*Purpose: The organ procurement organizations (OPOs) are evaluated by the Centers for Medicare & Medicaid Services (CMS) for quality of performance, and we compared the stability of tiers for the new CMS metrics for donation rate and transplant rate between 2019 and 2020.
*Methods: The CMS donation rate and transplant rate metrics for calendar years 2019 and 2020 were published by CMS in spring 2022 (available at https://qcor.cms.gov/main.jsp). OPOs were classified into 1 of 3 tiers based on whether they were not significantly below the 75th percentile for both metrics (tier 1) or median (tier 2) of all OPOs based on the prior calendar year’s evaluations (eg, 2020 percentiles were based on 2019 performance). The worse performing, tier 3 OPOs have 1 or more upper 95% confidence limits below the median cutoff.
*Results: For the donation rate metric, between 2019 and 2020, 67% of the OPOs stayed consistent in their tiers and 33% changed tiers (5 improved and 14 worsened) (Figure 1). For the transplant rate metric, 55% stayed consistent and 45% changed tiers (5 improved and 21 worsened). CMS’s overall assessment will use the lower of the 2 tiers. For the overall tiers, 59% stayed consistent and 41% changed tiers (5 improved and 19 worsened). Tier 1 OPOs decreased from 27 to 20, while tier 2 increased from 15 to 16 and tier 3 increased from 16 to 22.
*Conclusions: More OPOs failed CMS’s performance assessment in 2020 compared with 2019. This could be an artifact of national transplant rates improving from 2018 to 2019, thereby raising the median and 75th percentiles, whereas transplant rates declined nationally from 2019 to 2020 from 37.0 to 36.5 transplants per 100 potential donors, perhaps illustrating a limitation of using the prior year to set the performance targets.

Ajay Israni

Hennepin Healthcare, Univ of MN, Scientific Registry of Transplant Recipients

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