Background: The SRTR informs patients and payers about transplant center performance. Historically, transplant programs were rated on a 3-tier scale. In 2016, the SRTR introduced a 5-tier scale; several months thereafter this scale was temporarily rolled back. The consequences of classifying more centers as better or worse than expected is unknown.

Methods: As part of a larger survey about transplant quality metrics and in partnership with the American Society of Transplant Surgeons (ASTS) and American Society of Transplantation (AST), we surveyed ASTS and AST members on center experiences with patient and payer responses to 5-tier SRTR ratings (n=280). To prevent response bias from individuals with strong attitudes toward the scale, participants were not informed that the survey would ask about the SRTR 5-tier scale prior to participating.

Results: Participant-reported SRTR ratings and annual transplant volumes were representative of a national sample. About half of respondents (45.7%) reported that their center received a rating of "lower" or "somewhat lower" than expected on the 5-tier scale in ≥1 organ program. Over half of respondents (52.1%) reported ≥1 negative effect of the new 5-tier scale, including losing patients, losing insurers, increased concern among patients, and increased concern among referring providers (Figure 1). Lower SRTR 5-tier scores were associated with increased risk of reporting negative (p<0.01, Table 1) and increased risk of reporting individual negative effects (p<0.01, Table 1b). Few respondents (13.7%) reported any positive effects of the 5-tier scale.

Conclusions: The 5-tier scale provoked an immediate response in the transplant community that may have long-term implications for transplant center finances and patient options for transplantation.

CITATION INFORMATION: Rasmussen S., Thomas A., Garonzik-Wang J., Henderson M., Stith S., Segev D., Hersch Nicholas L. Reported Effects of the SRTR 5-Tier Rating System on US Transplant Centers Am J Transplant. 2017;17 (suppl 3).

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