活体肾移植后常规随访护理的成本管理：当代经验、实践与挑战的综述及调查
Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges.
作者信息
Lentine Krista L, Sarabu Nagaraju, McNatt Gwen, Howey Robert, Hays Rebecca, Thomas Christie P, Lebron-Banks Ursula, Ohler Linda, Wooley Cody, Wisniewski Addie, Xiao Huiling, Tietjen Andrea
机构信息
Saint Louis University Transplant Center, Saint Louis University Center for Abdominal Transplantation, 1201 S. Grand Blvd, St. Louis, MO 63104 USA.
University Hospitals Cleveland Medical, Cleveland, OH USA.
出版信息
Curr Transplant Rep. 2022;9(4):328-335. doi: 10.1007/s40472-022-00379-w. Epub 2022 Sep 22.
PURPOSE OF REVIEW
While living organ donor follow-up is mandated for 2 years in the USA, formal guidance on recovering associated costs of follow-up care is lacking. In this review, we discuss current billing practices of transplant programs for living kidney donor follow-up, and propose future directions for managing follow-up costs and supporting cost neutrality in donor care.
RECENT FINDINGS
Living donors may incur costs and financial risks in the donation process, including travel, lost time from work, and dependent care. In addition, adherence to the Organ Procurement and Transplantation Network (OPTN) mandate for US transplant programs to submit 6-, 12-, and 24-month postdonation follow-up data to the national registry may incur out-of-pocket medical costs for donors. Notably, the Centers for Medicare and Medicaid Services (CMS) has explicitly disallowed transplant programs to bill routine, mandated follow-up costs to the organ acquisition cost center or to the recipient's Medicare insurance. We conducted a survey of transplant staff in the USA (distributed October 22, 2020-March 15, 2021), which identified that the mechanisms for recovering or covering the costs of mandated routine postdonation follow-up at responding programs commonly include billing recipients' private insurance (40%), while 41% bill recipients' Medicare insurance. Many programs reported utilizing institutional allowancing (up to 50%), and some programs billed the organ acquisition cost center (25%). A small percentage (11%) reported billing donors or donors' insurance.
SUMMARY
To maintain a high level of adherence to living donor follow-up without financially burdening donors, up-to-date resources are needed on handling routine donor follow-up costs in ways that are policy-compliant and effective for donors and programs. Development of a government-supported national living donor follow-up registry like the Living Donor Collective may provide solutions for aspects of postdonation follow-up, but requires transplant program commitment to register donors and donor candidates as well as donor engagement with follow-up outreach contacts after donation.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40472-022-00379-w.
综述目的：在美国，活体器官捐赠者需接受为期2年的随访，但目前缺乏关于补偿随访相关费用的正式指导。在本综述中，我们讨论了移植项目对活体肾捐赠者进行随访的现行计费做法，并提出了未来管理随访成本及支持捐赠者护理成本中立的方向。
最新发现：活体捐赠者在捐赠过程中可能产生费用和财务风险，包括交通、误工和照顾受抚养人等方面。此外，美国移植项目需遵守器官获取与移植网络（OPTN）的规定，向国家登记处提交捐赠后6个月、12个月和24个月的随访数据，这可能使捐赠者产生自付医疗费用。值得注意的是，医疗保险和医疗补助服务中心（CMS）明确禁止移植项目将常规的、规定的随访费用计入器官获取成本中心或受者的医疗保险。我们对美国的移植工作人员进行了一项调查（于2020年10月22日至2021年3月15日开展），结果发现，参与调查的项目中，收回或支付规定的捐赠后常规随访费用的机制通常包括向受者的私人保险计费（40%），而41%的项目向受者的医疗保险计费。许多项目报告使用机构补贴（高达50%），一些项目向器官获取成本中心计费（25%）。一小部分（11%）报告向捐赠者或捐赠者的保险计费。
总结：为了在不给捐赠者造成经济负担的情况下保持对活体捐赠者随访的高度依从性，需要有最新的资源来以符合政策且对捐赠者和项目有效的方式处理常规捐赠者随访成本。像活体捐赠者集体组织这样由政府支持的全国性活体捐赠者随访登记处的建立，可能为捐赠后随访的各个方面提供解决方案，但这需要移植项目承诺登记捐赠者和潜在捐赠者，以及捐赠者在捐赠后参与随访外联联系。
补充信息：在线版本包含可在10.1007/s40472-022-00379-w获取的补充材料。
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