Background/Purpose: A national non-profit Kidney Paired Dontion (KPD) organization undertook a demonstration project to redesign payment for KPD transplants with a payment model similar to the current approach for deceased donor cost recovery–utilizing a standard acquisition charge (SAC). A 2012 Consensus Conference on KPD concluded a national SAC would remove many of the financial barriers and create cost certainty for transplant (Txp) centers. Aim One of the grant: Collect actual financial data from a clinically active KPD program to allow calculating the real-life cost per KPD transplant.

Methods: Over a number of months, stakeholders agreed on what costs should be reimbursed. Notably, the group decided on the appropriate tests included in the donor evaluations. Further, they compiled de-identified data on the current costs for the nephrectomy facility charges; the surgeon and anesthesiologist professional fees; and costs to pack and ship a living donor kidney. The de-identified data included the Medicare reimbursement rate for their geographic area plus average commercial insurance reimbursement calculated from 3 commercial payers of their choosing. The study started slowly, as it was necessary not only to achieve consensus, but for the Centers for Medicare and Medicaid Services (CMS) to give the awardee permission to move forward, as the project had direct implications for a Txp center's Medicare cost report. Approval was given in June 2014, and Txp centers formalized with their participation via a written agreement.

Results: The initial study was designed to provide reimbursement to Txp centers only for donor evaluations related to KPD; but it became obvious that in order to attract more centers to participate (thus broadening access for patients desiring KPD), paying centers for KPD donor nephrectomy was highly desired. The project evolved to one that paid participating centers for the cost of: donor evaluation, nephrectomy, surgeon & anesthesiologist's fees, and packing and shipping a kidney donated for KPD. In return, the Txp center receiving the donated kidney agreed to pay the organization a KPD SAC following transplantation of such a kidney. To date, 39 transplants have been performed using the KPD SAC mechanism since initiation in 2015.

Conclusion/Implications: This AHRQ-funded project overcomes barriers to creating additional living donor kidney transplants in the United States, leading to improved quality of care, access to care, and reduced cost.

CITATION INFORMATION: Rees M, Reece L, Rees S, Crandall B, Leichtman A. A Kidney Paired Donation Standard Acquisition Charge Pilot Program. Am J Transplant. 2016;16 (suppl 3).

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