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Diving brief:
- CMS is proposing a new mandatory Medicare payment model to test whether performance-based incentives for hospitals could improve the hodgepodge system connecting patients who need kidney transplants with viable organs.
- The six-year model announced on Wednesday, called Increasing Access to Organ Transplantsaims to encourage transplant hospitals to use more available kidneys and facilitate more transplants from living donors, thereby increasing access to organs for patients with end-stage renal disease while reducing Medicare spending. IOTA, if finalized, It would require about a third of the nation's organ transplant hospitals – 90 facilities in some donation service areas – to participate starting in 2025.
- The model would measure hospital performance based on the number of kidney transplants, organ acceptance rates and quality of transplant care. Based on these measurements, hospitals would either receive bonuses from CMS – up to $8,000 per registry – or be penalized for poor performance, up to $2,000 per registry.
Dive overview:
Research has shown that a kidney transplant improves survival rates and quality of life for those affected. hundreds of thousands of Americans with end-stage renal disease compared to remaining on dialysis. Currently, nearly 89,500 people are on the waiting list for a kidney. However, about one-third of donor kidneys go unused each year, according to CMS.
This is due to significant problems in the U.S. organ transplant system, which has suffered from decades of inefficiencies, outdated technological infrastructure, and monopolistic controls.
A 2022 Senate Finance Committee investigation found notable systemic failuresBetween 2007 and 2015, hundreds of people developed illnesses following organ transplants, including inappropriate organ screening and communication problems. Seventy people died from these diseases.
Much of these problems can be traced to organ procurement organizations, or OPOs — nonprofit organizations certified by the government to obtain organs from deceased donors and connect them to living transplant candidates. A separate investigation by a House subcommittee in 2022 also found The OPOs were failure to obtain many viable organscontributing to deaths.
According to government statistics, about 17 Americans die every day while waiting for an organ transplant.
However, OPOs have little external accountability and have for decades been allowed to calculate and report their own organ procurement data, triggering a government crackdown in 2019.
Last fall, controversy led President Joe Biden to sign bill overhaul the system by breaking the monopoly that allowed one nonprofit organization — the United Network for Organ Sharing, or UNOS — to serve as the sole contractor managing the organ procurement and distribution system.
Earlier this year, the government has launched calls for tenders to distribute contracts among multiple suppliers, while the House Energy and Commerce Committee launched another investigation into UNOS to ensure enforcement of the law.
Today, CMS has another bid to improve the troubled organ delivery system for patients with end-stage renal disease, particularly for underserved black and minority patients.
In addition to providing upside and downside risks to providers to try to hold them better accountable for transplant quality, IOTA includes a health equity performance adjustment giving hospitals more credit for transplants performed on low-income people.
Historically, principles of the organ distribution system such as racist testing led to pushing black candidates for kidney transplantation on the waiting list, exacerbating existing disparities. Black people in the United States are four times more likely develop kidney failure than whites, but are much less likely to receive a kidney transplant.
IOTA would also provide flexibilities for hospitals that address social determinants of barriers to care, such as food insecurity, while requiring hospitals to create health equity plans.
This model is the latest CMS model targeting renal care in the United States. The agency's innovation center launched the Treatment choice model for ESRD in 2021 with the aim of increasing access to kidney transplants and greater use of home dialysis. Likewise, the Kidney Care Choice Model launched in 2022 aims to improve care coordination to improve outcomes for people with chronic kidney disease.
However, such models tested by the CMS have gave mixed results. Treatment choices for ESRD, for example, failed to reduce costs in its first yearbut increased the number of patients on the transplant waiting list.