heart and lung transplantation program florida hospital medical center orlando mark r. milunski, md,...

Heart and Lung Transplantation ProgramHeart and Lung Transplantation ProgramFlorida Hospital Medical CenterFlorida Hospital Medical Center

OrlandoOrlando


OrlandoOrlando

Mark R. Milunski, MD, FACCMark R. Milunski, MD, FACCFlorida Heart Group, PAFlorida Heart Group, PA

Associate Professor of MedicineAssociate Professor of Medicine

University of Central Florida College of MedicineUniversity of Central Florida College of Medicine

Seminole County Medical SocietySeminole County Medical Society

September 16, 2008September 16, 2008

Mark R. Milunski, MD, FACCMark R. Milunski, MD, FACCFlorida Heart Group, PAFlorida Heart Group, PA

Associate Professor of MedicineAssociate Professor of Medicine

University of Central Florida College of MedicineUniversity of Central Florida College of Medicine

Seminole County Medical SocietySeminole County Medical Society

September 16, 2008September 16, 2008


OrlandoOrlando


OrlandoOrlando

Why do we need one?Why do we need one? What’s involved?What’s involved? Will it succeed?Will it succeed?

Why do we need one?Why do we need one? What’s involved?What’s involved? Will it succeed?Will it succeed?

Heart and Lung Transplantation ProgramHeart and Lung Transplantation ProgramFlorida Hospital Medical CenterFlorida Hospital Medical CenterOrlandoOrlando


Florida Adult Heart Transplantation Program UtilizationFlorida Adult Heart Transplantation Program Utilization

January 2007- December 2007January 2007- December 2007Hospital OTSA District Total ProceduresHospital OTSA District Total Procedures

Shands Hospital Shands Hospital at U of Fat U of F 11 33 3232

Mayo ClinicMayo Clinic 11 44 2222

Tampa GeneralTampa General 22 66 5151

Jackson Jackson MemorialMemorial 44 1111 2222

TOTALTOTAL 127127

OTSA - Organ Transplant Service AreaSource: AHCA Utilization Data for Pediatric and Adult Organ Transplantation Programs published April 4, 2008



Adult Heart Transplantations PerformedAdult Heart Transplantations Performed

January 2003-December 2007January 2003-December 2007

FacilityFacility

Jan ‘03Jan ‘03

Dec ‘03Dec ‘03

Jan ‘04Jan ‘04

Dec ‘04Dec ‘04

Jan ‘05Jan ‘05

Dec ‘05Dec ‘05

Jan ‘06Jan ‘06

Dec ‘06Dec ‘06

Jan ‘07Jan ‘07

Dec ‘07Dec ‘07 TOTALTOTAL

Shands Hospital at UFShands Hospital at UF 2929 3131 3333 2929 3232 154154

Mayo ClinicMayo Clinic 99 1212 77 1515 2222 6565

Tampa General HospitalTampa General Hospital 5555 4343 6161 5959 5151 269269

Jackson Memorial HospitalJackson Memorial Hospital 1818 3131 2020 2828 2222 119119

TOTALTOTAL 111111 117117 121121 131131 127127 607607

Source: AHCA Adult Organ Transplantation Program Utilization January 2003-December 2007



About 30-40 people are referred for heart About 30-40 people are referred for heart transplant evaluation out of District 3 every transplant evaluation out of District 3 every yearyear

Nearest centers are 85-112 miles awayNearest centers are 85-112 miles away District 3 is the only region in the state with District 3 is the only region in the state with

a major population center that doesn’t a major population center that doesn’t have a heart transplant programhave a heart transplant program

About 30-40 people are referred for heart About 30-40 people are referred for heart transplant evaluation out of District 3 every transplant evaluation out of District 3 every yearyear

Nearest centers are 85-112 miles awayNearest centers are 85-112 miles away District 3 is the only region in the state with District 3 is the only region in the state with

a major population center that doesn’t a major population center that doesn’t have a heart transplant programhave a heart transplant program

Why do we need one?Why do we need one?



InfrastructureInfrastructure Bricks and mortarBricks and mortar

$255 million Ginsburg Tower$255 million Ginsburg Tower ED area - 62,000 sq ft with 50 exam roomsED area - 62,000 sq ft with 50 exam rooms Cardiovascular Institute - 80,000 sq ftCardiovascular Institute - 80,000 sq ft

12 cath lab/OR’s with shell space for 3 more labs12 cath lab/OR’s with shell space for 3 more labs 14 pre-cath beds and 59 post-cath recovery beds14 pre-cath beds and 59 post-cath recovery beds Reinforced floor for cardiac MRIReinforced floor for cardiac MRI Full-service outpatient cardiovascular testingFull-service outpatient cardiovascular testing Dedicated unit for pre- and post-transplant patientsDedicated unit for pre- and post-transplant patients

InfrastructureInfrastructure Bricks and mortarBricks and mortar

$255 million Ginsburg Tower$255 million Ginsburg Tower ED area - 62,000 sq ft with 50 exam roomsED area - 62,000 sq ft with 50 exam rooms Cardiovascular Institute - 80,000 sq ftCardiovascular Institute - 80,000 sq ft

12 cath lab/OR’s with shell space for 3 more labs12 cath lab/OR’s with shell space for 3 more labs 14 pre-cath beds and 59 post-cath recovery beds14 pre-cath beds and 59 post-cath recovery beds Reinforced floor for cardiac MRIReinforced floor for cardiac MRI Full-service outpatient cardiovascular testingFull-service outpatient cardiovascular testing Dedicated unit for pre- and post-transplant patientsDedicated unit for pre- and post-transplant patients

What’s involved?What’s involved?

Ginsburg Tower at Florida Hospital OrlandoGinsburg Tower at Florida Hospital OrlandoGinsburg Tower at Florida Hospital OrlandoGinsburg Tower at Florida Hospital Orlando

15 stories15 stories Each floor the size of a Each floor the size of a

football field football field 440 new patient beds 440 new patient beds Will open on November Will open on November

20, 200820, 2008 First cardiac First cardiac

catheterization planned catheterization planned for December 12, 2008for December 12, 2008

15 stories15 stories Each floor the size of a Each floor the size of a

football field football field 440 new patient beds 440 new patient beds Will open on November Will open on November

20, 200820, 2008 First cardiac First cardiac

catheterization planned catheterization planned for December 12, 2008for December 12, 2008



Solid organ transplantation expertiseSolid organ transplantation expertise 35 years of experience35 years of experience

Kidney, bone marrow, pancreas, liverKidney, bone marrow, pancreas, liver

On-site tissue typing laboratoryOn-site tissue typing laboratory Pathology expertisePathology expertise

Cardiothoracic transplants are a natural Cardiothoracic transplants are a natural extension of both the cardiovascular and extension of both the cardiovascular and transplant programstransplant programs

Solid organ transplantation expertiseSolid organ transplantation expertise 35 years of experience35 years of experience

Kidney, bone marrow, pancreas, liverKidney, bone marrow, pancreas, liver

On-site tissue typing laboratoryOn-site tissue typing laboratory Pathology expertisePathology expertise

Cardiothoracic transplants are a natural Cardiothoracic transplants are a natural extension of both the cardiovascular and extension of both the cardiovascular and transplant programstransplant programs




ExperienceExperience Busiest cardiovascular program in the U.S.Busiest cardiovascular program in the U.S.

Over 82,000 cardiac surgical procedures over the Over 82,000 cardiac surgical procedures over the last 40 years with <2% mortalitylast 40 years with <2% mortality

One year period ending 12/31/07One year period ending 12/31/07 6,630 cardiac catheterizations6,630 cardiac catheterizations 1,488 cardiac surgical procedures1,488 cardiac surgical procedures

Second busiest thoracic program in the U.S.Second busiest thoracic program in the U.S.

ExperienceExperience Busiest cardiovascular program in the U.S.Busiest cardiovascular program in the U.S.

Over 82,000 cardiac surgical procedures over the Over 82,000 cardiac surgical procedures over the last 40 years with <2% mortalitylast 40 years with <2% mortality

One year period ending 12/31/07One year period ending 12/31/07 6,630 cardiac catheterizations6,630 cardiac catheterizations 1,488 cardiac surgical procedures1,488 cardiac surgical procedures

Second busiest thoracic program in the U.S.Second busiest thoracic program in the U.S.


2006 MedPAR data



ExperienceExperience Tissue typing facilities already well-establishedTissue typing facilities already well-established Established outpatient Heart Failure ClinicEstablished outpatient Heart Failure Clinic Multiple qualified medical and surgical Multiple qualified medical and surgical

subspecialists are already in placesubspecialists are already in place Psychological and social services personnel Psychological and social services personnel

already attuned to the transplant patientalready attuned to the transplant patient Recruitment of 2 UNOS certified transplant Recruitment of 2 UNOS certified transplant

cardiologists and pulmonologists and 2 surgeonscardiologists and pulmonologists and 2 surgeons

ExperienceExperience Tissue typing facilities already well-establishedTissue typing facilities already well-established Established outpatient Heart Failure ClinicEstablished outpatient Heart Failure Clinic Multiple qualified medical and surgical Multiple qualified medical and surgical

subspecialists are already in placesubspecialists are already in place Psychological and social services personnel Psychological and social services personnel

already attuned to the transplant patientalready attuned to the transplant patient Recruitment of 2 UNOS certified transplant Recruitment of 2 UNOS certified transplant

cardiologists and pulmonologists and 2 surgeonscardiologists and pulmonologists and 2 surgeons




RelationshipsRelationships Long-established cardiovascular research Long-established cardiovascular research

program - program - Florida Heart InstituteFlorida Heart Institute Affiliations with:Affiliations with:

Emory UniversityEmory University Loma Linda UniversityLoma Linda University University of Central Florida College of University of Central Florida College of

MedicineMedicine Burnham Medical Research InstituteBurnham Medical Research Institute

RelationshipsRelationships Long-established cardiovascular research Long-established cardiovascular research

program - program - Florida Heart InstituteFlorida Heart Institute Affiliations with:Affiliations with:

Emory UniversityEmory University Loma Linda UniversityLoma Linda University University of Central Florida College of University of Central Florida College of

MedicineMedicine Burnham Medical Research InstituteBurnham Medical Research Institute




ImplementationImplementation First heart transplant planned to take place before First heart transplant planned to take place before

July 1, 2009July 1, 2009 12 transplants planned for the first year12 transplants planned for the first year 18 transplants planned for the second year18 transplants planned for the second year A minimum of 10% of these will be Medicaid or charity A minimum of 10% of these will be Medicaid or charity

casescases 10 transplants will be provided to Medicare enrollees 10 transplants will be provided to Medicare enrollees

without charge while awaiting Medicare approvalwithout charge while awaiting Medicare approval Medicare approval after 10 transplants doneMedicare approval after 10 transplants done

Minimum volume of 10 transplants per yearMinimum volume of 10 transplants per year Meet Medicare-specified patient survival standardsMeet Medicare-specified patient survival standards

ImplementationImplementation First heart transplant planned to take place before First heart transplant planned to take place before

July 1, 2009July 1, 2009 12 transplants planned for the first year12 transplants planned for the first year 18 transplants planned for the second year18 transplants planned for the second year A minimum of 10% of these will be Medicaid or charity A minimum of 10% of these will be Medicaid or charity

casescases 10 transplants will be provided to Medicare enrollees 10 transplants will be provided to Medicare enrollees

without charge while awaiting Medicare approvalwithout charge while awaiting Medicare approval Medicare approval after 10 transplants doneMedicare approval after 10 transplants done

Minimum volume of 10 transplants per yearMinimum volume of 10 transplants per year Meet Medicare-specified patient survival standardsMeet Medicare-specified patient survival standards

Will it succeed?Will it succeed?



CON application approval - CON application approval - Florida Florida Administrative WeeklyAdministrative Weekly Florida HospitalFlorida Hospital

CON #10026 (Heart)CON #10026 (Heart) CON #10028 (Lung)CON #10028 (Lung)

ORMCORMC CON #10027 (Heart only)CON #10027 (Heart only)

http://ahca.myflorida.com/MCHQ/CON_FA/Batching/pdf/10027.pdf


CON application approval - CON application approval - Florida Florida Administrative WeeklyAdministrative Weekly Florida HospitalFlorida Hospital

CON #10026 (Heart)CON #10026 (Heart) CON #10028 (Lung)CON #10028 (Lung)

ORMCORMC CON #10027 (Heart only)CON #10027 (Heart only)



ReferencesReferences



CMSCMS http://www.cms.hhs.gov/CertificationandComplianc/http://www.cms.hhs.gov/CertificationandComplianc/

20_Transplant.asp20_Transplant.asp

CMSCMS http://www.cms.hhs.gov/CertificationandComplianc/http://www.cms.hhs.gov/CertificationandComplianc/

20_Transplant.asp20_Transplant.asp

ReferencesReferences


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heart and lung transplantation program florida hospital medical center orlando mark r. milunski, md,...

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