July/August 2015 Magazine

Influential: Business of the Heart

July/August 2015 Issue

John Ransom has invested much of his surgical career in the nationally recognized heart transplant program at the Baptist Health Transplant Institute, where he lives by the values of hard work and patient success.

Photograph by Cindy Momchilov

Top photo: Baptist Health Transplant Institute’s Dr. John Ransom continued the cutting-edge care of heart patients that he is known for when he implanted the state’s first HeartMate III device in June 2015.

For a retiree, physician John Ransom works pretty hard.

His days start around 5 a.m., and he arrives at the Baptist Health campus in Little Rock between 6 a.m. and 8 a.m., depending on whether he’s operating that day. He finishes up around 5 p.m. or 6 p.m., unless patients need him to stay later.

“Sometimes it’s day and night,” he said in a telephone interview. “There’s always something for me to work on.”

If he doesn’t sound retired, it’s because the Arkansas cardiovascular surgeon returned to work nine years ago to become the surgical director of the heart transplant program at the Baptist Health Transplant Institute.

“It’s sort of a vacation for me in some ways,” he said. “No one enjoys something all the time, but this is as close as I can get.”

Ransom, who conducts daily patient rounds and sees patients in his office, treats end-stage heart-failure patients with transplants or mechanical, circulatory-assist devices.

“Our program does an average of 10 transplants a year and somewhere between 30 to 40 HeartMate II patients a year,” he tallied, counting the patients in each category. “Follow-up is pretty intense.”

Since November 1989, 228 heart transplants have been performed, and the program has implanted more than 200 HeartMates, a left ventricular-assist device.

In June, Ransom implanted the state’s first HeartMate III device as part of a clinical trial. The Baptist program is among 60 centers nationwide chosen for the trial, which is expected to enroll 1,000 patients all over the country and evaluate the device’s safety and performance after six months in individuals with advanced heart failure.

“This is extremely exciting for our end-stage heart-failure patients,” Ransom said in a news release after the procedure. “Having the HeartMate III as a potential option for some of our patients will enhance our patient outcomes.”

What has surprised transplant and HeartMate II patients after the procedure takes place is how well they feel, Ransom said. “They’ve been really sick. They’ve been chronically ill for a long time. Within a couple of weeks, their depression is improved, they feel better.”

“This is one of the few programs where you can say without this, those patients would not see another birthday, another grandchild born, another holiday season,” said Greg Crain, vice president and administrator with Baptist Health.

That’s what motivates Ransom to continue working. “It keeps you coming back, how well the patients do.”

Critical Investment

Crain values Ransom’s success with his patients and his dedication to the transplant program.

“He made a financial investment to make the transplant institute possible. It’s the largest physician donation ever,” Crain said. “He’s not only a leader, but he gives his time, his talents and his treasure to make this center a reality.”

Ransom works closely with cardiologist Steve Hutchins, medical director of the transplant program and Ransom’s partner in starting the program. He recalled that in those early days of transplant procedures it was easier to find donor hearts for patients in need. But the situation changed in time.

“Then we started to get people who were good candidates for a transplant who would die before we found a heart for them,” he said. This made the Food and Drug Administration’s approval of the HeartMate XVE in 1999, which could prolong the life of patients waiting for a heart transplant, a big deal in his field. In 2008, the FDA approved the HeartMate II.

“People did well with it. Some patients have had it in for nine to 10 years,” he explained. Now, with FDA approval, he and Hutchins treat patients with it as a permanent therapy. “These aren’t candidates for transplant for various reasons, maybe they’re over 70 years old, etc.” Now, he said, most of his HeartMate II patients receive the device as their destination procedure — they’re not on their way to a transplant.

If Ransom doesn’t see himself as entrepreneurial, his dedication to his practice aligns his work ethic with other successful businesswomen and businessmen. There was a need for a transplant program, and he and Hutchins were both motivated and had developed the right expertise throughout their careers.

“The innovation and the technology in the field have been very attractive, and we try to make this program work as much for the hospital as we can,” Ransom said. “This is probably the most scrutinized portion of medicine you can imagine. We have to make sure our standards are up to what they should be.”

Of the bottom line, Ransom said, “If we can’t make the program work, we can’t help anyone.”

He acknowledged that the business of medicine has changed during his career, especially since the days when he ran his own practice. “Now it’s all bundled and integrated,” he said.

But there shouldn’t be many surprises to physicians on the business side of things. It’s complex, but most of it is done by practice-management groups, insurance billing and coding. “Physicians are going to be reimbursed based on their good results and how efficiently they do the work,” Ransom said.

“It’s going to become even more so,” he predicted.

Dr. John Ransom

Throughout his career, Ransom has invested his time and energy into taking care of his patients. Photograph by Janet Warlick

Getting The Best Results

Unlike many of his peers, Ransom didn’t choose cardiovascular surgery at a young age. In fact, he didn’t even decide to go to medical school until he was almost finished with college.

“Every rotation made me think I wanted to do it,” he remembered. General surgery was his final rotation, and he and his best friend decided to go into a surgical practice together. During a transitional time in which the training extended from four years to five, he began a cardiovascular and thoracic fellowship and completed it in 1981.

“There weren’t a lot of people doing heart surgery in 1981,” he said. “And Baptist has always been my home. Russ Harrington [former CEO of Baptist Health] came to me in 1988 and started to talk about a transplant program. We did the first heart transplant in Arkansas in 1989, and we’ve been able to grow the program. It’s very rewarding.”

Of course, someone who works as hard as Ransom does for his patients doesn’t succeed alone. Ransom said his wife, Kathy, “has done all the work” throughout their 40-year marriage. Their relationship began when he met her out on a date with her best friend. They got married on Halloween three years later because he wasn’t on call. They have two daughters and a son, two grandchildren and two more on the way.

“Now I consider my hours pretty darn easy,” he said. “Kathy took care of essentially everything when my kids were growing up, but we’d eat together no matter when I got home, even if it was 9 o’clock at night. We have a really close family, and my wife has been totally flexible. She was always understanding; she has never not understood my work.”

At the heart of the work, physicians are like any other people in business: They must do their best to get the best possible results, but the playing field is significant, and life-changing, as it involves individual health, individual lives and the lives of the families who love those patients.

“I always thought when you come to work, be as nice to people as you can and do your best work, [and] things will fall into place,” Ransom said. “Take care of your patients; make sure you get the best possible results. If you’re nice to people, they will refer you. It will be recognized. We’re nationally recognized — people know our program and our results.”

Baptist’s heart transplant program lists results that surpass national averages in 30-day survival, one-year survival and three-year survival rates.

“The real bottom line?” Ransom said. “Take care of people and put in whatever time and work that is necessary to take care of them.”

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