Organ Procurement and Transplantation Assessing Current Policies and the Potential Impact of the DHHS Final Rule (1999) / Chapter Skim
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7 Costs
7 Costs
Pages 123-130
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From page 123... ...
The committee also believes the health benefits of implementing broader sharing will be substantial and outweigh any net increase in expenditures. Some of those who have commented on the implications of the Final Rule believe it will increase the total expenditures associated with transplantation because of the combined effects of sharing donated organs over a greater geographic area and using donated organs in patients who are more severely ill.
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From page 124... ...
The major components of these billed charges include hospitalization of the patient before, during, and after the transplant; evaluation of the patient's condition and suitability for a transplant; acquisition of the donated organ and evaluation of its suitability; transportation of the organ from the site of donation to the site of transplantation; use of the operating room; fees of the various physicians; and posttransplant therapy, including immunosuppressive medications (Evans, 1985, 1986~. The charges associated with each component can vary, sometimes substantially, depending on the condition of the patient, the condition of the donor, the location and standard practices of the donor site and transplant program, and other factors.
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From page 125... ...
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From page 127... ...
Although there may be some offsetting decreases in expenditures, the committee concluded that these assumptions will result in a net increase in the overall expenditures associated with transplantation. TABLE 7-4 Information on Medicare-Covered Liver Transplant Recipients, Calendar Year 1995 through 1998 Status lStatus 2Status 3 Number of Patients199555737 Length of Stay, Days Mean393219 Range1-1851-7271-266 Days from Hospital Admission to Transplant Mear116121 Range()
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From page 128... ...
Therefore, although the committee did not assume that the amount of the expenditures for nonMedicare patients would be exactly the same as those for Medicare patients, it did accept the pattern of cost differentials among different status patients described in the GAO analysis as comparable to what would be seen in the general population. Thus, the committee concluded that implementation of the Final Rule would result in a net increase in total expenditures due to the transplantation of more severely ill patients.
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From page 129... ...
INCREASED EXPENSES FOR ORGAN ACQUISITION For the purpose of providing the committee with information about organ acquisition practices and expenses, the GAO collected data from a sample of six OPOs and some of their associated transplant centers. The results suggest that the acquisition practices and, therefore, acquisition expenses vary considerably among transplant centers and OPOs (Evans et al., 1993~.
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From page 130... ...
The committee is not, however, able to estimate with confidence how large the increase might be because it is not clear how the Final Rule will be implemented and how many patients in each status will be affected. In addition to transportation expenses, implementation will alter multiple factors affecting transplant expenditures.
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