Organ Procurement Organizations

Alternatives Being Developed to More Accurately Assess Performance Gao ID: HEHS-98-26 November 26, 1997

Because the demand for human organs for transplants exceeds the supply, organ procurement organizations are required under law to make a systematic effort to acquire all usable organs from potential donors. However, the Health Care Financing Administration's (HCFA) current population-based performance standard cannot adequately assess the organizations' ability to acquire all usable organs because HCFA does not identify the number of potential donors within the organizations' service areas. Although potential organ donors share certain characteristics, including causes of death, absence of certain diseases, and being in a certain age group, the populations in organ procurement organizations' service areas can differ greatly in these characteristics. Two alternative performance measures that HCFA did not consider show promise for accurately identifying the number of potential donors. Reviewing hospital medical records is the most accurate method of estimating the number of potential donors in an organization's service area. Another alternative, modeling, shows promise and would be less expensive than medical records reviews. HCFA believes that its current standard identifies organ procurement organizations that are "poor performers." In its final rule, however, the agency indicated its interest in any empirical research that would merit consideration for further refining its standards. The approaches GAO has identified merit HCFA's consideration.

GAO noted that: (1) HCFA chose a population-based standard to assess OPO performance after considering the availability and cost to the OPOs of obtaining and analyzing various types of data; (2) when HCFA first applied this standard in 1996, five OPOs were subject to action for failing to meet the standard; (3) this resulted in two OPOs' service areas being taken over by adjacent OPOs, a portion of one OPO's service being taken over by an adjacent OPO, and the merger of one OPO with another; (4) the fifth OPO that failed the standard was determined to be a new entity and not subject to meeting the performance standard; (5) HCFA's current population-based standard, however, is not an accurate measure for assessing OPO performance because OPO service areas consist of varying populations; (6) although potential organ donors share certain characteristics, including causes of death, absence of certain diseases, and being in a certain age group, OPO service area populations have generally differing characteristics; (7) thus, the number of potential organ donors may vary greatly for OPOs serving equally sized populations; (8) GAO ranked the OPOs, using 1994-95 OPO procurement and transplant data, according to three measures--population, number of deaths, and adjusted deaths; (9) although three OPOs would not qualify for recertification under any of these measures, the number of and which OPOs would not qualify vary depending on the measure used; (10) HCFA did not consider two alternative measures--medical records reviews and modeling--that show promise for determining OPOs' ability to acquire all usable organs; (11) consistently applied and uniform reviews of hospital medical records with verifiable results may accurately assess the number of OPOs' potential donors; (12) because most OPOs already conduct some records review, any added expense and increase to the cost of organs may be negligible; (13) the cost of producing independently verified estimates of the number of each OPO's potential donors may be substantial, however, and the expense and impact on OPOs and organ cost must be considered; (14) though not yet fully developed, a modeling approach using substitute measures to determine the number of potential donors may be less expensive and easier to execute; (15) unless OPO performance is measured according to the number of potential donors, HCFA cannot determine OPOs' effectiveness in acquiring organs; and (16) the measures GAO has identified provide alternatives for HCFA to pursue to more accurately assess OPO performance.


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