The Center for Medicare and Medicaid Innovation has released a proposed mandatory payment model focusing on increasing patients’ access to kidney transplantation. 

The 6-year, multi-payer Increasing Organ Transplant Access (IOTA) Model will begin in 2025. It will randomize an estimated 90 transplant centers of the 231 facilities actively performing kidney transplants nationwide.

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. The model would hold kidney transplant hospitals accountable for the care they provide. 

Hospitals eligible to be selected for the proposed model are non-pediatric facilities that conduct a minimum of 11 transplants each during a three-year baseline period. 

The proposed model would require participating transplant hospitals to establish health equity plans to identify gaps in access among populations in their communities and develop strategies to address these gaps. 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.

“The American Society of Nephrology (ASN) has been advocating for increased investment and reform in the U.S. transplant system for many years” stated ASN President Deidra C. Crews, M.D., in a statement. “People with kidney failure deserve to have access to the best therapy—a kidney transplant—maximized at every opportunity. ASN is grateful for the leadership of the Biden-Harris Administration in testing patient-centered changes to how kidney transplant care is delivered, and we welcome the opportunity to review and suggest improvements to the proposed IOTA Model released today.”

Healthcare Innovation recently interviewed Benjamin Hippen, M.D., senior vice president, head of transplant medicine and emerging capabilities at Fresenius Medical Care, about elements he thinks a transplant-inclusive value-based care model should have.

The proposed IOTA model would provide incentives for transplant hospitals to promote the following goals:
• Maximize the use of deceased donor kidneys. Currently, approximately 30% of donor kidneys go unused annually.
• Improve quality of care before, during and after transplantation.
• Identify more living donors and assist potential living donors through the donation process.
• Create greater equity in access to a kidney transplant by addressing social determinants of health and other barriers to care.
• Improve care coordination and patient-centeredness in the kidney transplant process.
• Reduce Medicare expenditures.
“I am optimistic about this new model benefitting the patients I serve today and into the future,” said transplant nephrologist and ASN Past President Michelle A. Josephson, M.D., in a statement. “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.”

CMS said the proposed mandatory model would align with the HHS Organ Transplant Affinity Group’s strategy to coordinate a series of initiatives to increase transplantation access through payment, quality, and regulatory efforts. 


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