The federal contractors that evaluate and procure organs for transplants would be subject to more government evaluation under changes proposed Dec. 17 by the Trump administration aimed at increasing the number of organ transplants.
The proposed changes are part of President Donald Trump’s executive order aimed at rebooting Medicare’s approach to kidney care to ease one of the largest domestic drains on taxpayers. Researchers estimate that 43,000 people in the U.S. die each year when a kidney transplant could have saved their lives. Doctors and researchers say there are enough organs, but inefficiencies mean all of them aren’t used.
Approximately 60 federal contractors, known as organ procurement organizations (OPOs), are responsible for connecting organ donors and recipients in specific geographic regions. Under the proposal, government evaluations would shift by measuring the number of usable organs each organization procures and those that are actually transplanted to waiting patients. Currently, OPOs self report their own data to the government and include organs that are also donated for research.
Each month, 3,000 people are added to the national kidney waiting list and hundreds pass away while awaiting a transplant. “This is unacceptable,” said Joe Grogan, director of the white House Domestic Policy Council.
Approximately 95,000 peopple are currently awaiting a kidney. The proposed rule will shorten wait times. Nearly 7,000 of the 36,000 organ transplant performed each year come from living donors, Grogan said. Blacks—who make up 13% of the population but one-third of the kidney transplant wait list—would benefit in particular, Grogan said.
The government plans to look at two measures from each contractor—the number of deaths of people under age 75 who are eligible to be donors and percentage of actual organs transplanted from that available pool. Under the proposed measure, an OPO wouldn’t receive credit for procuring an organ if it is not transplanted. That encourages procurement organizations to ensure all viable organs are transplanted, according to a fact sheet.
Procurement organizations would be evaluated against the top-performing contractors that set the standard for the forthcoming year.
“These simple, yet powerful outcome measures eliminate today’s perverse incentives and will instead incentivize OPOs to seek as many organs as possible—perfect and imperfect alike,” Centers for Medicare & Medicaid Services Administrator Seema Verma said.
Patients would receive “robust information” on the quality of the organ they’re receiving, Verma said. The final decision on whether to accept an imperfect organ would lie with the patient and their doctor, Verma added.
“But for countless patients, an imperfect organ is better than no organ at all. And for someone on a wait list, that may be the difference between life and death.”
The National Living Donor Assistance Center currently reimburses up to $6,000 in expenses, including travel, lodging, meals, and incidentals for living donors. The proposal will add reimbursement for lost wages, child care, and even elder care to help remove barriers that discourage low-income people from donating organs.
The Centers for Medicare & Medicaid Services earlier set up a new pilot program to change the way the government pays doctors and hospitals for kidney care as part of the kidney care executive order.
Four of those models are voluntary and doctors are currently able to apply to participate, but financial accountability won’t start until 2021. One model pays nephrologists a set fee per patient, and those doctors receive bonuses for each patient that receives a transplant and stays healthy. The other three models rely on nephrologists and other kidney-care providers to work together to manage the total care for patients with late-stage chronic kidney disease and kidney failure. Those providers receive a set payment for each case and a portion of any financial savings to Medicare.
The final model is being delayed and is listed as a long-term action in the department’s agenda. It would require nephrologists, transplant providers, and dialysis facilities to receive a set payment for handling Medicare patients with end-stage renal disease. It’s designed as an incentive for those teams to manage costs.