“The organ transplant industry, like every other part of society, is not immune to racial inequities,” U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said recently. “Black Americans disproportionately struggle with life-threatening kidney disease, yet they receive a smaller percentage of kidney transplants. The Biden-Harris Administration is taking concrete steps to remove racial bias when calculating wait times and rooting out profiteering and inequity in the transplant process.”
Kidney transplantation is the best treatment for most individuals with end-stage renal disease (ESRD), offering better outcomes and quality of life compared to dialysis. Despite the scarcity of organs leading to increased mortality and long wait times, about 30 percent of donor kidneys go unused each year. This gap highlights issues in procurement, distribution, and utilization. In 2023, over 28,000 kidney transplants were performed, but more than 90,000 people remained on the wait list. Urgent measures are needed to improve the system’s efficacy and efficiency. My father-in-law was one of the Black Americans who died waiting for a transplant that could have saved his life.
The Centers for Medicare & Medicaid Services (CMS) has proposed a new mandatory Medicare payment model called the Increasing Organ Transplant Access Model (IOTA Model). This model aims to enhance access to kidney transplants for patients with ESRD by providing performance-based incentive payments to participating kidney transplant hospitals. The goal is to increase the number of kidney transplants while maintaining or improving the quality of care and reducing Medicare expenditures.
Key features of the IOTA Model include the following:
The model also seeks to advance health equity by addressing disparities in health outcomes through a health equity plan requirement and a performance adjustment based on equity.
The proposed rule includes standard provisions that would apply to Innovation Center models, starting with the first performance period on or after Jan. 1, 2025. These provisions cover areas such as beneficiary protections, model evaluation and monitoring, audits, data rights, compliance, and more. These standards aim to enhance transparency, efficiency, and clarity in the governance of Innovation Center models.
Public comments on the proposed rule must be submitted electronically via http://www.regulations.gov, by regular mail, or by express or overnight mail to the specified addresses, referencing file code CMS-5535-P. The comment period ends 60 days after the rule’s publication in the Federal Register.
For further information, questions related to the IOTA Model can be directed to CMMItransplant@cms.hhs.gov, and inquiries about the standard provisions for Innovation Center models can be sent to CMMI-StandardProvisions@cms.hhs.gov.
While President-elect Trump’s pick for U.S. Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., put the agency in even international newspapers
A few weeks ago, during the weekly Monitor Monday broadcast, healthcare attorney David Glaser, presented a great segment that simplified the two-midnight rule into two
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
