Maximizing patient access to the optimal form of therapy for kidney failure, transplantation, has long been a top policy and advocacy goal for ASN. In recent years, the society has advocated for a new payment model to test mechanisms of supporting and incentivizing greater access to kidney transplants, and to expanding that access to to populations that have historically had lower rates of kidney transplantation.

Those ASN goals are reflected in the recently-proposed Increasing Organ Transplant Access (IOTA) Model, released on Wednesday, May 9 by the Center for Medicare and Medicaid Innovation (CMMI). “ASN has been advocating for increased investment and reform in the U.S. transplant system for many years,” stated ASN President Deidra C. Crews, MD, ScM, FASN. “ASN is grateful for the leadership of the Biden-Harris Administration in testing patient-centered changes to how kidney transplant care is delivered, and we welcome the opportunity to review and suggest improvements to the proposed IOTA Model.”

As proposed, IOTA is projected to enroll approximately 90 of the 231 active kidney transplant programs in the United States on a mandatory basis. 

The proposed model aims to increase access to kidney transplantation for all Americans with kidney failure and will incentivize kidney transplant centers to increase both living donor and deceased donor transplants over a six-year period. Transplant centers will also be assessed on their organ offer acceptance ratios, which CMMI hopes will help increase organ use. Today, more than 1 in 4 kidneys go unused even though data suggest they would benefit many waitlisted patients, yet 5,000 people die waiting for a kidney annually. 

In addition to increasing transplant rates, IOTA also looks to improve quality of care before, during and after transplantation. Looking at patient outcomes on a more longitudinal basis and supporting their ongoing access to high-quality care over time—not just during the immediate post-transplant period—has been a strong area of emphasis for ASN.

Expanding access to kidney transplantation for socioeconomically disadvantaged people was a focal point of ASN’s advocacy in support of this model development. Concurring with ASN that socioeconomic factors affect access to kidney transplantation, CMMI aims to incentivize IOTA model participants to decrease disparities in the overall transplant rate among patients of various income levels. Pursuant to this aim, CMMI has proposed “a health equity performance adjustment” that would boost participants’ performance scores for each low-income patient who receives a transplant. CMMI has also proposed that participants would be required to develop a health equity plan, including investing in improvement activities that address barriers to care, including social determinants of health.

“As a transplant nephrologist, I am particularly gratified to see that this proposed model emphasizes increasing kidney transplant rates overall while simultaneously focusing on boosting access for people who are socioeconomically disadvantaged, a population that has historically had less access to transplantation” said ASN Policy and Advocacy Committee chair Roslyn B. Mannon, MD, FASN. 

The proposal also emphasizes providing greater transparency for patients about their own care and decisions made on their behalf, and for greater public transparency about transplant program criteria, steps for which ASN has strongly advocated. 

“For too long, the journey to receiving a kidney transplant has been a black box for patients and general nephrologists. For many, it can be a challenge to determine which transplant center would be a good fit, to know if a kidney was offered and declined on their behalf, or even if a patient is active on the waitlist. This proposed model offers promising components that I believe could help increase access to kidney transplantation by better equipping patients, their families, and their general nephrologists with information that empowers them to more effectively navigate the transplant system,” said transplant nephrologist and ASN Past President Michelle A. Josephson, MD, FASN. 

The model arrives in stride with several years of increased momentum across the federal government to increase access to kidney transplantation, much of which has encompassed and reflected changes for which ASN has advocated—and will continue to advocate for in the months and years to come.

The ASN Quality Committee and the ASN Transplant Workgroup are in the process of analyzing the proposed model in detail and will prepare feedback and suggestions to strengthen it for CMMI in coming weeks. In the meantime, Dr, Josephson observes, “I am optimistic about this new model benefitting the patients I serve today and into the future.” 

For more information about the model, visit www.cms.gov/priorities/innovation/innovation-models/iota