The University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) is seeking approximately 8–10 people to serve on a technical expert panel to make recommendations on access to kidney transplantation measures that would be appropriate for public reporting. The Centers for Medicare & Medicaid Services has contracted with UM-KECC to create the measure.

Background
The results of numerous studies have indicated that the recipients of renal transplants have better survival than comparable dialysis patients. The ESRD Conditions for Coverage mandate a comprehensive reassessment of each patient annually (at minimum) with the revision of the Plan of Care. Both the patient assessment and Plan of Care should include reevaluation of treatment modality and transplant status. Specifically, Section 494.80(a)(10) of the revised Conditions for Coverage for ESRD Facilities, effective October 14, 2008, sets forth requirements for patient assessment with regard to transplantation referral: "Evaluation of suitability for a transplantation referral, based on criteria developed by the prospective transplantation center and its surgeon(s). If the patient is not suitable for transplantation referral, the basis for non-referral must be documented in the patient’s medical record." Additionally, objectives CKD-12 and CKD-13 of Healthy People 2020 have the goal to “increase the proportion of dialysis patients wait-listed and/or receiving a deceased donor kidney transplant within 1 year of ESRD start (among patients under 70 years of age)” and “increase the proportion of patients with treated chronic kidney failure who receive a transplant”. Substantial variations by facility and geographic region, as well as disparities by race and socio-economic status in transplantation rates raise concerns about current processes for provision of access to transplantation.

In 2004 and 2005, ESRD Network 9/10 conducted a Technical Expert Panel (TEP) to develop transplant referral clinical performance measures.  The TEP proposed three clinical performance measures, Incident Patient Discussion, Prevalent Patient Discussion, and Referral to Transplant Center, and two descriptors, Interest and Contraindication.  In its report, the TEP and Contractor stated that attention and measurement of the dialysis facility side of process, without equal attention and measurement of the transplant center side of the process was shortsighted. Ensuring all appropriate dialysis patients are referred to a transplant center is important, but equally critical is what happens between the time of referral and time of wait listing for deceased donor transplantation or live donor transplantation. Therefore, two additional transplant center-specific measures were also recommended (wait listing and live donor transplantation).

TEP requirements

  • Transplant process expertise (from candidate evaluation through to transplantation) including transplant nephrologists, transplant surgeons, social workers, transplant coordinators/nursing;
  • Dialysis facility perspective on referral to transplant evaluation including nephrologists, nurses, social workers
  • Transplant policy expertise;
  • Individuals with consumer/patient/family perspective and consumer and patient advocates; specifically, patients with experience with transplant work-up, time on the waitlist, transplantation and failed transplants
  • Individuals with research expertise with Medicare data and issues pertaining to access to kidney transplantation;
  • Individuals with perspectives on healthcare disparities in access to transplantation;
  • Expertise in performance measurement and quality improvement

Patient nominees
UM-KECC is also seeking patients who can provide unique and essential input on these quality measures, based on their own experiences and outlooks as transplant patients, particularly as they relate to access to renal transplantation or related issues and complications of renal transplantation or access to or remaining on the waitlist. Patient nominees should submit a completed and signed TEP Nomination Form and letter of interest as described below but are not required to submit a curriculum vitae

TEP expected time commitment

  • TEP members should expect to come together for one to three teleconference calls prior to the in-person meeting held April 2015, in Baltimore.
  • The in-person meeting (dates to be determined).
  • After the in-person meeting, additional conference calls may be needed.
  • Patient participants are not required to submit a curriculum vitae and may elect to keep their names confidential in public documents.

The TEP Charter and Nomination form can be found on the CMS website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/TechnicalExpertPanels.html

If you wish to nominate yourself or other individuals for consideration, complete the form and email it with your CV and letter of interest to: dialysisdata@umich.edu by 5:00 p.m. ET on Feb. 15.