Finance of Liver Transplantation

Abstract

Organ transplantation, particularly liver transplantation, is one of the most expensive and complicated services that a hospital can provide. There are varied disciplines involved in the daily operations of a liver transplant program. There are numerous payment methodologies, contract types, and reimbursement methods due to transplant being more complicated than most medical procedures. Private commercial insurers and Medicare are the primary sources of payment in liver transplant. Medicare’s payment system is a threefold process, consisting of a diagnosis-related group payment, the Medicare Cost Report, and ambulatory payment classifications. Commercial payers work through managed care organizations that contract with specialty transplant networks. While a majority of liver transplants are covered by Medicare and private payers, Medicaid and self-pay are other payment sources. The expansion of health coverage through the Patient Protection and Affordable Care Act has greatly impacted the finances of transplant programs in the United States. Patients who are candidates for a transplant will have increased access to transplant care; however, the Medicare reimbursement will be reduced through decreased payments of the diagnosis-related group and organ acquisition cost. A transplant program must increase focus on quality and efficiency while understanding the costs involved in providing liver transplantation.