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)相关的费用是最大的医疗保险费用类别，占2007年整个医疗保险预算的近6%。这一应用程序提供了一种策略，通过重新设计对被发现血型不合的健康捐赠者的支付方式，增加每年可以通过肾脏配对交换进行移植的患者数量。该项目将确定这种创造更多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战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移植的付款，以创建一种可持续的付款模式，该模式将类似于美国目前用于支付已故捐赠者肾脏的评估、恢复和运输费用的付款策略。到该项目结束时，估计将有451个KPD活体捐赠者肾脏移植，否则是不可能的。示范项目的总成本将为199万美元(每次移植20478美元)，但与这些仍在接受透析的患者相比，创建451例肾脏移植可能为医疗保险和商业保险公司节省9500多万美元，并提供1.2-2.25亿美元的生活质量价值。目前，美国只有一个器官采购组织，即西南移植联盟(STA)，拥有CMS批准的现行标准采购费(SAC)，用于支付KPD血型不合的捐赠者评估。值得注意的是，STA SAC费用仅涵盖每个KPD移植的11,000美元，并且仅支付KPD移植总费用中不相容的在世供者评估部分。与传统的活体供肾移植相比，KPD产生的额外费用尚无补偿策略。因此，我们的具体目标如下：具体目标一：从临床上活跃的肾脏配对捐赠计划中收集实际财务数据，以便计算每个KPD移植的实际成本，以便能够设计出现实的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，直到设计出一个可持续的KPD SAC。具体目标三：由于每个KPD移植的成本将在示范项目过程中显著降低，示范计划资金将支付建立一个准确、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战略以创建未来可持续模式的可能性。 公共卫生相关性：终末期肾病对社会造成了巨大的损失--无论是在生命损失、肾病患者的生活质量方面，还是在当前医疗体系的难以置信的负担方面(据报道，2007年占所有医疗保险支出的6%)。为8.4万等待器官配对捐赠的8.4万人提供更多肾脏移植的创新方法，受到了当前支付制度的阻碍，这给移植中心和潜在的无私和不相容的捐赠者的参与造成了障碍。建立标准收购收费模式来支付配对交换移植的费用，将有能力改变目前的医疗支付结构，从而挽救生命并节省数百万美元的医疗支出。

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. PUBLIC HEALTH RELEVANCE: End stage renal disease takes a huge toll on society - both in terms of lives lost, quality of life of those suffering from kidney disease, and the incredible burden to the current healthcare system (reportedly 6% of all Medicare expenditures in 2007). An innovative approach to providing more kidney transplants to the 84,000 people awaiting an organ - kidney paired donation - is hampered by the current payment system, which creates barriers to participation from both transplant centers and potential altruistic and incompatible donors. Establishment of a Standard Acquisition Charge model to pay for paired exchange transplants has the power to transform the current healthcare payment structure, thereby saving lives and saving millions of dollars in healthcare spending.