Interaction between ischemic time and donor age under the new donor heart allocation system: Effect on post-transplant survival.

BACKGROUND: Ischemic time (IT) under the new heart transplant (HTx) allocation system has increased compared to the old system. We investigated the effect of IT and donor age on post-HTx survival. METHODS: The United Network for Organ Sharing (UNOS) database was analyzed to identify adult HTx between October 2015 and August 2020. Recipients were stratified by donor age, transplantation era, and IT. Kaplan-Meier and log-rank tests were used to compare 180-day post-HTx mortality. Cox proportional hazards modeling and propensity score matching were performed to adjust for confounders. RESULTS: Under the new system (N = 3654), IT≥4 h led to decreased survival compared to IT < 4 h (91.4% vs. 93.7%; P = .02), although this decrease was undetectable among those with donors ≥39 years old (90.4% vs. 91.1%; P = .73). IT≥4 h led to decreased survival with donors < 39 years old (91.7% vs. 94.6%; P < .01). Under the old system (N = 5987), IT≥4 h resulted in decreased survival (89.8% vs. 93.9%; P < .01), including with donors ≥39 years old (86.9% vs. 92.4%; P < .01). CONCLUSIONS: IT≥4 h remains a risk for post-HTx mortality under the new system. However, the magnitude of this effect is blunted when donor age is ≥39 years, likely secondary to increased allocation of these organs to lower status, more stable recipients.

Medicare payment trends compared to inflation for anesthesia services.

STUDY OBJECTIVE: Identify changes and trends in the real value of Medicare payments for anesthesia services between 2000 and 2020 and how it may affect practices. DESIGN: Retrospective analysis. SETTING: We utilized the Physician/Supplier Procedure Summary (PSPS) datasets of Medicare Part B claims to identify high volume anesthesia services in 2020 with 20 years of data. The Consumer Price Index was used as a measure of inflation to adjust prices. PATIENTS: The PSPS datasets contain summaries of all annual Medicare Part B claims and payment amounts by carrier and locality. INTERVENTIONS: Patients receiving anesthesia services. MEASUREMENTS: For each service, identified by Current Procedural Terminology (CPT) codes, we trended the average Medicare payment per procedure from 2000 to 2020 and calculated year to year changes and compound annual growth rate (CAGR). We also evaluated base and time units for each CPT code and the national Medicare anesthesia conversion factor (CF) for the same years. MAIN RESULTS: The average Medicare payment in the study sample increased 20.1% from 2000 to 2020. After adjusting for inflation, the average Medicare payment per anesthesia service decreased by 20.8% over that period. The Medicare anesthesia CF increased 24.9% in the same period, and after adjusting for inflation, the real value of the CF decreased 16.9%. Average CAGR across the 20 anesthesia services was 0.88%, compared to the average annual inflation at 2.06%. CONCLUSIONS: Average Medicare payment for common anesthesia services after adjusting for inflation have decreased from 2000 to 2020, consistent with findings in other physician specialties. Understanding these trends is important for practice viability and suggests significant financial implications for anesthesia practices and hospitals if the trend were to continue.

Improved 3 Year Heart Transplant Survival in Black Recipients Following the Affordable Care Act.

To improve healthcare access, the US government implemented the Affordable Care Act (ACA) in 2014. Previous studies investigating its impact on healthcare inequities showed significant improvement in Black transplant recipient outcomes. Our objective is to determine the ACA's impact on Black heart transplant (HTx) recipients. Using the United Network for Organ Sharing database, we analyzed 3,462 Black HTx recipients pre- and post-ACA (January 2009 to December 2012, and January 2014 to December 2017). Black recipient numbers and rates of overall HTx, insurance effects on survival, geographic changes in HTx, and post-HTx survival were compared pre- and post-ACA. Black recipients increased from 1,046 (15.3%) to 2,056 (22.2%) post-ACA ( p < 0.001). Three year survival increased among Black recipients (85.8-91.9%, p = 0.01; 79.4-87.7%, p < 0.01; 78.3-84.6%, p < 0.01). Affordable Care Act implementation was protective for survival (hazard ratio [HR] = 0.64 [95% confidence interval [CI], 0.51-0.81], p < 0.01). Publicly insured patient survival increased post-ACA to match that of privately insured (87.3-91.8%, p = 0.001). United Network for Organ Sharing (UNOS) Regions 2, 8, and 11 experienced improved survival post-ACA ( p = 0.047, p = 0.02, and p < 0.01, respectively). The post-ACA era showed improved HTx access and survival in Black recipients, indicating that national medical policy may play a strong role in eliminating racial disparities. Further attention is required to improve inequities in medical care. http://links.lww.com/ASAIO/B2.