Hospital Choice Question

[Fingers]

So, I'm looking through my work health benefits and leave policies to figure out what I'm going to need to do (I need and AVR and a MV repair/replacement). I found that with some of the company offered insurance plans have program to go to the Cleveland Clinic. They fly you and a companion there and you stay at their facilities, all covered by insurance, from what I read. The program seems tailor made for my situation.

I currently live in Southern CA and would get the surgery at Kaiser Sunset, as of right now with my current insurance plan. So, I can switch insurance or just go ahead with what I have.

They both seem like pretty good choices to me. There would be a delay in the Cleveland Clinic option, as I would have to change insurance and start the process over. I'm already through that part of the process with Kaiser. I've read that there are several folks on the forum that have been to either of these facilities. I'm leaning toward the Cleveland Clinic option, but would appreciate input/opinions on which avenue to pursue.

Thanks

 

[AZ Don]

Kaiser Permamente (on Sunset) is the 25th ranked hospital nationally for Cardiology and Heart Surgery: http://health.usnews.com/best-hospi...Angeles, CA&distance=100&specialty_id=IHQCARD. You actually have 3 higher ranked hospitals locally (maybe not on your insurance?) and of course Cleveland Clinic is #1. All are probably very good choices. Perhaps the timing or finding a surgeon that you are comfortable with might help you decide. I have not been to any of these hospitals but I'm sure if you asked enough people you would find many happy customers and a few that had issues.

 

[Fingers]

Thank you for the response and link. I realize this a 1st World issue. I don't think there's a bad choice here.

Kaiser has the advantage of being local to me. My wife and her family (I'm a SoCal transplant) are close. A big advantage for support for both her and I. The stress on my wife and traveling back after surgery are big negatives to me when evaluating the Cleveland Clinic option. This is really boiling down to the MV and whether I think I have a better shot at getting if repaired rather than replaced and if it's worth it. The surgeon that did my angiogram at Kaiser didn't think the MV was repairable and the surgeon said he'd have to see it first. From what I've read, the MV repair is much more desirable than the replacement. I think Cleveland (no real basis to this, unfortunately) would give me a better chance at repair, hence my leaning.

 

[AZ Don]

I think Cleveland will give you a second opinion remotely, based on your scans. So perhaps you can ask them if they think it is repairable without even traveling there. Perhaps UCLA or Cedars Sinai might be more open to the repair option?

 

[Zoltania]

To change insurance, don't you have to wait until January of next year for the new insurance to take effect, unless you have a "qualifying life event" like a job loss? If so, you would have to judge whether you can safely wait that long.

Is MV repair supposed to be significantly better than replacement even if you're also having another valve replaced at the same time?

 

[Catie]

FWIW, I did the remote consult at CC. It was very helpful, but it took quite a bit longer than their website said it would. And insurance won't cover the cost of a long-distance consultation.

 

[Fingers]

Thanks for the replies.

As far as repair replace, there are articles that I've found that say it's better to repair and some that say no difference. So, which do I believe? Repair seems like the most desirable alternative.

I'll try to contact them and see. I may just go ahead and go with Kaiser. I doesn't seem like I'm missing much by going that route.

 

[tom in MO]

I would go to my local hospital if they are capable of doing the surgery. Traveling will make everything more stressful and if, god forbid, you have complications after you get home...you'll be going to the local hospital. Ask your cardio if they would have it done local or at Cleveland. Ask your surgeon how many AV/mitrals his team does a year.

 

[dornole]

if you need to have AVR regardless . . . . would you get much benefit from mitral repair vs replacement? What are the benefits supposed to consist of? Curious what you've read, since I also have issues with mitral (but my other valves are fine)

 

[RobThatsMe]

I had to face a similar decision a few years ago. When asked by a good friend while overseas why I was going to the local hospital rated 27th in the country, I told him so that my wife and family could be there for me, and for my wife's support. He then asked me which one was the best hospital, and I told him Cleveland Clinic was rated #1. So he then said, other than hotel and transportation to get there, are the costs for the surgery and hospital the same, and I said yes. He looked at me and said, " Then why go to your local hospital when you can go to the best? So let the family and friends come visit with you after the surgery, go to the best as it is your life, not theirs."
They have preformed so many heart surgeries at Cleveland, you can be sure that they have seen and worked on about every type of heart issue that there is, or complication that has arisen during surgery. If you do decide to stay local, then be sure to interview your doctor/surgeon well, don't be afraid to ask pointed questions about your procedure. It's the doctors and surgical team, not the hospital, that will be the ones fixing you.

Good luck with your up-coming surgery.

Rob

 

[cldlhd]

This is one of those things where a Crystal ball would be nice. If the surgery turned out fine going locally then that would be a lot easier but if you had a better result traveling then its worth it. Unfortunately there's no way to know ahead of time. I felt fortunate the the Hospital of the University of Pennsylvania was close by so I didn't feel the stress of this decision. Hoping all turns out well.

 

[Fingers]

Thanks for the replies. My crystal ball is cloudy on this one.

I talked to the Kaiser surgeon again earlier this week. He didn't think I needed to get the surgery right away. He said probably within the next year or so, but didn't think I needed to rush in to get this done. He also indicated it would be a DVR from his perspective. Maybe he is just saying this in the event he can't do the repair and didn't want to set my expectations too high. I just get the feeling they won't try to repair it.

Looking at the Cleveland Clinic site, they claim they can repair 95% of mitral valves. The site also claims the following advantages for repair:
[h=3]Compared to valve replacement, mitral valve repair provides better long-term survival, better preservation of heart function, lower risk of complications, and usually eliminates the need for long-term use of blood thinners (anticoagulants). For these reasons, Cleveland Clinic surgeons are committed to mitral valve repair, when possible.[/h] So I'm a little more motivated to try the Cleveland Clinic. It seems like I have the time to set this up. The traveling and family issues are a disadvantage, but it seems like it's worth it.

I would like to hear from folks that went and travelled to the Cleveland Clinic and how the post-surgery and travel back home went.

 

[RTZdad]

I travelled to CC from Denver. I would happily share my experience with you. It was amazing. I would choose to go there. No question. Send me a PM and I will give you my contact info. Good luck with your surgery.

Tom

 

[dornole]

Were you planning on a tissue valve for your AVR, and re-operation in a few years? If you are going mechanical, you'll be on anticoagulants regardless of what they do for your mitral.

I'd ask about the durability of the repair also. Mine they said 10-15, but as it was a low-impact balloon procedure, that was totally worth it. If they said the same timeline for OHS repair, not sure I'd be too keen.

Sounds to me like you should do a consult with CC for your specific situation. What do you have to lose?

 

[river-wear]

Good luck with your decision. I traveled from NorCal to Philadelphia for an aortic valve repair two years ago. I felt that was my best chance for a successful repair and I'm very happy I did it. My husband and I planned to stay for two weeks, which turned out to be a good thing. Two days after being discharged I was re-admitted for an irregular heartbeat that turned into a-fib the next day. I was in the hospital for nine nights out of 15. It was a little scary flying home, but we planned ahead and requested a wheelchair to get us to the gate and pick us up on the other end. A non-stop flight definitely helped too. It was scary for me, but uneventful in the end.

I've been fine ever since and don't even have to take any medications. I hope you have a textbook recovery, regardless of which choice you make.

 

[cldlhd]

Good luck with your decision. I traveled from NorCal to Philadelphia for an aortic valve repair two years ago. I felt that was my best chance for a successful repair and I'm very happy I did it. My husband and I planned to stay for two weeks, which turned out to be a good thing. Two days after being discharged I was re-admitted for an irregular heartbeat that turned into a-fib the next day. I was in the hospital for nine nights out of 15. It was a little scary flying home, but we planned ahead and requested a wheelchair to get us to the gate and pick us up on the other end. A non-stop flight definitely helped too. It was scary for me, but uneventful in the end.

I've been fine ever since and don't even have to take any medications. I hope you have a textbook recovery, regardless of which choice you make.

Glad to hear you're doing well , if I'm not mistaken didn't you just hit the 2 yr mark recently?

 

[Dodger Fan]

While the Cleveland Clinic is awesome, you have the 2 best hospitals for heart surgery in California (according to US News) in your own backyard. Cedars is #10 and UCLA was #12. I live in Temecula and seriously considered going to Cedars Sinai (#10 nationally/ #1 in California). It's a 100 mile drive which I figured would be a pain in the ass for follow up appointments, family, and friend visits, etc. I ended up going to Scripps La Jolla (#19 nationally/ #1 in California). This is only a 50 mile drive. I feel like they took really good care of me.

If I lived in California, had Kaiser Insurance, an opportunity to change insurance companies, and time before the surgery was needed I would go to Cedars.