Kidney Disease Patients: Proposed Rule Aims to Increase Transplants

IOTA Model

The organ transplant industry, like every other sector (kidney transplants IOTA model), is not free from racial disparities,” remarked U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. “Black Americans face a disproportionate burden of life-threatening kidney disease, yet they receive a smaller share of kidney transplants. The Biden-Harris Administration is implementing concrete measures to eliminate racial bias in wait time calculations and to address profiteering and inequities in the transplant process.”

Kidney transplantation is the optimal treatment for most individuals with end-stage renal disease (ESRD), offering superior outcomes and quality of life compared to dialysis. However, despite the severe shortage of organs, resulting in increased mortality and prolonged wait times, about 30 percent of donor kidneys are discarded annually. This discrepancy underscores significant issues in procurement, distribution, and utilization. In 2023, over 28,000 kidney transplants were performed, but more than 90,000 individuals remained on the waitlist. Urgent reforms are essential to enhance the system’s efficiency and effectiveness.

The Centers for Medicare & Medicaid Services (CMS) has proposed a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model). This initiative aims to improve access to kidney transplants for patients with ESRD by offering performance-based incentive payments to participating transplant hospitals. The objective is to increase the number of kidney transplants while maintaining or enhancing care quality and reducing Medicare costs.

Key features of the IOTA Model include:

      • Performance-based incentives for hospitals, incorporating both rewards and penalties;
      • A focus on increasing kidney transplants from both living and deceased donors;
      • Encouragement of investments in care processes and value-based care;
      • Promotion of hospital accountability by linking payments to performance.

The model also aims to advance health equity by addressing disparities in health outcomes through a mandatory health equity plan and a performance adjustment based on equity.

The proposed rule encompasses standard provisions applicable to Innovation Center models, starting with the first performance period on or after January 1, 2025. These provisions cover areas such as beneficiary protections, model evaluation and monitoring, audits, data rights, compliance, and more, aiming to enhance transparency, efficiency, and clarity in the governance of Innovation Center models.

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