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57 FINANCE CMO / CARE DELIVERY 'Beyond horrifying': Cardiologists warned UNC Children's of heart program issues By Mackenzie Bean C ardiologists at UNC Children's Hos- pital in Chapel Hill expressed serious concerns about the safety and quality of the hospital's pediatric heart surgery program in 2016, aer noticing an uptick in surgical com- plications and deaths, according to a 7,000-word investigative report from e New York Times. For the investigation, NYT reporters interviewed nearly two dozen current and former physicians and nurses at UNC; spoke with patients' fami- lies and physicians from other hospitals; and re- viewed emails, state death data, medical records and audio recordings of cardiology department meetings in 2016 and 2017 that were corroborat- ed by several sources. Seven takeaways: 1. Nine cardiologists on staff at UNC Health Care began expressing concerns about the quali- ty of its pediatric heart surgery program in 2016. e physicians had noticed more children were experiencing surgical complications aer low- risk procedures or dying aer high-risk surger- ies. ey did not identify a specific reason for these issues but pointed to a lack of program resources and shared apprehensions about the program's chief pediatric cardiac surgeon. "I mean, our house is in total disarray. is is cra- zy what we're doing," Timothy Hoffman, MD, division chief of pediatric cardiology at UNC Children's, said of the program in an audio re- cording cited by NYT. "I've never seen anything like it, quite frankly. And we're going backwards, not forward." 2. Some cardiologists questioned whether they should refer patients to heart surgeons at UNC Children's Hospital. Jennifer Whitham, MD, a former cardiologist at the hospital, said she would oen send patients to get second opinions at other hospitals in the area with comprehen- sive pediatric heart programs. "As a mother of three children, oh my God. ... It's inexcusable. As a physician, I mean, we all took the oath. We are supposed to do what's right for our patients," she said in audio recordings of a cardiology meeting in which physicians shared their concerns about the program. "I can't get past this. is is beyond horrifying." 3. Former hospital president Kevin Kelly, MD, met with the cardiologists aer they expressed these concerns and urged them to listen to their conscience when deciding where to refer pa- tients. However, he also warned the physicians that fewer surgeries at UNC would affect reve- nues and put some of their jobs at risk, according to NYT. Dr. Kelly, who retired last year, did not respond to the publication's request for com- ment. 4. On June 17, UNC shared numerous initia- tives to "restore confidence in its pediatric heart surgery program," including creating its own external advisory board to review the cardiac surgery program and suggest improvements as necessary. e hospital will not perform com- plex heart surgeries until the advisory board and state and federal health officials have completed their inspections of the program. 5. UNC Children's Hospital also shared risk-ad- justed outcomes data for its cardiac surgery program June 17, which shows mortality rates continued to rise aer cardiologists voiced their concerns about the program's quality and safe- ty. e data set includes observed and expected mortality rates for five categories of pediatric cardiac surgeries ranked by complexity. Between January 2015 and December 2018, UNC Chil- dren's reported higher than expected mortality rates for all but one surgical complexity category, according to e News & Observer. 6. In a statement on its website, UNC Children's noted the surgical categories "are imperfect and do not uniformly account for how sick a child is." e hospital also said the outcomes data "does not capture several risk factors that dispro- portionately impact our patient population as North Carolina's safety net hospital." 7. UNC Children's Hospital has stood behind its heart program, which administrators call "very strong." Leaders denied any past issues with pa- tient care and told NYT "a dysfunctional group" generated mistrust and created "team culture issues" in 2016. Since then, four of the nine pediatric cardiologists at UNC have le. e health system hired a new cardiologist last year and plans for three more to start this sum- mer. UNC also plans to hire more cardiac in- tensive care doctors and open a cardiac intensive care unit, although it denies that the program lacked adequate re- sources in 2016. n 3,800+ ATTENDEES FROM HOSPITALS AND HEALTH SYSTEMS ACROSS THE NATION REGISTER BY AUGUST 1, 2019 AND SAVE! CELEBRITY KEYNOTES BY 5TH ANNUAL HEALTH IT + REVENUE CYCLE CONFERENCE OCTOBER 9-12, 2019 HYATT REGENCY | CHICAGO, ILLINOIS REGISTER HERE www.beckershospitalreview.com/health-it-revenue- cycle-conference registration@beckershealthcare.com, jcole@beckershealthcare.com, sbecker@ beckershealthcare.com or 800.417.2035. Hear 215+ speakers from hospitals and health systems - focused on Health IT and Revenue Cycle 215+ GREAT HOSPITAL AND HEALTH SYSTEM LEADERS SPEAKING Hilary Clinton Former U.S. Secretar y of State and Former U.S. Senator for New York Peyton Manning NFL Legend Kevin O'Leary MBA, Chairman, O'Shares ETF Investments, and Star, ABC's Shark Tank