Background: SRTR program reports provide detailed information on transplant center performance relative to risk-adjusted expected values. These measures are utilized by the Centers for Medicare and Medicaid Services (CMS) for their Conditions of Participation (CoP). The CMS CoP is designed to improve patient outcomes, as a result transplant physicians may alter their selection of patients and donor organs in response to the CMS CoP. This research provides a descriptive analysis of aggregate changes resulting from the CMS CoP.

Methods: UNOS data on 187 high-volume transplant centers from 6/30/2007-6/30/2010 were used to analyze 29,552 deceased donor transplants. SRTR program reports were used to construct indicator variables for whether or not a center did not meet one of the CMS CoPs at the time the transplant was performed. For each transplant the donor and patient risk factors that are used in the current risk adjustments by SRTR for the program reports was collected. The differences in patient and donor risk profiles that exist between deceased donor transplants performed when a transplant center is not subject to CMS review and when they are subject to review was determined.

Results: Preliminary results indicate that patients selected for transplantation were healthier when a center was subject to CMS review then when they were not subject to review. The percentage of patients with a high functional status at listing increased from 63% to slightly over 69%. Furthermore, there is a general increase in transplantation of patients that have previously received a transplant. Roughly 12% of the transplants performed at a center that meets the CMS CoP for 1-year graft survival are for a patient with a previous transplant, whereas they consist of approximately 14% of the transplants at centers that do not meet the CMS CoP. Fewer donors were selected from higher risk categories, such as Hepatitis C (reduction from 2.6% to 1.3%), hypertension status (reduction from 28% to 26%), and ECD status (reduction from 18% to 16%).

Conclusion: When a transplant center does not meet one of the CMS CoP the center may alter their mix of patients and donors. Preliminary results suggest that this altered mix results in healthier patients receiving a transplant as well as healthier donors being selected during this time period. Further analysis is warranted to investigate regional variation as well as variation resulting from the different CMS CoPs.

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