Sunday, July 1, 2012

How should we pay for kidney exchange?

Rees, Michael A.,  Mark A. Schnitzler, Edward Zavala, James A. Cutler,  Alvin E. Roth, F. Dennis Irwin, Stephen W. Crawford,and Alan B.  Leichtman,“Call to Develop a Standard Acquisition Charge Model for Kidney Paired Donation,”American Journal of Transplantation, 2012, 12, 6 (June), 1392-1397.

Abstract:  We propose a Medicare Demonstration Project to develop a standard acquisition charge for kidney paired donation. A new payment strategy is required because Medicare and commercial insurance companies may not directly pay living donor costs intended to lead to transplantation of a beneficiary of a different insurance provider. Until the 1970s, when organ procurement organizations were empowered to serve as financial intermediaries to pay the upfront recovery expenses for deceased donor kidneys prior to knowing the identity of the recipient, there existed similar limitations in the recovery and placement of deceased donor organs. Analogous to the recovery of deceased donor kidneys, kidney paired donation requires the evaluation of living donors prior to identifying their recipient. Tissue typing, crossmatching and transportation of living donors or their kidneys represent additional financial barriers. Finally, the administrative expenses of the organizations that identify and coordinate kidney paired donation transplantation require reimbursement akin to that necessary for organ procurement organizations. To expand access to kidney paired donation for more patients, we propose a model to reimburse paired donation expenses analogous to the proven strategy used for over 30 years to pay for deceased donor solid organ transplantation in America.


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People with chronic kidney disease have a 10-year risk for myocardial infarction of around 12%, report researchers who found that this was higher than that for people with diabetes.

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Living donors are financially responsible for their routine annual health maintenance testing (e.g., pap smear, mammogram, colonoscopy, etc.) or medical clearance that may be required for pre-existing conditions. However, all other testing required for the living donor evaluation as well as the hospitalization costs and physician services provided during the donation process are covered either by recipient’s insurance or the University of Maryland Medical Center. Donors will be provided with a special billing form that they will need to present during their testing and hospitalization, rather than their private health insurance information. Transplant-related complications are covered for at least 90 days.