Economics

Of

Kidney

transplant

Janea Matherly, RN

John C. McDonald Regional Transplant Center

I have no relationship(s) with industry to disclose relevant to the content of this CME activity

Disclosure Statement

Learning Objectives

• Discuss the financial constraints – requirements for transplant centers

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• Recognize the financial challenges for kidney transplant recipients

Kidney Disease

• An estimated 20 million Americans suffer from chronic kidney disease to include 400,000 who are undergoing treatment for end-stage renal disease (ESRD), or kidney failure

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• Without dialysis or a kidney transplant, patients suffering from kidney failure will not survive.

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• More than 185,000 Americans

live with a kidney transplant

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• More than 128,000 are on the

waiting list

Renal Physicians Association

Transplant Value

Transplant is a resource intensive service that has been subject to scrutiny in the area of cost containment

Kidney Transplantation

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• Have been proven to be cost effective care for

patients with End Stage Renal Disease (ESRD)

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• Less Long-term costs compared to chronic dialysis

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• Provide significant societal benefits

Kidney Transplant

According to UNOS

United Network for Organ Sharing

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1^st year billed charges for a kidney Transplant

more than $262,000

Transplant Economics

Transplant economics can be divided into two areas

Transplant Center Allocation

• Kidney Transplant centers have the unique ability to pass pre-transplant costs to the Medicare cost report

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• Transplant centers are reimbursed on a cost to charge ratio by Medicare

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• Organ Acquisition Cost are any direct costs incurred to evaluate potential

recipient or living donors

regardless of whether the

patient becomes an actual

recipient and (indirect cost)

• Salary
• Rent
• Supplies

• Immunological testing
• Waitlist maintenance
• Living donor cost
• Procuring organs

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Indirect Cost

Cost Allocation

Transplant Center

Evaluation testing

Procurement

Professional fees

Transplant Costs

The cost of Transplant care has significantly increased over time

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There is a significant difference between organ supply and recipient demand

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Higher Financial Cost

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Payer Highlights

Medicare Eligibility

U.S. Department of Health & Human Services – Centers for Medicare & Medicaid Service

Medicare Coverage Begins

Medicare Plans

Medicare Cost 2014

Premium

Deductible

Medicare Termination

Based on……………

Recipient Cost

Kidney transplant must be done in a hospital that’s approved by Medicare to be covered.

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After Transplant Cost

Anti rejection/other is approximately $3,000 per month

Medication Resource Options

What can we do to help?