The adopted model for end stage liver (MELD) disease system prioritizes patients awaiting liver transplant by severity of illness.
The model for end stage liver disease included progressive renal dysfunction.
Unfortunately, current reimbursement for liver transplantation is not adjusted by severity of illness.
The model is also not adjusted for need of simultaneous liver-kidney transplantation.
Dr David Axelrod and colleagues examined hospital cost and reimbursement for liver transplantation and liver-kidney transplantation.
The researchers determined the effect of MELD on transplant center financial outcomes given current reimbursement practices and outlier threshold limits.
Liver transplantation was performed for 86 adults prior to and 127 following the implementation of MELD.
|Liver-kidney transplants performed increased from 6% to 17%|
|American Journal of Transplantation|
The research team found that between the eras, there was a substantial increase in the average laboratory MELD score from 17 to 21.
The team noted that the percentage of liver-kidney transplants performed increased from 6% to 17%.
The researchers observed that increasing MELD score was associated with higher costs of $4309 per MELD point.
An increased MELD score was associated with decreasing transplant centers net income at $1512 per MELD point.
In patients not achieving the Medicare outlier status, predicted net loss was $17,700 for high-MELD patients.
In addition, the team found that the predicted net loss for Medicare outlier patients and for those needing liver-kidney transplantation was $19,133.
Dr Axelrod's team commented, “Contractual reimbursement agreements that are not indexed by severity of disease may not reflect the increased costs resulting from the MELD system.”
“Even with outlier thresholds, Medicare reimbursement is inadequate resulting in a net loss for the transplant center."