Medicare Ignored Expert Advice to Cut Tests for Transplant Patients: Report

Providers at the Centers for Medicare and Medicaid Services (CMS) have cut off access to tests for transplant patients who could show early signs of organ rejection, despite medical experts advising otherwise, 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 recommendations given by the government’s 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 for 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 a predominantly Black and brown transplant community that over the past year has lived with more anxiety than it should.”

“It has never been more important that these cuts are reversed and that coverage without any link to a biopsy is restored,” he added.

The FOIA request detailed that the contractors failed to disclose and then ignored the nearly unanimous advice of medical experts, chosen by the contractors, to evaluate the usefulness of 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 tests had significant clinical benefits, including for routine testing.

But in March 2023, the contractor published a new “billing article” that drastically reduced Medicare coverage of these tests. Instead, transplant recipients who rely on the federal health insurance program can only access these non-invasive tests for routine surveillance rather than a biopsy.

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

The coalition, founded by musical artist Al B. Claro! and Reverend Al Sharpton, following the billing article, said the change disproportionately affected black and brown transplant recipients.

Black, Hispanic and Latinx Americans represent 40% of transplant recipients in the country, according to the coalition. They also represent 50% of people on the 100,000-person transplant waiting list.

But the issue has become bipartisan, with 14 House members, 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 this month alone, more than two dozen leading transplant doctors sent a letter to CMS Administrator Chiquita Brooks-LaSure.

Doctors detailed the negative impacts of the policy change, including increased rejection events among organ transplant recipients, which they believe are associated with the restrictions.

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