CMS, HHS Finalize Mandatory Model to Boost Kidney Transplant Access, Equity

Author(s):

Key Takeaways

The model aims to increase kidney transplants, improve care quality, and reduce disparities nationwide, involving 103 hospitals in diverse regions.
Hospitals are incentivized to perform more transplants, focusing on achievement, efficiency, and quality, with financial rewards or penalties.
The model addresses the organ supply-demand gap, with 90,000 on the waiting list and only 28,000 organs available annually.
Implementation starts July 1, 2025, with revisions made to support patients and reduce hospital burdens, including increased financial incentives.

The 6-year mandatory Increasing Organ Transplant Access Model aims to boost kidney transplants and address disparities by incentivizing hospitals, enhancing care coordination, and measuring transplant outcome performance.

CMS and HHS finalized the 6-year mandatory Increasing Organ Transplant Access Model last Tuesday to boost kidney transplants and address related disparities, according to a press release.¹

More specifically, the model aims to increase access to kidney transplants, improve the quality of care for those seeking kidney transplants, and reduce disparities in the kidney transplant process. Its effects will be evenly distributed at kidney transplant hospitals nationwide, engaging more value-based care specialists.

Kidney illustration | Image Credit: Tom - stock.adobe.com

The Increasing Organ Transplant Access Model aims to boost kidney transplants and address disparities by incentivizing hospitals, enhancing care coordination, and measuring transplant outcome performance. | Image Credit: Tom - stock.adobe.com

About 130,000 Americans are diagnosed with chronic kidney disease annually, accounting for 24% of Medicare spending each year. Kidney transplantation is widely recognized as the most effective treatment for patients with chronic kidney disease and end-stage renal disease (ESRD). Those who receive a kidney transplant often experience significant improvements in their quality of life and a reduction in overall medical costs.

However, 12 Americans on average die daily while waiting for a kidney transplant due to a gap in organ supply and demand.² Currently, about 90,000 people are on the kidney transplant waiting list, facing a wait time of 3 to 5 plus years for an offer¹; only 28,000 organs are procured annually.

Access to organ transplantation is currently influenced by distance to transplant centers and other sociodemographic and economic factors. The finalized Increasing Organ Transplant Access Model created a representative national sample of kidney transplant hospitals to boost the number of transplants performed. It is designed to enhance care coordination, improve the process's patient-centeredness, and expand access to kidney transplants.

Therefore, the model provides participating hospitals with a financial incentive to perform more transplants and a disincentive to perform fewer. It will measure performance based on the number of transplants (“achievement”), rates of accepting organs offered (“efficiency”), and post-transplant outcomes (“quality”).

Depending on its final performance score, a participating hospital will either receive a payment from CMS, fall in a neutral zone where it neither receives nor owes a payment, or, beginning in performance year 2, owe a payment back to CMS; these payments are in addition to the traditional Medicare fee-for-service payment.

CMS is selecting half of the country’s donation service areas (DSAs) and all eligible hospitals within those DSAs to participate, totaling 103 kidney transplant hospitals; these hospitals are in various geographic locations and have varied experiences with value-based care. This model will encourage participating hospitals to identify their underserved populations, address gaps in care and social determinants of health for donors and transplant recipients, and develop strategies and tools to create a more accessible transplant process.

CMS issued this proposed rule on May 17, 2024. The agency made significant revisions after receiving 160 comments, aimed at better supporting patients with kidney disease and reducing the burden on participating hospitals. For example, it delayed the start date to July 1, 2025, to allow participating hospitals additional preparation time.

Other changes include increasing the maximum amount a transplant hospital may receive based on its performance score to $15,000 per Medicare kidney transplant and adjusting the transplant target to reflect the average number of deceased or living donor transplants during the baseline years vs the highest count.

“The Biden-Harris Administration is leading an important overhaul of the organ transplantation system,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “The Increasing Organ Transplant Access Model will increase the number of kidney transplants that will not only save lives but will enable people to live longer and healthier ones.”

References