Kidney Week 2025 Annual Meeting-An IOTA of Sense: What Should Nephrology Professionals Know About the Increasing Organ Transplant Access Model?

Video Transcription

Video Summary

The session introduces and debates CMS’s new mandatory value-based payment model for kidney transplantation, IOTA (Increasing Organ Transplant Access), launched July 1, 2025. Speakers explain that despite rising ESKD, waitlisting and early transplant access have been flat for decades, with major inequities and many potentially eligible patients never reaching the waitlist. IOTA aims to expand access, improve equity, increase use of organs previously declined, support living donation, strengthen care coordination, and maintain quality.<br /><br />Programs are scored across three domains (100 points total): an “achievement” (volume growth) domain worth up to 60 points, plus 20 points each for “efficiency” (organ offer acceptance rate compared with other centers) and “quality” (composite graft survival percentile). Incentive payments can be substantial (up to $15,000 per Medicare fee-for-service transplant), with minimal downside risk (up to $2,000 starting year two). Selection into IOTA was randomized by donor service areas; 103 hospitals participate for six years.<br /><br />A general nephrologist perspective emphasizes new transparency requirements (publishing listing criteria, patient updates), expanded “safe harbor” supports (transportation, lodging, devices, mental health services, cost-sharing help), and a new “IOTA collaborator” role enabling formal agreements and potential gainsharing with nephrology practices.<br /><br />NYU’s experience shows high-volume growth can coexist with strong outcomes through team-based infrastructure, consistent patient education on high-KDPI/HCV organs, deliberate organ evaluation, outpatient delayed graft function pathways, and living donor tools.<br /><br />Finally, concerns include extreme inefficiency in organ offers, lack of risk adjustment in the 6-year graft metric, Medicare Advantage growth reducing incentives, and resource constraints for smaller/rural programs, though Medicare cost reports may offset upfront investments.

Asset Subtitle

Moderator(s): Roy Bloom, Mallika Mendu

Presentation(s):

What Is the IOTA Model? What Are the Proposed Metrics? Perspectives from an IOTA Program - Vineeta Kumar
What You Need to Know About IOTA as a General Nephrologist: This Matters for Your Patients - Rajendra Baliga
How Can Hospitals Increase Their Kidney Transplant Volumes While Maintaining Outcomes? - Nicole Ali
Outcome Metrics and Insurance Coverage: Balancing Risks and Rewards for Stakeholders in the IOTA Era - Sumit Mohan

ASN thanks the ASN Transplant Workgroup for assistance with this session.

Meta Tag

Date 11/9/2025

Pathway 1 Kidney Transplantation

Pathway 2 Dialysis

Session ID 507273

Keywords

CMS IOTA model

Increasing Organ Transplant Access

value-based payment kidney transplant

mandatory transplant payment model

ESKD waitlist inequities

transplant access expansion

organ offer acceptance rate

high-KDPI kidney utilization

HCV-positive donor organs

living kidney donation support

graft survival quality metric

safe harbor patient supports

care coordination nephrology collaboration

IOTA collaborator gainsharing

Medicare FFS transplant incentive payments