Evaluation of a Standard Acquisition Charge Model for Kidney Paired Donation

描述（由申请人提供）：与终末期肾病（ESRD）相关的费用是2007年医疗保险费用中最大的一类，占整个医疗保险预算的近6%。该应用程序提供了一种策略，通过重新设计被发现不相容的健康供体的支付方式，每年通过肾脏配对交换增加可移植患者的数量。该项目将确定这种创造额外活体肾脏移植的新方法所产生的真实成本，并将通过量化通过实施新的支付策略实现的移植数量来确定付款人的投资回报。该示范项目将重新设计KPD移植的支付方式，以创建一种可持续的支付模式，类似于美国目前用于支付已故捐赠肾脏的评估、回收和运输的支付策略。到项目结束时，预计将有451例KPD活体肾脏移植，否则将无法实现。该示范项目的总成本为199万美元（每次移植20,478美元），但与这些仍在透析的患者相比，451例肾脏移植的产生有可能为医疗保险和商业保险公司节省超过9500万美元，考虑到生活质量，提供1.2 - 2.25亿美元的价值。目前，美国只有一个器官采购组织，西南移植联盟（STA）有一个CMS批准的标准获取费用（SAC），用于支付与KPD不相容的供体评估。值得注意的是，STA SAC费用仅涵盖每次KPD移植11,000美元，并且仅支付可归因于KPD移植的总费用中不相容的活体供体评估部分。与传统的活体肾移植相比，目前还没有适当的策略来补偿KPD所产生的额外费用。因此，我们的具体目标如下：具体目标一：从临床活跃的肾脏配对捐赠计划中收集实际的财务数据，这将允许计算每次KPD移植的实际成本，以便设计一个现实的KPD标准获取成本（SAC），以反映准确的历史数据。具体目标二：支付与平均KPD移植相关的额外费用，这些费用目前是不允许的，直到设计出可持续的KPD SAC。具体目标三：由于在示范项目的过程中，每次KPD移植的成本将显著降低，示范项目资金将支付建立准确、负担得起的KPD SAC的高昂启动成本，从而增加利益相关者采用重新设计的支付策略以创建未来可持续模式的可能性。

DESCRIPTION (provided by applicant): Costs related to end stage renal disease (ESRD) represent the largest category of Medicare expenses accounting for nearly 6% of the entire Medicare budget in 2007. This application offers a strategy to increase the number of patients that can be transplanted each year through kidney paired exchanges by redesigning the payment for healthy donors who are found to be incompatible. The project will define the true costs incurred by this new approach to creating additional living donor kidney transplants, and will identify the return on investment for payers by quantifying the number of transplants that are achieved through implementation of a new payment strategy. The demonstration project will redesign payment for KPD transplants to create a sustainable payment model that will be analogous to the current payment strategy employed to pay for the evaluation, recovery and transportation of deceased donor kidneys in America. By the end of the project, it is estimated that 451 KPD living donor kidney transplantations will be created that would not otherwise have been possible. The overall cost of the demonstration project will be $1.99 million ($20,478 per transplant), but the creation of 451 kidney transplants compared to these same patients remaining on dialysis has the potential to result in savings of over $95 million for Medicare and commercial insurance carriers and provide a value of $120-$225 million considering quality of life. At present only one Organ Procurement Organization in America, Southwest Transplant Alliance (STA) has an active CMS- approved standard acquisition charge (SAC) in place to pay for KPD incompatible donor evaluations. It is notable that the STA SAC fee only covers $11,000 per KPD transplant and only pays for the incompatible living donor evaluation component of the total expenses attributable to a KPD transplant. There is no strategy in place to reimburse the additional costs incurred by KPD compared with traditional living donor kidney transplantation. Thus, our specific aims are as follows: Specific Aim One: Collect actual financial data from a clinically active kidney paired donation program that will allow the calculation of the real-life cost per KPD transplant so that a realistic KPD standard acquisition cost (SAC) can be designed to reflect accurate historical data. Specific Aim Two: Pay for the additional expenses associated with the average KPD transplant that are not currently allowable until a sustainable KPD SAC is designed. Specific Aim Three: Since the cost per KPD transplant will decrease significantly over the course of the demonstration project, the demonstration program funds will pay for the high start-up costs of establishing an accurate, affordable KPD SAC and thereby increase the likelihood that the stakeholders will adopt the redesigned payment strategy to create a sustainable model for the future.