Increasing Organ Transplant Access model (IOTA)
Model Name:
Increasing Organ Transplant Access (IOTA)
Theory of Action:
The proposed model holds selected transplant hospitals accountable through upside and downside performance-based payments and includes requirements to address health equity and transparency. Transplant hospitals selected for participation would receive upside risk payments from CMS, fall into a neutral zone, or owe downside risk payments to CMS, based on a final performance score that would be calculated on a set of metrics in three proposed domains.
How It Works:
A six-year proposed mandatory model aiming to increase access to life-saving kidney transplants for patients living with kidney disease and reduce Medicare expenditures. It will support greater care coordination and improved outcomes for people with the disease and increase equitable access to kidney transplants. Transplant hospitals will be scored on three domains:
Achievement: based on the number of kidney transplants for a total of 60 points.
Efficiency: based on the organ offer acceptance rate ratio for a total of 20 points.
Quality: based on the CollaboRATE Shared Decision-Making Score, Colorectal Cancer Screening, Three-Item Care Transition Measure, and a post-transplant composite graft survival rate measure for a total of 20 points.
The maximum positive payment per Medicare fee-for-service (FFS) transplant under the model (the upside risk payment) would be $8,000. The maximum negative payment per Medicare FFS transplant under the model (the downside risk payment) would be $2,000.
Key Dates:
Planned Duration: January 1, 2025 – December 2030
Application Submission: N/A - Participation would be determined by donation service area (DSA). CMS would select half of the DSAs in the country and all eligible transplant hospitals with an active kidney transplant program would be selected to participate in the model. The other half of transplant hospitals would serve as the comparison group for evaluation purposes.
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