If the transplant program fails to meet some tough stipulations presented to it today by the Centers for Medicare and Medicaid Services, the program will lose its certification and effectively be shut down.

CMS extended UMC's deadline from Dec. 3 to improve the quality of care it provides patients in its kidney transplant center, but not without some tough stipulations.

Under the extension, the state's only kidney transplant center must explain its surgical capabilities, develop an effective internal quality assessment and performance improvement program, and describe its administrative and surgical leadership.

"After examining the unique circumstances of the UMC, the imminent efforts to effectuate improvements, and most importantly our shared desire to minimize disruption to the health care of potential organ recipients, we will extend the termination date until Jan. 8, 2009," stated a letter addressed to UMC Chief Executive Officer Kathy Silver from CMS.

In a written statement Friday, UMC officials said postponement of decertification until after the first of the year allows the hospital and CMS to negotiate the terms of an agreement that will allow the transplant center to continue operations.

"Patient safety is the primary goal of both UMC and CMS, and both organizations will be working collaboratively to ensure that common goal," the statement says.

Members of Nevada's congressional delegation, who spearheaded discussions with CMS and UMC to rectify deficiencies found during two inspections of the transplant program earlier this year, said they were pleased with the decision.

The deficiencies, combined with a death rate that significantly exceeded federal standards, led to CMS' decision to revoke the transplant program's Medicare certification, effective Dec. 3.

"I'm real pleased and applaud the congressional delegation," said Rep. Jon Porter, R-Nev. "I appreciate the work of CMS acting administrator Kerry Weems and his staff. ...And, more importantly I applaud UMC for taking fast action. Families can rest assured that this program will remain in Nevada."

Rep. Shelley Berkley, D-Nev., made similar comments. She said it is important that the kidney transplant center remain open and available to Nevadans. The need, she said, "is too great.”

"I have every confidence that UMC will meet the benchmarks that are part of the agreement to extend and that not only will our transplant program continue, but it will be improved and strengthened," Berkley said.

The extension also allows UMC more time to explain recent actions taken by the hospital to come into compliance with federal requirements for patient safety and quality of care, reduce mortality rates, and implement improvements, the CMS letter says. For example, UMC's kidney transplant program has no surgeon.

In recent letters to CMS, UMC said it has negotiated contracts with three University of Utah surgeons in recent months to conduct transplants. Those surgeons would come to Las Vegas on a rotating basis and conduct kidney transplants.

"If the agreements provide for rotational coverage, there must be significant protections and processes in the agreement to ensure that the rotational coverage does not result in fragmented care for patients during the post-transplant period," CMS officials wrote in Friday's letter to Nevada's only kidney transplant center.

CMS has asked UMC to provide the federal agency with the written agreements for each of the surgeons and describe the "nature and breadth of coverage by the surgical team during the transplant period."

CMS also provided UMC with 15 questions for the Utah transplant surgeons that must be answered by Nov. 12.

The hospital's internal quality assessment and performance improvement program, which is a requirement under this deal, must regularly review patient survival rates, readmissions and complications of patients, and verify compliance with blood type verification.

In addition to not meeting minimum required patient survival rates, CMS has said UMC's transplant program did not timely submit key information of patients and living donors, and proper verification of blood type and donor identification.

"There have been problems across the country in which mismatched blood types have led to complications in transplant patients," said Thomas Hamilton, director of CMS' Survey and Certification Group earlier this week. "Having a quality assessment and performance improvement program is a very important aspect of modern health care and CMS regulation."

Hamilton said transplant centers, in general, must track the quality of care they provide, and monitor and identify deficiencies without relying on external parties to require them to do so.

In November, CMS will review details of UMC's improvement strategy. If the federal health agency determines that improvement actions are not likely to enable fulfillment of the Medicare certification requirements, CMS will continue with the scheduled termination.

However, if CMS finds that the transplant program is on pace to be in compliance and meets certain standards during an inspection, then decertification will be terminated.

"At least 200 people need kidney transplants in Nevada, and the thought that they would close our only transplant program, which would cause people living in Nevada to have to travel great distances to get this procedure done, is unthinkable," Berkley said. "I think the entire delegation got it. You didn't have to draw a blueprint for us."

Contact reporter Annette Wells at awells@reviewjournal.com or 702-383-0283.