The Centers for Medicare & Medicaid Services (CMS) has finalized the Increasing Organ Transplant Access (IOTA) Model, a six-year mandatory program aimed at improving access to kidney transplants.
The IOTA Model, which will begin on July 1, 2024, was developed with input from stakeholders, including hospitals. CMS Administrator Chiquita Brooks-LaSure highlighted the potential of the model to save lives and enhance the quality of life for individuals with kidney disease.
The IOTA Model seeks to address the long waiting list for kidney transplants by incentivizing hospitals to increase the number of transplants performed. A total of 103 kidney transplant hospitals will participate in the model, covering half of the donation service areas and all kidney transplant facilities nationwide.
Under the IOTA Model, participating hospitals will receive financial incentives for performing more kidney transplants. Conversely, hospitals that fail to meet transplant performance benchmarks will face financial penalties. The evaluation criteria will focus on the number of transplants conducted, organ acceptance rates, and overall health outcomes. The number of transplants will carry the most weight in performance assessments.
Hospitals will have the opportunity to earn performance-based payments, with the potential for refunds to the CMS or remaining in a neutral financial zone. Negative financial incentives will be implemented in the second year of the model. CMS has made adjustments to address hospital concerns, including increasing the maximum performance score upside and modifying the expectations for the number of donor transplants.
The IOTA Model also emphasizes addressing social determinants of health that can affect patients' ability to access transplants. Hospitals will be encouraged to provide support services, such as transportation assistance, to help patients navigate the transplant process. This approach aims to ensure equitable access to kidney transplants for all patients, regardless of socioeconomic status.
The implementation of the IOTA Model aligns with broader efforts to reform the Organ Procurement and Transplantation Network.
Recent legislative changes have also impacted the kidney transplant landscape. The Biden administration enacted a law in September 2023 to diversify the management of the Organ Procurement and Transplantation Network, potentially leading to improved outcomes for patients.
The finalization of the IOTA Model raises questions about its future, particularly considering the Congressional Review Act lookback period. This provision allows for greater scrutiny and potential rescission of regulations by the incoming administration, which could complicate the implementation of the model. The success of the IOTA Model will depend on the commitment of participating hospitals and ongoing support from federal agencies. It represents a significant step forward in addressing the shortage of kidney transplants in the United States, aiming to create a more effective and equitable transplant system.