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The problem starts with improving the performance of local organ procurement organizations
The United States just passed a law updating its organ donation network for the first time in 40 years. But can what is truly broken be repaired?
This country's organ donation system is mandated by Congress 1984is called Organ Procurement and Transplant Network (network). This will allow individual transplant programs across the country to work together to get more donor organs to patients in need.
When created, the network was mandated to be operated by a single private entity. an organization called Unified network for organ sharing (UNOS) won the federal contract in 1986 and has had full control of the network without competition ever since.
Critics have long argued that UNOS' network monopoly has led to complacency and error. Congress finally listened and passed it in 2023. Securing the U.S. Organ Procurement and Transplant Network Act To allow the federal government to contract with multiple organizations at once to operate the network.
The new competition aims to improve operational efficiency and increase the number of annual transplants. But the new law doesn't actually address the most dysfunctional part of the network: the local organ procurement organizations (OPOs), which carry out day-to-day operations.
Poor OPO performance and patient impact
the current, 56 OPOs across the country coordinate the procurement, transportation, and transplanting of plants. thousands of Number of organs and tissues each year. Each OPO operates within an exclusive scope. Designated service area. for example, Midwest Transplant Network OPO coordinates all of Kansas and much of Missouri; life bank OPO serves only 20 counties in Ohio.
OPOs do not compete with each other and have little regulation from UNOS or the Centers for Medicare and Medicaid Services (CMS), which oversees OPOs. Unfortunately, in this case, light regulation had disastrous consequences.
2022 Senate report It outlined a series of alarming operational and procedural lapses by the OPO. In 2020, an OPO threw a recently acquired kidney into the trash, rendering it sterile and unusable. Even more alarming, in both 2017 and 2018, two different OPOs were overseeing the organ retrieval of donors who were still alive at the time of surgical entry into the thoracic cavity. One of these cases was filed with UNOS by an anonymous reporter, but was dismissed by the organization.
In fact, only 40 percent of such claims are referenced back up the chain within UNOS. Additional reviews. As a result, an OPO with a critical error will continue to operate. These errors can render hundreds of organs unusable, leading to OPO efficiency issues.
CMS performance guidelines
new CMS rules seeks to address this issue by strengthening the authorities' existing powers to revoke the accreditation of underperforming OPOs.
The rule provides that CMS will begin judging OPO performance based on donation and transplant rates. Essentially, the more donations and transplants an OPO coordinates, the better its overall performance score will be. According to these new guidelines, the worst performing OPOs will be subject to decertification and replacement.
Ideally, this threat would motivate underperforming OPOs to make changes in advance of the CMS's quadrennial review. But 2021 data reveals: 42 percent OPOs are already performing so poorly that they are automatically subject to decertification under these new standards.
Only time will tell whether the new rules have an effect. In the meantime, the country may also consider changing the way it pays OPOs.
Fair payments to OPOs
For now, Cost-based reimbursement system Centralize Medicare payments to OPOs. “Reasonable cost” Costs incurred during procurement and transplantation, such as transportation costs and diagnostic test costs. States do not pay OPOs based on self-reported costs; Performance-based payment model.
These models comply with new CMS regulations and allow payments to be made to OPOs based on donation and transplant rates. However, an increase in trading volume does not necessarily mean that OPO's actual performance is improving. To address this issue, CMS could include performance indicators beyond quantity, such as patient survival rates and the number of organs an OPO discards each year.
Transforming networks and holding OPOs accountable could have a major impact on racial equity in organ donation. By 2022, more than half of the total white patient Only 30 percent of black patients on transplant lists received organs. Ensuring improvements in underperforming OPOs is an important issue for the entire system, but especially for underserved patients who already face additional challenges accessing life-saving care.
No matter what tools you use, one thing is clear: You cannot continue to reward OPOs that are underperforming. The 2023 law aims to break the UNOS monopoly, and introducing competition is an important way to encourage improvement. But we can't stay in the competition. Regulatory muscles also need to be flexible.
Catherine O'Malley He is a policy analyst at BU's School of Public Health and the Department of Veterans Affairs' affiliated Evidence-Based Policy Resource Center. She can be reached at [email protected].
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