Medicare ignored expert advice to cut tests for transplant patients: Report

April 19, 2024

Contractors for the Centers for Medicare and Medicaid Services (CMS) cut access to tests for transplant patients that could show early signs of organ rejection despite expert physicians advising the opposite, a new report has found. 

The Health Equity in Transplantation Coalition (HEiTC) announced Friday that a Freedom of Information Act request found that Medicare contractors limited access to blood tests even after the recommendations given by the government-chosen panel of medical experts. 

Al B. Sure!, executive chairman of HEiTC, said he was “incredibly alarmed” by the findings. 

“Instead of listening to these experts and considering what these tests meant to tens of thousands of transplant recipients, the contractor not only ignored but withheld their expert opinion,” he said. “In the process, they took away a vital tool for other doctors to monitor an overwhelmingly Black and Brown transplant community, which for the last year has lived with more anxiety than they should.”

“It’s never been more important that these cutbacks are reversed and coverage without any tie to a biopsy is restored,” he added.

The FOIA request detailed that contractors failed to disclose and then ignored the near-unanimous advice of expert physicians, who were picked by the contractors, to evaluate the utility for tests that could detect early signs of organ rejection in organ transplant recipients without a biopsy. 

Five out of six experts testified in November 2022 that such testing had significant clinical benefits, including for routine testing. 

But in March 2023, the contractor issued a new “billing article” that dramatically cut Medicare coverage on such tests. Instead, transplant recipients who rely on the federal health insurance program can only access these noninvasive tests for routine surveillance in lieu of a biopsy. 

This, HEiTC argues, significantly compromises the ability to catch organ rejection before it actually happens.

The coalition, which was founded by music artist Al B. Sure! and the Rev. Al Sharpton following the billing article, said the change disproportionately affected Black and Brown transplant recipients. 

Black, Hispanic and Latino Americans account for 40 percent of transplant recipients in the nation, according to the coalition. They also make up 50 percent of those on the 100,000-person transplant waiting list. 

But the issue has become bipartisan, with 14 members of the House, led by Reps. Anna Eshoo (D-Calif.) and Michael Burgess (R-Texas), sending a letter of concern to CMS about the rollbacks.

A follow-up letter was sent in October, and just this month, more than two dozen leading transplant clinicians sent a letter to CMS Administrator Chiquita Brooks-LaSure. 

The clinicians detailed the negative impacts of the policy change, including rise in rejection events among organ transplant recipients, which they believe to be associated with the restrictions.

CMS will spend the next few weeks determining whether the cutbacks will remain permanent.