New federal model for increasing kidney transplants begins July 1
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Key takeaways:
- The demonstration project aims to increase kidney transplants by limiting discarded organs and encouraging living donations.
- Participation in the 6-year study is mandatory for 103 transplant centers.
CMS and HHS finalized a federal rule aimed at increasing the number of kidney transplants and addressing disparities among potential organ recipients, according to a CMS press release.
“The goal of the Increasing Organ Transplant Access model [IOTA] is to ensure more people with end-stage renal disease get access to transplants, by increasing the use of kidneys suitable for transplant that become available in the United States and increasing the number of transplants from living donors,” the release stated.
The 6-year mandatory demonstration project will begin July 1, 2025, and include 103 transplant centers — all the centers in half the donation service areas in the U.S. — representing a range of geographic locations and experience with value-based care, according to the release. Centers in the other donation service areas will serve as controls. Participating centers can receive up to $15,000 per Medicare kidney transplant based on increasing the number of transplants performed, reducing the number of inappropriately discarded kidneys and maintaining medical outcomes. Centers that fail in these areas may be required to pay a $2,000 assessment to CMS beginning in the second performance year of the project, according to a fact sheet from CMS.
“The Increasing Organ Transplant Access model aims to improve the effectiveness of the nation's kidney transplant system, which currently is not meeting the needs of many patients. On average, 13 Americans die each day while waiting for a life-saving kidney transplant. Despite the significant gap between organ supply and demand, nearly 30% of donor kidneys are discarded each year. There are approximately 90,000 people on the kidney transplant waiting list, facing a wait time of 3 to 5 years or longer for an offer. However, only 28,000 organs are procured annually,” according to the release.
The final rule incorporated some comments on the proposed rule released in May, including delaying the start date, eliminating certain requirements for reviewing organs that are declined, and increasing payments to hospitals, according to the fact sheet.
In addition, the final rule made health equity programs optional while still encouraging hospitals to identify underserved groups and address gaps in care and social determinants of health.
“Kidney transplantation is the optimal therapy for most people with kidney failure. I am optimistic that IOTA’s focus on increasing transplant rates will mean that more of the 550,000 Americans on dialysis can benefit, given the known survival and quality of life advantages that kidney transplantation confers. … I view this model as continuing the legacy of the 2019 Advancing American Kidney Health initiative, which established ambitious goals for increasing access to transplantation,” Deidra C. Crews, MD, ScM, FASN, president of the American Society of Nephrology, said in a press release from the organization.
“The new IOTA model is an important next step towards those goals, and we commend the CMS Innovation Center for advancing reform. Still, more must be done,” Kevin Longino, CEO of the National Kidney Foundation, said in a press release from the foundation. “We are disappointed that some provisions on patient communication and transparency were not included in the new model. For example, it does not require transplant centers to inform patients about the number of organs declined on their behalf or the reasons for these declines. We urge CMS to prioritize reinstating such requirements in future iterations of the model. Nevertheless, this is progress and that should bring some hope to the nearly 90,000 people waiting for a kidney transplant in the U.S. right now and the more than a half million Americans who need regular dialysis treatment to live.”
The final rule on the Increasing Organ Transplant Access model will be published Dec. 4 in the Federal Register at https://www.federalregister.gov/public-inspection/2024-27841/medicare-program-alternative-payment-model-updates-and-the-increasing-organ-transplant-access-model.
References:
American Society of Nephrology welcomes new CMMI model aimed at boosting transplant rates. https://www.asn-online.org/about/press/releases/?y=2024. Published Nov. 27, 2024. Accessed Dec. 2, 2024.
CMS. Biden-Harris administration finalizes new model to improve access to kidney transplants. https://www.cms.gov/newsroom/press-releases/biden-harris-administration-finalizes-new-model-improve-access-kidney-transplants. Published Nov. 27, 2024. Accessed Dec. 2, 2024.
National Kidney Foundation leadership speaks out on new IOTA model. https://www.kidney.org/press-room/national-kidney-foundation-leadership-speaks-out-new-iota-model#:~:text=Changes%20to%20the%20IOTA%20Model%20are%20designed%20to%20enhance%20the,of%20care%20and%20health%20outcomes. Published Nov. 27, 2024. Accessed Dec. 2, 2024.
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