The Impact of CMS CoP on Kidney Transplant Waiting Times

SRTR program reports provide detailed information on transplant center performance relative to risk-adjusted expected values. Designed to improve outcomes, the behavioral implications of these reports may generate a longer wait time for transplant. UNOS data for 28,839 deceased donor kidney transplants performed during 6/2007- 6/2010 and 79,725 registered patients waiting for a kidney transplant during this time period were merged with SRTR program report data; Patient-specific and transplant center controls were created. An indicator variable was constructed for whether or not a transplant center did not meet the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoP) during a patient's waiting period for a transplant. A censored Cox-proportional hazard model was utilized to investigate the impact of CMS CoP on the length of time until transplant. Data analysis reveals that a transplant center's failure to meet either the 1-year graft or patient survival rates, according to CMS criteria, is associated with the expected waiting time until transplantation. Further the results suggest that centers may elect to transplant healthier patients and patients for whom they would receive a risk compensation in the SRTR model.