CMS finalizes new kidney transplant model: 10 things to know

HHS and CMS have finalized a new, mandatory model for kidney transplant coordination across 103 hospitals. The model aims to increase access, address disparities and improve care coordination for patients navigating the kidney transplant process, while also reducing Medicare expenditures. 

For participating transplant hospitals, the six-year Increasing Organ Transplant Access Model will go into effect July 1 and end June 30, 2031, according to a fact sheet released Nov. 26 by CMS. 

Here are 10 things to know about the new transplant model:

1. Twenty-four percent of annual Medicare spending goes toward the 130,000 Americans diagnosed with chronic kidney disease each year. Around 90,000 people are on the waiting list for a kidney transplant, typically for more than three years.
   
   
2. Around 28,000 kidney transplants are performed annually, with 30% of donor kidneys discarded each year.
   
   
3. All eligible kidney transplant hospitals from half of the donation service areas in the U.S., representative of a range of geographic locations, will be required to participate in the new model. Hospitals in the other half of donation service areas will serve as the comparison group.
   
   
4. The model incorporates financial incentives for hospitals based on the number of adult kidney transplants performed, the hospital's organ-offer acceptance rate ratio and the post-transplant composite graft survival rate.
   
   
5. In addition to regular Medicare FFS payment, participating hospitals will be eligible to receive performance based payment from CMS during the first year of the model.
   
   
6. In the second year of the model, participating hospitals will either receive a payment from CMS, owe a payment to CMS or neither receive nor owe a payment, based on their performance.
   
   
7. The maximum payment per Medicare FFS transplant given by CMS under the model will be $15,000. The maximum payment per Medicare FFS transplant owed to CMS under the model will be $2,000.
   
   
8. Participating hospitals will be "provided flexibilities" to address barriers to care for underserved populations such as transportation and out-of-pocket drug costs.
   
   
9. Prospective patients will be notified if their hospital is participating in the transplant model and will have the freedom to seek care from a different Medicare provider, should they choose.
   
   
10. CMS made revisions to the model based on public comment received regarding the model's proposed rule, issued May 17.

Read more about the new model here.