Dialysis or transplant ?

[Simon Dog]

There is no longer an "extended criteria" list, just a KDPI/KDRI scores to express the expected quality of an organ.

Also, new protocols from OPTN will help to ensure that donor organs and recipients are better matched in order to get maximum life from the organs.

That is the OPTN "marketingspeak".   A more accurate statement is "Organs in the top 20% of quality will be reserved for younger, healthier patients, with no patient over 53 getting a top 20% organ unless nobody else wants it".

The new rules create winners and losers - allocation of organs is a zero sum game, and you cannot create winners without also creating losers.    I am a loser since I am over 53, and the only thing the new rules will do is assure I do not get the call if a top 20% organ comes in when my name is at the top of the list.

[justagirl2325]

One of my fellow patients who was reluctant to get on the list just had a double kidney pancreas transplant. He stopped back to visit the center and was bouncing with joy.  It was nice to see some one graduate from dialysis.

This is my husband's dream.  So nice to hear someone getting this, we hope to have this one day too.

[MooseMom]

There were winners and losers under the old system, too.  One thing is sure, though, is that you're more likely to be a winner if you have private insurance.

[Simon Dog]

There were winners and losers under the old system, too.  One thing is sure, though, is that you're more likely to be a winner if you have private insurance.

I have not yet seen a difference in how the xplant team treats me now that I transitioned from private to medicare.    I am still eligible for surgery at the same major hospital, and still in the same place on the waiting list.    The clinic I use is now getting paid about half what it used to get, as is my neph.   

"Winner and loser" is relative, and comes into play whenever the rules are changed and some people end up better off and others worse.  The new system may indeed increase the number of successful "functioning transplant years" so, on average, players in the game win (which is of little consolation to the losers).    The system obfuscates who the losers are (I will never get a call "just thought you might like to know, the KDPI 15 we would have given you under the old rules just went to a younger person behind you on the list) which makes it an easier sell.

[Michael Murphy]

Since by law every dialysis patient must be on Medicare after 30 months with a 3 month waiting period ( effectively 33 months), and the average waiting time is over that time if Medicare patients were discriminated against there would be not a lot of transplants done.  As of January I am on Medicare with my insurance as secondary, since Medicare must be primary whatever I am charged must be at Medicare rates.

[MooseMom]

Since by law every dialysis patient must be on Medicare after 30 months with a 3 month waiting period ( effectively 33 months), and the average waiting time is over that time if Medicare patients were discriminated against there would be not a lot of transplants done.  As of January I am on Medicare with my insurance as secondary, since Medicare must be primary whatever I am charged must be at Medicare rates.

Do you think that there is never a circumstance in which a patient on the tx waitlist who has private insurance is transplanted before a patient who is already on Medicare?

[Simon Dog]

There are definitely going to be such cases, since there is a "medical call" - is this kidney a good enough match for person #1 on the list, or would be be more likely to survive if it went to #2 or #3?

It would be interesting to know if the person making the allocation decision has access to the insured status of the recipients.  If the organ network is making the decision, the decision maker might not even have access to that info.

It is interesting how you never hear of a famous person who needs a liver not getting one (think Jobs, Moakley, Allman, Mantle, Hagman, etc.).

[cattlekid]

I have seen this with my own eyes. 

I have private insurance which is now secondary for just a few more months until I no longer qualify for Medicare.  Because I had private insurance, I could multi-list.  I live in the Chicago area, with higher wait times.  I chose to transfer my wait time to University of Wisconsin, with lower wait times.

One of the techs at our local nail salon had to start dialysis last year.  She is on Medicaid/Medicare and therefore cannot list outside the state of Illinois so she has to endure the longer wait time as she has no ability to "circumvent" the system as I did.

There were winners and losers under the old system, too.  One thing is sure, though, is that you're more likely to be a winner if you have private insurance.

[Michael Murphy]

The state limit is imposed by Medicaid which is state based.  New York State pays for care in New York,  Maine pays for care in Maine etc.  the amount of money the provider is paid is set by Medicare since it must be primary.  So I have private insurance with Medicare, Medicare sets the payment for patients that have been on dialysis for more than 33 months or have joined early. The problem is Medicare is designed to cover the cost of a procedure with a modest profit.  Without secondary insurance the 20% not paid for by Medicare changes it into a money looser for the provider.  The fact that  Medicaid is state based unlike Medicare which is National is what causes people to be stuck waiting unable to apply out of state.

[Simon Dog]

Without secondary insurance the 20% not paid for by Medicare changes it into a money looser for the provider.

Patients are required to pay the 20% if they do not have secondary insurance (medicaid is a form of secondary insurance).

The cash cows are those still on private insurance, which gives clinics a great incentive to keep you alive for at least 30 months.