Introduction: A non-profit kidney paired donation (KPD) organization undertook an Agency for Healthcare Research and Quality (AHRQ)-funded demonstration project to redesign reimbursement for the costs associated with KPD donation utilizing a payment model similar to that used for deceased donor transplants (TXP) – a standard acquisition charge (SAC). A 2012 Consensus Conference on KPD concluded that a national KPD SAC would alleviate administrative and financial challenges that limit TXP center (CTR) participation when KPD involves more than one TXP CTR.

Methods: Participating TXP CTRs decided on the tests to include in the donor evaluations and compiled de-identified data on the costs for living donor kidney recovery (facility fees and professional fees of the surgeon and anesthesiologist) as well as the costs for preservation, packaging and shipping of a living donor kidney. The de-identified data included the Medicare reimbursement rate for the services in each geographic area, plus the average commercial insurance reimbursement calculated from three commercial payers of their choosing. CMS approval was given in June 2014, and TXP CTRs formalized participation via a written agreement.

Results: The initial study was designed to provide reimbursement to TXP CTRs only for donor evaluations related to KPD; but it became obvious that in order to attract more TXP CTRs to participate (thus broadening access for patients desiring KPD), paying TXP CTRs for KPD donor nephrectomy was highly desired. The project evolved to include payment from the non-profit to KPD donor hospitals for the cost of donor evaluations, facility and professional costs for nephrectomy, and preservation, packaging and shipping the donated kidney. In return, the KPD TXP CTR receiving the donated kidney agreed to pay the non-profit a KPD SAC. To date, 100 transplants have been performed using the KPD SAC mechanism since its initiation in 2015 and more than 40 TXP CTRs have signed cooperative agreements to participate.

Conclusion: This AHRQ-funded project has provided a mechanism to reduce the administrative burden of negotiating payment and legal agreements between providers for the costs associated with KPD. It has also provided cost certainty for TXP CTRs and payers. In so doing, greater TXP CTR participation in KPD has been achieved, leading to additional living donor kidney transplants in the United States.

CITATION INFORMATION: Rees M, Reece L, Rees S, Crandall B, Leichtman A. A Kidney Paired Donation Standard Acquisition Charge. Am J Transplant. 2017;17 (suppl 3).

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