Program-specific reports

Abstract

Purpose of review Measuring and monitoring transplant center performance is vital to ongoing quality assessment and performance improvement initiatives geared toward ensuring optimal care for patients with end-stage organ failure. The impact of regulatory oversight on transplant center behavior and programmatic decision-making is complex. Recent findings Program specific reports (PSR) are published by the Scientific Registry for Transplant Recipients (SRTR) and are publically available for use by a variety of stakeholders, including patients, regulators, insurers and care providers. PSRs have been both groundbreaking and controversial. The principal areas of concern relate to (a) potential unintended consequences of PSRs, (b) limitations in both the data collected by the registry and the currently used statistical methodology employed by the SRTR for risk adjustment, and (c) the subsequent impact on transplant program behavior. Summary PSRs, which serve the purposes of fueling ongoing performance improvement initiatives, and informing consumers and payers by fostering transparency in the communication of risk, also involve trade-offs due to their unintended use for regulatory oversight and subsequent impact on transplant center behavior. Future research is necessary to improve data integrity and risk adjustment methodologies which will enhance regulation and preserve access to transplantation among vulnerable patient populations.

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

“…Identifying LT-specific MACE risk factors has important policy implications for both Medicare reimbursement, candidate selection, and for organ allocation(46). The Scientific Registry of Transplant Recipients (SRTR) risk prediction models are used by the Centers for Medicare & Medicaid Service (CMS) to certify transplant centers for reimbursement.…”

Measuring Transplant Center Performance: the Goals Are Not Controversial but the Methods and Consequences Can Be

“…[9, 20, 28] As such, heightened regulation and attention to the post-transplant survival metrics will “threaten scientific innovation and advancement.”[9] The American Society of Transplant Surgeons (ASTS) touched on this important consideration citing desensitization and ABO-incompatible kidney transplant protocols as important areas of research and improving techniques which have proven success in terms of improved survival for patients compared with no transplantation, but results in inferior outcomes compared with standard kidney transplants thus threatening center metrics given the lack of protection provided by current risk-adjustment. [9] An analysis of a multi-institutional experience with desensitization demonstrated a two-to-ten-fold increased risk in flagging in centers performing 5–20% positive cytotoxic crossmatch transplants.…”

The Combined Risk of Donor Quality and Recipient Age

“…Transplant programs have heightened regulatory oversight compared to other medical and surgical disciplines, with the risks of “underperformance” potentially leading to some centers to choose more risk-averse behaviors including declining offers from organs of low or very low quality. (14) Our results suggest that the utilization of these organs in older recipients may occur without significant detriment to outcomes. It is also known that kidneys with a higher KDPI have an increased likelihood of being discarded, with recent estimates being between 15–30% for KDPI scores of 61 st -80 th percentile (i.e.…”