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Why a financial analysis makes sense.

Last month I suggested that transplantation in the United States needs an objective outside analysis from a financial perspective. I'll try to lay out some of the ways the transplant community and our patients can benefit from such an analysis. Transplant medicine is excellent in this country. However, financial issues drive some elements of the process and those issues affect patients.

A central point is that kidney transplantation is very cost effective when compared to keeping patients on dialysis. Likewise, other solid organ transplants reduce hospitalization and lingering expense. That much-discussed public policy receives nearly universal agreement. If we can present financial data in a consistent business-like manner, we can prove that a small amount of additional money and a realignment of current spending is a very wise thing to do. It makes more transplants possible, which not only is better for patients but can also drive the total cost of health care down. Enhancing transplantation is one thing that everyone can actually agree on; and, it will work.

My suggestion that Transplant Communications take the lead in this brings it out of the normal array of organizations and companies with vested interest in transplantation. Usually they are only interested in parts of the situation that directly impact them. Also Transplant Communications has a voice that can make sure the results are heard, understood and acted on by all the stakeholders.

The obvious first thing that comes to mind is covering immunosuppressive drugs for life for more patients. The Institute of Medicine, many scientific papers and simple common sense made that case long ago. But, that's only the beginning of a financial strategy to improve care and lower costs.

There are many other financial elements of transplantation that can also be proven. One way to prove cost effectiveness is by focusing on data. Better, more current and longer term data could help identify ways to improve the process. Yet, the burden is placed on the transplant centers to cover the cost of collecting and reporting data. Change without anyone to pay for it is very difficult to bring about. The financial analysis should look at the actual cost of data collection and the benefits of enhancing it.

There are many implications of this. The kidney paired living donor exchange pilot program was successful. But, to expand nationwide more data will be needed. Patients could use comparative program specific data to find centers that participate. More paired exchange programs can increase the number of recipients that get transplanted. Centers should be encouraged to participate in such programs, and costs associated with their management and the collection of data about results should be covered by private insurance and Medicare/Medicaid. That is, if we can prove it's in their interest.

Other issues that should be studied include the national discard rate of recovered organs. There is disagreement as to the correct target rate. But, there is little disagreement that the current rate is too high. The role reimbursement plays in this is an important question. Another issue is the way insurance companies and CMS evaluate transplant programs. Risk of poor evaluation by CMS or losing "center of excellence" referrals by insurance companies may result in fewer higher risk organs being made available to recipients who have risk factors. Such worries may result in centers turning down organs with higher risk. Yet, the payment for recovery of organs ultimately discarded may still be made, thus incurring cost without benefiting patients. Again, data should be available to patients who are looking for centers that do more high risk transplants if that is what they need. That data could also prove to payers that they should adjust their evaluation of programs based on the risk associated with recipients and donated organs.

Also, the cost issues associated with long term follow-up of recipients should be analyzed. For some patients there may be no way to cover routine, long term care. Many patients who lose Medicare coverage may not be able to return to their transplant center. This leaves care up to whatever resources the patient has locally. That could be a first rate specialist or an emergency room that has never seen a transplant recipient. Does this have implications for greater graft loss and result in costs of a second transplant? Also, long term data on recipients may be needed to improve overall results and lower costs. Similar data on the long term effect of living donation might encourage more potential donors. Likewise, long term care of living donors should be studied from a financial perspective.

The cost implications of using more extended criteria donors and donation after cardiovascular death should also be objectively explored. The justification of addition cost and the increase in transplants can be weighed by data and financial analysis. The tremendous variation around the country in such donations should provide clear input to a study.

There are many more issues that a real outside financial analysis could address. The result of such a study should encourage payers to realize the true cost effectiveness of transplantation. Lower health care costs are everyone's goal. Governments, employers and health authorities can figure this out for themselves. It is also common sense. Yet, a high quality financial analysis and more extensive data could prove it.

It would be nice to focus only on the well being of patients and what is best for their quality of life and life expectancy. But, money drives many health care decisions. People who make such decisions can use the backup so when they make their decisions, financial benefit and patient outcomes are both improved.

By John Davis

Occassional Contributor
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Title Annotation:Commentary
Author:Davis, John
Publication:Transplant News
Date:Nov 1, 2012
Words:939
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