Are the Center for Medicare and Medicaid Services Metrics Evaluating Organ Procurement Organization Performance Too Fragile?

Quality metrics are ubiquitous in healthcare in the United States and entrenched in the field of transplantation, including mandatory public reporting of both Organ Procurement Organization(OPO) and transplant center performance. There have been numerous iterations in scope and implications of quality reporting for transplant providers, including those by CMS, the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. Notably, after years of evaluating transplant center performance as part of their Conditions of Participation for transplant centers, CMS discontinued the use of one-year post-transplant outcomes for assessment of transplant center performance in 2019. This change was the result of thoughtful evaluation and acknowledgment of significant unintended consequences associated with performance evaluations, including "decreased utilization of marginal organs" and "deselection of patients from the waitlist" [1].