrey Morgan took over as the program’s top surgeon in 2016. A few cardiologists began referring some of their patients to other hospitals for transplants.

Two weeks after the story was published on May 16, St. Luke’s temporarily suspended the heart transplant program in order to review the cases of two more patients who died after receiving transplants this year. The hospital reactivated the program on June 15 after administrators said they made additional changes to improve care.

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St. Luke’s stopping and restarting the program also caught the attention of federal regulators. CMS notified the hospital last month that it violated a federal statute when it failed to notify the agency of its plans to temporarily suspend the program. Regulators said they only learned of the suspension when it appeared in news articles.

CMS noted on Monday that heart failure patients who wish to leave St. Luke's have two other options within two miles of the hospital in the Texas Medical Center: Both Houston Methodist and Memorial Hermann operate Medicare-approved heart transplant programs, and according to federal regulators, together they have the capacity to handle patients defecting from St. Luke's.

It appears the heart program's troubles have already caused a shift in care in Houston. Through the first six months of 2018, Memorial Hermann and Methodist have each performed 25 heart transplants, putting Hermann on pace to perform more than twice as many as last year, according to data compiled by the United Network for Organ Sharing, the Virginia-based nonprofit that manages the nation's organ waiting list.

St. Luke’s, meanwhile, performed just nine heart transplants in the first six months of this year, and none since June 1.

Three of the nine recipients have died.

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This story is the result of a collaboration between the Chronicle and ProPublica, an independent nonprofit newsroom based in New York. Mike Hixenbaugh is an investigative reporter at the Houston Chronicle. Charles Ornstein is a senior editor at ProPublica.

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