Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 309
*Purpose: Medicare organ acquisition reimbursement from the Medicare Cost Report includes costs associated with transplant hospitals acquiring an organ for Medicare transplant patients and the costs of procuring deceased donor organs and live donor organs for Organ Procurement Organizations (OPOs) and Certified Transplant Centers (CTCs). Since the Provider Reimbursement Manual (PRM 15-1), Chapter 31 considers Medicare transplants and organs procured for OPOs and CTCs as reimbursable by Medicare in the Medicare Cost Report, CTCs are financially advantaged by being an organ donor hospital. We performed this study to quantify the financial impact of organ donation and live donor organ procurement for certified transplant centers.
*Methods: We calculated the total Medicare organ acquisition reimbursement by organ reported in the Medicare Cost Report (CMS Form 2552, Worksheet D-4, Part III, Line 69, Column 1) by all CTCs using the 2016 Healthcare Cost Report Information System database. The reported Medicare reimbursement includes the costs of organ acquisition for Medicare transplants performed at each CTC and the deceased and live donor organs acquired for OPOs and other CTCs from the procuring CTC hospital. We then utilized additional information found in the Medicare Cost Report using the Healthcare Cost Report Information System database to recalculate what Medicare reimbursement would have been if the costs, revenues received, and organs procured for OPOs and other CTCs were excluded. Since procurement costs are not separately reported, it was assumed that the procurement costs equal revenues received for organs procured. The difference in Medicare organ acquisition reimbursement under each method can be attributed to organ procurement.
*Results: Table 1 shows the average increase in Medicare Organ Acquisition reimbursable for each organ procured for OPOs and CTCs in FY 2016 is $10,918 per kidney; $11,291 per liver; $11,371 per heart; and $9,294 per lung. The average increase in Medicare Organ Acquisition reimbursable for each type transplant program attributable to organ procurement is $456,243 for kidney; $593,643 for liver; $385,306 for heart; and $260,504 for lung.
*Conclusions: Medicare organ acquisition reimbursement through the Medicare Cost Report provides a significant revenue stream for transplant programs. The Medicare organ acquisition reimbursement will be increased for transplant programs based at strong deceased organ donor hospitals and transplant programs involved with live organ donor procurement for other CTCs.
To cite this abstract in AMA style:Zavala EY, Rogers J. The Impact of Transplant Hospital Organ Procurement on Medicare Cost Report Reimbursement [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-transplant-hospital-organ-procurement-on-medicare-cost-report-reimbursement/. Accessed June 26, 2019.
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