A simple risk-based reimbursement system for kidney transplant

Area of Science:

• Nephrology
• Transplant Surgery
• Health Economics

Background:

• Executive Order on Advancing Kidney Health aimed to increase kidney transplant (KTx) access.
• Medicare reimbursement for KTx lacks adjustments for major complicating comorbidities (MCCs), unlike other transplants.
• Higher-risk patients and organs are increasingly accepted, necessitating evaluation of associated costs and outcomes.

Purpose of the Study:

• To assess the prevalence of MCCs in kidney transplant recipients.
• To compare hospital resource utilization and financial margins for KTx with and without MCCs under Medicare reimbursement.
• To determine the financial impact of KTx in patients with MCCs.

Main Methods:

• Retrospective analysis of 260 KTx cases from 10/15 to 10/19 at a single academic center.
• Utilized Medicare ICD-10 criteria for MCCs, excluding end-stage kidney disease.
• Calculated hospital costs (excluding organ acquisition) and estimated financial margins based on Medicare reimbursement.

Main Results:

• 19% of KTx recipients had an MCC.
• Patients with MCCs experienced longer wait times and received organs with longer cold ischemic times, with fewer living donors.
• KTx with MCCs incurred 31% higher costs and resulted in significantly lower estimated financial margins (-$7750 vs -$1001).

Conclusions:

• Kidney transplantation for patients with qualifying MCCs leads to substantial financial losses.
• Current Medicare reimbursement for KTx is insufficient to cover the increased costs associated with higher-risk patients.
• Modification of KTx payment methodology is needed to align with other organ transplants and ensure financial viability.