Transplant Economics Post Implementation of the Affordable Care Act and the Budget Control Act Sequestration Adjustment on Medicare Reimbursement.
1VUMC, Nashville
2Tx Mgmt Group, San Diego
3Mayo Clinic, Jacksonville
Meeting: 2017 American Transplant Congress
Abstract number: 282
Keywords: Economics, Medicare, Public policy, Resource utilization
Session Information
Session Name: Concurrent Session: Transplant Regulation and Management: Allocation, Access and Other Transplant Management Topics
Session Type: Concurrent Session
Date: Monday, May 1, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: E451b
Purpose: Adjustments in the Affordable Care Act (ACA) of 2010 and sequestration from the Budget Control Act (BCA) of 2011 have impacted Medicare reimbursement for hospitals by reducing DRG and Organ Acquisition Pass-Through payments. We performed this study to determine the impact of the reductions on tx centers.
Methods: We calculated a national average Medicare reimbursement for tx DRGs by merging facility and area specific variables from CMS and tx volumes by tx center to develop the current reimbursement before reductions. We applied the projected ACA reductions to the DRG base rate, Indirect Medical Education, Disproportionate Share and Capital Payment rates effective 10/01/16, and the 2% BCA sequestration reduction to the total DRG reimbursement. Organ acquisition reimbursement was reviewed from 190 tx hospitals from filed Medicare cost reports with FYs ending in CY 2015. We determined the median organ acquisition reimbursement per hospital and applied the 2% sequestration reduction.
Results: DRG reductions ranged from ($2,136) for Kidney to ($26,121) for Heart w/ MCC. The median tx hospital organ acquisition reimbursement reduction of $153,271 will further decrease reimbursement.
| DRG/Organ | DRG Payment
Pre Reductions |
DRG Payment
Post Reductions |
Modeled
Reduction |
% Decrease |
| 652
Kidney |
$28,088 | $25,952 | ($2,136) | -7.6% |
| 010
Pancreas |
$32,877 | $30,448 | ($2,429) | -7.4% |
| 008
Kidney/Pancreas |
$46,347 | $42,081 | ($4,266) | -9.2% |
| 005
Liver w/ MCC |
$87,823 | $79,314 | ($8,509) | -9.7% |
| 006
Liver w/o MCC |
$41,120 | $37,659 | ($3,461) | -8.4% |
| 001
Heart w/ MCC |
$237,008 | $210,887 | ($26,121) | -11.0% |
| 002
Heart w/o MCC |
$127,706 | $128,736 | ($12,244) | -8.9% |
| 007
Lung |
$83,382 | $75,268 | ($8,114) | -9.7% |
| Transplant Hospital Median Organ
Acquisition Reimbursement FY 2015 |
Sequestration Reduction | % Decrease |
| $7,663,551 | ($153,271) | (2.0%) |
Conclusion: The ACA and BCA have a disproportionate negative reimbursement impact on high-cost inpatient services. For some centers, this may make transplantation a budget negative endeavor despite the clinical benefits. These Medicare reductions may compromise access and the ability to provide high quality tx care.
CITATION INFORMATION: Zavala E, Rogers J, Howey R, Karp S. Transplant Economics Post Implementation of the Affordable Care Act and the Budget Control Act Sequestration Adjustment on Medicare Reimbursement. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Zavala E, Rogers J, Howey R, Karp S. Transplant Economics Post Implementation of the Affordable Care Act and the Budget Control Act Sequestration Adjustment on Medicare Reimbursement. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-economics-post-implementation-of-the-affordable-care-act-and-the-budget-control-act-sequestration-adjustment-on-medicare-reimbursement/. Accessed November 25, 2024.« Back to 2017 American Transplant Congress