Then, in February, the Clymers received more devastating news. The federal Centers for Medicare and Medicaid Services (CMS) canceled Sutter Medical Center, Sacramento's contract for its Heart Transplant Program. That meant Clymer would need to get his transplant at a Bay Area hospital, and he and his wife would have to live in San Francisco for at least six weeks until Larry was well enough to return home, and then make regular visits to the Bay Area hospital's heart transplant clinic for the rest of Larry's life.

"Not only was Larry's situation physically and mentally draining," said Larry's wife, Abbie, "but it now also threatened to drain us financially. We faced losing our home and everything we have."

However, the news just got better for the Clymers and other Northern California heart patients and their families. After an eight-month battle that first played itself out in the courts and then took a major, positive turn outside of court thanks in large part to Congresswoman Doris Matsui, D-Sacramento, CMS reviewed Sutter Medical Center, Sacramento's Heart Transplant Program and certified it anew.

"The Sutter Heart Transplant Program is a critical component of our region's health care system, and I am extremely pleased that by working together we have been able to keep the program in Sacramento," Congresswoman Matsui said. "As the only heart transplant program in the Valley, its location in Sacramento provides unfettered access for individuals in our community get the care they need – when they need it. Sutter has shown extraordinary leadership and determination to keep this program in our community to serve the people of Sacramento and the entire Valley, and I congratulate them on this important victory."

Being the only heart transplant program in Northern California outside the Bay Area, the new certification means that heart transplant patients will be able receive the care they need without having to go through the inordinate expenses of travel, hotel rooms, parking and other major inconveniences.

The 20-year-old, groundbreaking Sacramento program that has transplanted 117 heart patients and produced some of the best success rates in the nation now will be able to transplant Clymer and other Medicare patients after the program's own life was threatened due to the CMS decertification in February.

"We just couldn't afford to have Larry's heart transplant in San Francisco," Abbie Clymer said. "We even researched the possibility of moving to Oklahoma, where we are originally from, and having the transplant there."

CMS withdrew the Sutter Medical Center Heart Transplant Program's certification in February 2009 because it did not meet the CMS annual volume criteria, which is 10 for Medicare. The decision was based solely on the annual volume requirement and does not take into account the excellent outcomes that the Sutter Heart Transplant Program has historically had.

For the past three years, Sutter Medical Center worked closely with both the state and federal governments to increase the heart transplant program's volume. In 2007, Sutter Medical Center started a ventricular assist device (VAD) program that includes a full range of devices to help extend patients' lives until they can receive a heart transplant. Clymer's machine is a HeartMate, a left ventricular assist device that does the pumping for the heart.

This CMS decertification only affected those patients who have Medicare as their primary insurance, and four Medicare patients on the heart transplant list were transferred to programs in the Bay Area. During the eight months, one of them was transplanted at California Pacific Medical Center in San Francisco.

While not all heart transplants are paid through Medicare, the decision by CMS put the entire Sutter Medical Center Heart Transplant Program in jeopardy because insurance companies usually look for a hospital's Medicare certification in their own approval processes. Since the CMS decertification, Medi-Cal and private insurances worked with Sutter Medical Center on a patient-by-patient basis, and SMCS has transplanted six patients so far this year at its Sutter Memorial Hospital campus, where the Sutter Heart & Vascular Institute is based.

Sutter Medical Center leadership took the decertification issue to the courts but determined that directly working with CMS to resolve this issue was better for patients and the community. With help from the community and, especially, Matsui and her office, CMS concurred and agreed to evaluate the current program for certification based on the hospital's efforts to grow the program over the last several months and due to the rate of successful outcomes.

"We are extremely proud of the heart transplant program we have built at Sutter," said Sutter Medical Center, Sacramento CEO Tom Gagen. "Our positive outcomes are due in part to our successful team approach, including dedicated surgeons, cardiologists, nurses, transplant coordinators, and a very active post-heart transplant clinic. We have the sixth largest open-heart program in California, and this allows our surgeons to maintain competency and maintain our excellent outcomes in transplants and all other complex surgeries."

Sutter Medical Center, Sacramento provides other transplants besides hearts. Its kidney, pancreas and bone marrow transplant programs are thriving and have not been threatened with decertification by CMS.

Sutter Medical Center, Sacramento, is affiliated with Sutter Health, a not-for-profit, community-based health system located throughout Northern California. For more information on Sutter Medical Center, Sacramento, visit the Web site at suttermedicalcenter.org.

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