CMS releases proposed rule aimed at increasing efficiencies, access to kidney transplants
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Key takeaways:
- CMS and HHS announced details of a new model aimed at improving efficiencies at transplant centers and reducing disparities in access to kidney transplants.
- The model will involve about 90 transplant centers.
CMS and HHS have announced a proposed rule aimed at improving the performance of transplant centers and addressing disparities in access to kidney transplants.
The 6-year demonstration would be mandatory for about one-third of transplant centers in the United States and begin Jan. 1, 2025.
“The organ transplant industry, like every other part of society, is not immune to racial inequities,” Xavier Becerra, MD, HHS Secretary, said in a press release announcing the proposed Increasing Organ Transplant Access Model. “Black Americans disproportionately struggle with life-threatening kidney disease, yet they receive a smaller percentage of kidney transplants. The Biden-Harris administration is taking concrete steps to remove racial bias when calculating wait times and rooting out profiteering and inequity in the transplant process.”
According to the release, the goals of the model, which would be managed by the CMS Innovation Center, include the following:
- increase access to kidney transplants for people living with end-stage renal disease;
- improve the quality of care for people seeking kidney transplants;
- reduce disparities in kidney transplantation; and
- increase the efficiency and capability of transplant hospitals selected to participate.
“Modernizing the organ transplantation system is a top priority for the Biden-Harris administration,” Chiquita Brooks-LaSure, CMS Administrator, said in the release. “Kidney transplantation helps people live healthier and longer lives because they no longer have to undergo dialysis. The Increasing Organ Transplant Access Model would be an important step forward in improving the kidney transplant process for everyone on a waitlist and those who have received a transplant.”
In the proposed model, participating transplant hospitals would be measured by increases in the number of transplants, increased organ acceptance rates and post-transplant outcomes. Participating transplant hospitals would need to establish health equity plans to identify gaps in access among populations in their communities and develop strategies to address these gaps, according to the release.
“For example, participants could establish programs to educate and support potential living donors from underserved communities or to provide transportation assistance to patients on a waitlist. Participating transplant hospitals would also have the flexibility to address barriers related to social drivers of health, such as food insecurity and out-of-pocket prescription drug costs,” according to the release from CMS. HHS would offer additional performance incentives to participating transplant hospitals to improve equity access in the transplant process.
Hospitals eligible to be selected for the proposed model are non-pediatric facilities that conduct a minimum of 11 transplants each during a 3-year baseline period. Of the 257 transplant hospitals in the country, an estimated 90 would be required to participate in the model, according to the release.
In statements, the National Kidney Foundation, Kidney Care Partners (KCP) and the American Society of Nephrology voiced support of the model. “Currently, approximately 20% [to] 25% of deceased donor kidneys recovered for transplant are not transplanted, which is a disservice to those who donate their kidneys, their families and the countless kidney patients who must remain on dialysis to live,” Kevin Longino, CEO of the NKF, said in a press release. “Therefore, it is fundamentally necessary to reform the transplant ecosystem to one that honors organ donors and their selfless, life-saving gifts.”
Mahesh Krishnan, MD, MPH, MBA, chair of KCP, said: “While we are still evaluating the full impact of this proposal, by improving safety, equity and accountability within the U.S. organ transplant network, we can help ensure that the current system makes improvements to better serve those living with kidney failure.”
Michelle A. Josephson, MD, past president of the ASN and a transplant nephrologist, said in a press release: “I am optimistic about this new model benefitting the patients I serve today and into the future. For too long, the journey to receiving a kidney transplant has been a black box for patients and general nephrologists. For many, it can be a challenge to determine which transplant center would be a good fit, to know if a kidney was offered and declined on their behalf or even if a patient is active on the waitlist.
“This proposed model offers promising components that I believe could help increase access to kidney transplantation by better equipping patients, their families and their general nephrologists with information that empowers them to more effectively navigate the transplant system,” Josephson said.
The proposed rule on the Increasing Organ Transplant Access Model will be published May 17 in the Federal Register at https://www.federalregister.gov/public-inspection/2024-09989/medicare-program-alternative-payment-model-updates-and-the-increasing-organ-transplant-access-model. Questions about the model can be submitted to CMMItransplant@cms.hhs.gov.
References:
Increasing Organ Transplant Access (IOTA) Model announced to Increase patient access to kidney transplantation. https://www.newswise.com/articles/view/810849/?sc=mwhr&xy=10007438. Published May 9, 2024. Accessed May 10, 2024.
Kidney Care Partners applauds CMS’s proposed rule to increase organ transplant access. https://kidneycarepartners.org/press/kidney-care-partners-applauds-cmss-proposed-rule-to-increase-organ-transplant-access-2/. Published May 8, 2024. Accessed May 9, 2024.
The NKF applauds groundbreaking CMS policy to increase kidney transplantation. https://www.kidney.org/news/nkf-applauds-groundbreaking-cms-policy-to-increase-kidney-transplantation#:~:text=This%20proposal%20has%20the%20potential,dependent%20on%20dialysis%20to%20live. Published May 8, 2024. Accessed May 9, 2024.
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