Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr;50(2):330-50.
doi: 10.1111/1475-6773.12188. Epub 2014 May 19.

Patient selection and volume in the era surrounding implementation of Medicare conditions of participation for transplant programs

Sarah L White  1 , Dawn M Zinsser, Matthew Paul, Gregory N Levine, Tempie Shearon, Valarie B Ashby, John C Magee, Yi Li, Alan B Leichtman
Affiliations

Patient selection and volume in the era surrounding implementation of Medicare conditions of participation for transplant programs

Sarah L White et al. Health Serv Res. 2015 Apr.

Abstract

Objective: To evaluate evidence of practice changes affecting kidney transplant program volumes, and donor, recipient and candidate selection in the era surrounding the introduction of Centers for Medicare and Medicaid Services (CMS) conditions of participation (CoPs) for organ transplant programs.

Data: Scientific Registry of Transplant Recipients; CMS ESRD and Medicare claims databases.

Design: Retrospective analysis of national registry data.

Methods: A Cox proportional hazards model of 1-year graft survival was used to derive risks associated with deceased-donor kidney transplants performed from 2001 to 2010.

Findings: Among programs with ongoing noncompliance with the CoPs, kidney transplant volumes declined by 38 percent (n = 766) from 2006 to 2011, including a 55 percent drop in expanded criteria donor transplants. Volume increased by 6 percent (n = 638) among programs remaining in compliance. Aggregate risk of 1-year graft failure increased over time due to increasing recipient age and obesity, and longer ESRD duration.

Conclusions: Although trends in aggregate risk of 1-year kidney graft loss do not indicate that the introduction of the CoPs has systematically reduced opportunities for marginal candidates or that there has been a systematic shift away from utilization of higher risk deceased donor kidneys, total volume and expanded criteria donor utilization decreased overall among programs with ongoing noncompliance.

Keywords: Medicaid; Medicare; kidney transplantation; quality improvement; regulation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percentage Change in Aggregate Transplant Volume, by Organ Type, Relative to Year Prior to First Outcomes Flag (Time Zero, Indicated by the Vertical Line); for Programs That Were Never Flagged, Percentage Change Is Calculated Relative to Kidney Transplant Volume in the Twelve Months from July 2006 to July 2007
Figure 2
Figure 2
Average Program Utilization of ECD Kidneys, as a Percent of All Kidney Transplants in That Time Interval (Unweighted); Error Bars Show the Standard Error around the Mean Values
Figure 3
Figure 3
Aggregate Risk of One-Year Graft Failure, Relative to the Overall Risk in 2007, Associated with Donor, Recipient and Overall Transplant Characteristics (Deceased Donor Kidney Transplants) Aggregate Risk is the Average Risk within Each Group of Programs, Weighted for Program Size. The Average Sample Sizes (Average Annual Number of Transplants, 2001–2011) for Each Group of Programs Were 847 (Single Flag), 995 (Multiple Flags, Returned to Compliance), 1,702 (Ongoing Non-Compliance), and 10,078 (Never Flagged)
See this image and copyright information in PMC

Comment in

References

    1. Abboud I, Antoine C, Gaudez F, Fieux F, Lefaucheur C, Pillebout E, Viglietti D, Serrato T, Verine J, Flamant M, Peraldi MN. Glotz D. Pulsatile Perfusion Preservation for Expanded-Criteria Donors Kidneys: Impact on Delayed Graft Function Rate. International Journal of Artificial Organs. 2011;34(6):513–8. - PubMed
    1. Abecassis MM, Burke R, Klintmalm GB, Matas AJ, Merion RM, Millman D, Olthoff K. Roberts JP. American Society of Transplant Surgeons Transplant Center Outcomes Requirements–A Threat to Innovation. American Journal of Transplantation. 2009;9(6):1279–86. - PubMed
    1. Ashby VB, Port FK, Wolfe RA, Wynn JJ, Williams WW, Roberts JP. Leichtman AB. Transplanting Kidneys without Points for HLA-B Matching: Consequences of the Policy Change. American Journal of Transplantation. 2011;11(8):1712–8. - PubMed
    1. Axelrod DA. Balancing Accountable Care with Risk Aversion: Transplantation as a Model. American Journal of Transplantation. 2013;13(1):7–8. - PubMed
    1. Centers for Medicare and Medicaid Services. 2007. “ Hospital Conditions of Participation: Requirements for Approval and Re-Approval of Transplant Centers To Perform Organ Transplants; Final Rule.” 42 CFR Parts 405, 482, 488 and 498 Medicare Programs. Department of Health & Human Services. Federal Register.

Publication types

LinkOut - more resources