Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges.
Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges.
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DOI：
10.1007/s40472-022-00379-w
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发表时间：
2022
影响因子：
2.1
通讯作者：
Tietjen, Andrea
中科院分区：
文献类型：
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作者：
Lentine, Krista L;Sarabu, Nagaraju;McNatt, Gwen;Howey, Robert;Hays, Rebecca;Thomas, Christie P;Lebron-Banks, Ursula;Ohler, Linda;Wooley, Cody;Wisniewski, Addie;Xiao, Huiling;Tietjen, Andrea
在美国，活体器官供者的随访时间为2年，但缺乏关于回收随访护理相关费用的正式指导。在这篇综述中，我们讨论了活体肾供者随访移植项目的当前计费做法，并提出了管理随访成本和支持供者护理成本中立的未来方向。活体捐献者在捐赠过程中可能会产生费用和财务风险，包括旅行、失去工作时间和受抚养人的照顾。此外，遵守器官获取和移植网络（OPTN）对美国移植项目的授权，向国家登记处提交捐赠后6个月、12个月和24个月的随访数据，可能会给捐赠者带来自付医疗费用。值得注意的是，医疗保险和医疗补助服务中心（CMS）明确禁止移植项目将常规的、强制性的后续费用支付给器官获取成本中心或接受者的医疗保险。我们对美国的移植工作人员进行了一项调查（分布于2020年10月22日至2021年3月15日），调查发现，在响应项目中，恢复或支付强制性捐献后常规随访费用的机制通常包括账单接受者的私人保险（40%），而41%的账单接受者的医疗保险。许多项目报告使用了机构补贴（高达50%），一些项目向器官获取成本中心收费（25%）。一小部分（11%）报告了向捐赠者或捐赠者的保险付款。为了在不给捐赠者带来经济负担的情况下保持对活体捐赠者随访的高度坚持，需要最新的资源，以符合政策并对捐赠者和项目有效的方式处理日常捐赠者随访费用。发展一个由政府支持的国家活体捐赠者随访登记系统，如活体捐赠者集体，可能会为捐赠后的随访提供解决方案，但需要移植项目承诺登记捐赠者和捐赠者候选人，以及捐赠者参与捐赠后的后续联系。在线版本包含补充材料，可在10.1007/s40472-022-00379-w获得。
While living organ donor follow-up is mandated for 2 years in the USA, formal guidance on recovering associated costs of follow-up care is lacking. In this review, we discuss current billing practices of transplant programs for living kidney donor follow-up, and propose future directions for managing follow-up costs and supporting cost neutrality in donor care. Living donors may incur costs and financial risks in the donation process, including travel, lost time from work, and dependent care. In addition, adherence to the Organ Procurement and Transplantation Network (OPTN) mandate for US transplant programs to submit 6-, 12-, and 24-month postdonation follow-up data to the national registry may incur out-of-pocket medical costs for donors. Notably, the Centers for Medicare and Medicaid Services (CMS) has explicitly disallowed transplant programs to bill routine, mandated follow-up costs to the organ acquisition cost center or to the recipient’s Medicare insurance. We conducted a survey of transplant staff in the USA (distributed October 22, 2020–March 15, 2021), which identified that the mechanisms for recovering or covering the costs of mandated routine postdonation follow-up at responding programs commonly include billing recipients’ private insurance (40%), while 41% bill recipients’ Medicare insurance. Many programs reported utilizing institutional allowancing (up to 50%), and some programs billed the organ acquisition cost center (25%). A small percentage (11%) reported billing donors or donors’ insurance. To maintain a high level of adherence to living donor follow-up without financially burdening donors, up-to-date resources are needed on handling routine donor follow-up costs in ways that are policy-compliant and effective for donors and programs. Development of a government-supported national living donor follow-up registry like the Living Donor Collective may provide solutions for aspects of postdonation follow-up, but requires transplant program commitment to register donors and donor candidates as well as donor engagement with follow-up outreach contacts after donation. The online version contains supplementary material available at 10.1007/s40472-022-00379-w.