A mandate in spring of 2009 by the Centers for Medicare & Medicaid Services (CMS) ruled that only CMS certified centers would be eligible for reimbursement under Medicare for Ventricular Assist Device (VAD) implantation. The CMS visited in July, and Jefferson was accredited as of August 11, 2009.

“This ensures that we are able to offer our first-rate care to the widest possible patient population,” says Director of the Mechanical Circulatory Support Program Scott Silvestry, MD, “which is critical to our mission as an academic medical center.”

During the CMS two-day visit, the auditor had what Dr. Silvestry describes as “an extremely favorable impression of the multidisciplinary and collaborative spirit between the surgical and medical teams.” VAD Coordinator Barbara Ebert, CRNP, is instrumental in managing care and assuring consistency across the entire process. “These patients are extremely labor-intensive for caregivers—even more so after the LVAD implant,” Dr. Silvestry notes. “They require constant monitoring and evaluation. Multidisciplinary collaborative care is essential to good outcomes for all of our patients.” He adds that the Departments of Pharmacy, Physical and Occupational Therapy, and Nursing, as well as students and fellows, have been active collaborators, from the organ harvest process, to echocardiograms, to post-operative care in the Intensive Care Unit (ICU) and Heart Failure Unit (at 5 West in the Gibbon Building).

VAD technology shows a significant and sustainable benefit for patients with heart failure who are not candidates for a heart transplant. “The reality is that few patients are eligible for transplants,” Dr. Silvestry says. For some patients who are candidates, the wait time may exceed 200 days. “VADs, including experimental therapies such as the Jarvik Heart, can get them through this potentially long wait to transplant.

Under the leadership of James Diehl, MD, Director of the Cardiothoracic Surgery Division, the Cardiac Surgery Program as a whole has expanded greatly over the last six years and recruited several excellent surgeons. Linda Bogar, MD, who was recruited five years ago, has now taken on a more senior role, which includes mentoring the more junior surgeons as well as performing a number of heart transplants and VAD procedures on her own. Benjamin Youdelman, MD, has now been on staff for two years. His practice, based primarily at Einstein Hospital, specializes in endovascular and thoracic aortic surgery, valve repair and replacement. Michel Haddad, MD, who joined Jefferson in 2008, is acting Director of the Surgical Cardiac Care Unit. With a wealth of experience in intensive care of cardiac surgery patients, Dr. Haddad splits his time between the operating room and the ICU. Finally, Hitoshi Hirose, MD, who recently completed fellowships at Hahnemann and Jefferson, joined the faculty last August which further increases the program’s capacity to care for complex cardiac patients.