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2024 Studies
Below are curated studies from 2024.
Are the New CMS Performance Tiers Biased against Larger OPOs?
G. Lyden, J. Miller, R. Hirose, J. Snyder, Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, American Journal of Transplantation (AJT), Volume 24, Issue 6, Supplement 1; Oral Abstracts Pg. S531, Abstract 1168, https://www.amjtransplant.org/issue/S1600-6135(24)X0006-4
Summary
This study uses simulation to assess for potential biases against larger OPOs in the CMS OPO 2020 metric.
Smaller OPOs in Scenario 2 were much more likely to be placed in Tier 1, resulting in a 95% probability that the largest OPOs would have to recompete compared to only a 26% probability for the smallest OPOs.
Large OPOs have an equal chance of being in Tier 1 only when all OPOs have an underlying rate equal to the previous year’s 75th percentile, but not in other scenarios where all OPOs perform the same.
Reducing Bias against Larger Organ Procurement Organizations in Performance Evaluations
G. Lyden, J. Miller, R. Hirose, J. Snyder, Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; American Journal of Transplantation (AJT), Volume 24, Issue 6, Supplement 1. Poster Abstracts Pg. S1114, Abstract D294, https://www.amjtransplant.org/issue/S1600-6135(24)X0006-4.
Summary
Under the CMS OPO 2020 metric smaller OPOs have a higher probability of being automatically recertified.
The purpose of this study is to propose an alternative tiering system that is not biased against large OPOs.
In scenario 1, the CMS method incorrectly placed the smallest OPO in Tier 1 72% of the time and virtually never placed the largest OPO in Tier 1.
The O-to-E method has a uniform error rate across OPO volumes when all OPOs perform the same, thus removing the bias against larger OPOs, without sacrificing power to detect underperforming OPOs.
Prediction of Cause, Age, and Location-Consistent Deaths: A Useful Tool to Identify Areas for Improvement for Organ Procurement Organizations
J. Miller 1, D. Zaun 1, N. Wood 1, G. Lyden 1, R. Hirose 2, A. Israni 1, J. Snyder 1, 1 Scientific Registry of Transplant Recipients, Minneapolis, MN, 2 University of Washington, Seattle, WA; American Journal of Transplantation (AJT), Volume 24, Issue 6, Supplement 1. Oral Abstracts Pg. S532, Abstract 1170, https://www.amjtransplant.org/issue/S1600-6135(24)X0006-4
Summary
Data used for CMS’ 2023 OPO evaluations are deaths from 2021. The data lag limits OPOs’ ability to track impacts of changes to their practice in near-real time.
This study presents a method to predict OPOs’ current CALC deaths using Scientific Registry of Transplant Recipients (SRTR) data.
The predicted CALC deaths can be used as a denominator for donation rate or transplant rate in years for which actual CALC deaths are not yet available from CDC or reported by CMS.
Adjusting for race in metrics of organ procurement organization performance
Jonathan M. Miller 1,2,* , David Zaun 1 , Nicholas L. Wood 1,2 , Grace R. Lyden 1,2 , Warren T. McKinney 1,2 , Ryutaro Hirose 1,3 , Jon J. Snyder 1,2,4; https://www.amjtransplant.org/article/S1600-6135(24)00122-9/fulltext
Summary
CMS chose not to adjust for most demographic variables other than age (for the transplant rate), arguing that there is no biological reason that these variables would affect the organ donation/utilization decision.
However, organ donation is a process based on altruism and trust, not a simple biological phenomenon.
When adjusting for race, 8 of the 58 OPOs moved 1 tier: 5 in one direction and 3 the other direction.
Among the OPOs that moved to a lesser tier ranking in our study, 2 of the 3 currently underperform the national rates among White potential donors.
We have shown that failing to adjust for race puts OPOs that are currently performing well among minorities relative to national rates at risk.
Are the Centers for Medicare & Medicaid Services metrics evaluating organ procurement organization performance too fragile?
Jesse D. Schold* Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA, Rocio Lopez Department of Surgery, University of Colorado Anschutz Department of Surgery, University of Colorado Anschutz, Sumit Mohan Department of Epidemiology, Columbia University, New York, New York USA; American Journal of Transplantation, https://doi.org/10.1016/j.ajt.2024.03.025
Summary
In statistical terms, Miller et al and Lopez et al research on CMS OPO metrics studies suggest that the CMS models are fragile.
OPO performance). This fragility, in the context of highly consequential ramifications, may be concerning without clear evidence validating poor OPO performance beyond current models.
The policy could lead to a revolving door (or a shrinking pool) of OPOs with additional performance cycles—and the attendant challenges of disruption to the donation/transplant process.