There are about 90,000 people in the US waiting for kidneys, and nearly one out of every 20 dies each year, according to an estimate by the United Network for Organ Sharing, a nonprofit that manages organ donations nationwide.
Many problem solvers are getting creative in their quests to bridge this gap, going so far as to genetically engineer pig kidneys for human transplantation, for instance, though only a handful of those procedures have been performed so far.
On July 1, the federal government rolled out a new solution: the Increasing Organ Transplant Access (IOTA) model. Over six years, the model will test whether performance-based payments can increase kidney transplants without hurting care quality.
The deets. The Centers for Medicare and Medicaid Services (CMS) has selected 103 hospitals across the US to participate in the model, including big names like New York’s Mount Sinai Medical Center and Baltimore’s Johns Hopkins Hospital.
Under the model, CMS will vary hospital payments for each adult Medicare fee-for-service kidney transplant based on that hospital’s number of adult kidney transplants per year, organ-offer acceptance rate ratios, and survival rates.
During the first year, CMS will give out bonus payments up to $15,000 per transplant to centers doing more procedures with higher organ-offer acceptance ratios and survival rates based on comparisons to that hospital’s historical benchmarks and national benchmarks. But from year two on, some hospitals will also be charged up to $2,000 a transplant by CMS for low performance based on similar benchmarks.
Multiplied, that adds up. Participating hospitals performed a range of 12 to 394 kidney transplants in 2023, according to CMS data. That could mean a bonus ranging between $180,000 to $5.9 million or a penalty of $24,000 to $788,000.
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The reaction. Trade group the American Hospital Association (AHA) is concerned because participation in the model isn’t optional for the selected hospitals. It’s also arguing the model may be incentivizing volume at the expense of quality.
It “could have an immediate detrimental impact on the quality of care or on patients’ access to care by overburdening their providers,” Jennifer Holloman, AHA senior associate director of policy, told Healthcare Brew over email.
CMS told us patient safety is “paramount” and performance will be “closely” monitored, with the model tweaked as needed.
“The model is specifically designed to reward appropriate, high-quality transplant activity, not simply volume,” a CMS spokesperson said in an email.
LaVarne Burton, president and CEO of the nonprofit American Kidney Fund (AKF), told Healthcare Brew in an email AFK understands where AHA is coming from, but the country needs to test better approaches to care.
“Given the number of people in need of a transplant and the better health and quality of life outcomes associated with a transplant, we need to find ways to improve the status quo,” she said.
That said, however, Burton said AKF didn’t get everything it would have wanted out of this model. An earlier proposal from CMS included a health equity performance adjustment that would have given more weight to transplants performed on low-income patients. Its removal left AKF “disappointed,” she said.
“The health equity performance adjustment would have been an important tool to ensure IOTA participants are not unfairly penalized if they serve a high number of low-income populations,” Burton said.