Organ Procurement Organizations:

Alternatives Being Developed to More Accurately Assess Performance

HEHS-98-26: Published: Nov 26, 1997. Publicly Released: Nov 26, 1997.

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Pursuant to a congressional request, GAO reviewed whether the Health Care Financing Administration's (HCFA) population-based standard appropriately measures the extent to which organ procurement organizations (OPO) are maximizing their ability to identify, procure, and transplant organs and tissue, focusing on: (1) the strengths and weaknesses of the current standard; and (2) alternatives to the current standard.

GAO noted that: (1) HCFA chose a population-based standard to assess OPO performance after considering the availability and cost to the OPOs of obtaining and analyzing various types of data; (2) when HCFA first applied this standard in 1996, five OPOs were subject to action for failing to meet the standard; (3) this resulted in two OPOs' service areas being taken over by adjacent OPOs, a portion of one OPO's service being taken over by an adjacent OPO, and the merger of one OPO with another; (4) the fifth OPO that failed the standard was determined to be a new entity and not subject to meeting the performance standard; (5) HCFA's current population-based standard, however, is not an accurate measure for assessing OPO performance because OPO service areas consist of varying populations; (6) although potential organ donors share certain characteristics, including causes of death, absence of certain diseases, and being in a certain age group, OPO service area populations have generally differing characteristics; (7) thus, the number of potential organ donors may vary greatly for OPOs serving equally sized populations; (8) GAO ranked the OPOs, using 1994-95 OPO procurement and transplant data, according to three measures--population, number of deaths, and adjusted deaths; (9) although three OPOs would not qualify for recertification under any of these measures, the number of and which OPOs would not qualify vary depending on the measure used; (10) HCFA did not consider two alternative measures--medical records reviews and modeling--that show promise for determining OPOs' ability to acquire all usable organs; (11) consistently applied and uniform reviews of hospital medical records with verifiable results may accurately assess the number of OPOs' potential donors; (12) because most OPOs already conduct some records review, any added expense and increase to the cost of organs may be negligible; (13) the cost of producing independently verified estimates of the number of each OPO's potential donors may be substantial, however, and the expense and impact on OPOs and organ cost must be considered; (14) though not yet fully developed, a modeling approach using substitute measures to determine the number of potential donors may be less expensive and easier to execute; (15) unless OPO performance is measured according to the number of potential donors, HCFA cannot determine OPOs' effectiveness in acquiring organs; and (16) the measures GAO has identified provide alternatives for HCFA to pursue to more accurately assess OPO performance.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: Health Care Financing Administration (HCFA) has approved funding for a contract to evaluate one organization's model for estimating Organ Procurement Organization's (OPO's) potential organ donor pools. HCFA will use the evaluation to help determine the feasibility of using the model to estimate the numbers of organ donors and assess OPO performance against the estimates. Centers for Medicare and Medicaid Services (CMS) (formerly known as HCFA) published a final rule on May 31, 2006, which includes new outcome and process performance measures for OPOs based on the organ donor potential and other related factors in each service area of qualified OPOs, with the goal to improve OPO performance and increase organ donation.

    Recommendation: To better ensure that HCFA accurately assesses OPOs' organ procurement performance and that OPOs are maximizing the number of organs procured and transplanted, the Secretary of Health and Human Services should direct HCFA to evaluate the ongoing development of methods for determining the number of potential donors for an OPO. These methods include medical records reviews and a model to estimate the number of potential donors. If HCFA determines that one or both of these methods can accurately estimate the number of potential donors at a reasonable cost, it should choose one and begin assessing OPO performance accordingly.

    Agency Affected: Department of Health and Human Services

 

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