activemandatorydisease-specific

IOTA

Increasing Organ Transplant Access Model

The Increasing Organ Transplant Access (IOTA) Model aims to increase access to life-saving kidney transplants for patients living with end-stage renal disease (ESRD). It incentivizes kidney transplant hospitals to improve their care delivery capabilities and efficiency, and supports greater care coordination in the organ transplant waitlist process.

Active since 2025-07-01

Innovation

Implements performance-based payments separate from standard Medicare IPPS/OPPS payments, utilizing upside and downside risk based on achievement, efficiency, and quality domains.

The Problem

Kidney transplantation is the best treatment for most patients with chronic kidney disease and ESRD, but there are far more people in need of a kidney than there are organs available. Many people die every day while waiting for a kidney transplant.

The Solution

The IOTA Model provides incentives for kidney transplant hospitals to increase the number of kidney transplants, by maximizing the use of deceased donor kidneys and facilitating more transplants from living donors and improving the process and quality of care for people awaiting treatment.

Expected Outcomes

Improving the transplant system helps patients with chronic kidney disease access life-saving, high quality treatment resulting in optimal long-term health outcomes and reducing Medicare spending.

Strategy

The IOTA Model demonstrates the critical impact of receiving high value care to promote healthier living and drive down long-term medical expenses.

Model Goals

  • Encouraging transplant hospitals to use more available kidneys
  • Reducing the number of discarded kidneys
  • Supporting and educating potential living donors
  • Improving care coordination and patient-centered care
  • Enhancing the quality of care before, during, and after receiving a transplant

Patient Eligibility

Patients 18 years of age or older who are registered on a kidney transplant waitlist or who receive a kidney transplant from an IOTA participant.

  • Alive at the time CMS conducts attribution
  • 18 years of age or older
  • Registered on a kidney transplant waitlist or receives a kidney transplant from an IOTA participant

Provider Eligibility

Kidney transplant hospitals located in selected donation service areas (DSAs) that meet a minimum volume threshold.

  • Located in one of the selected donation service areas (DSAs)
  • Performed 11 or more kidney transplants for patients aged 18 years or older in each of the baseline years

Care Categories

Organ Transplantation

Kidney TransplantEnd-Stage Renal Disease (ESRD)

CMS Benchmarks & Thresholds

eligibility

Minimum Baseline Kidney Transplants for Eligibility11
Minimum Patient Age for Baseline Kidney Transplant Count18
Minimum Patient Age for Transplant Target Calculation18

financial

Maximum Upside Risk Payment per Medicare Kidney Transplant15,000
Performance Year Downside Risk Payments Begin2
Downside Risk Payment Due Period60
Performance Score Threshold for Upside Risk Payment60
Upside Risk Payment Formula Divisor40
Upside Risk Payment Formula Multiplier$15,000
Performance Score Threshold for Downside Risk Payment40
Downside Risk Payment Formula Divisor40
Previous Maximum Upside Risk Payment per Medicare Kidney Transplant (Proposed Rule)8,000
Downside Risk Payment Formula Multiplier$2,000
Maximum Downside Risk Payment per Medicare Kidney Transplant2,000

operational

Model Duration6
Model Start DateJuly 1, 2025
Minimum Termination Percentage for New Participant Selection0.1%
Organ Offer Acceptance Criteria Review Frequency6
Model End DateJune 30, 2031
Preliminary Performance Assessment Review Period30
Minimum Delay for Final Score Notification30
Preliminary Performance Assessment Calculation Delay3 – 6
Preliminary Performance Assessment Notification Delay5 – 9

population

Number of Participants103

quality

Maximum Possible Performance Score Points100
Minimum Performance Score for Neutral Zone41
Maximum Performance Score for Neutral Zone59
Performance Year Neutral Zone Starts2
Performance Year Neutral Zone Ends6

See how this model fits your organization

Answer three quick questions about your facility and get matched to the VBC models that fit your profile — with benchmark context from organizations like yours.

Start Assessment