Table IV-3.  Transplant Calculations

"Under the CMS-HCC risk adjustment system of payments for ESRD patients, payment for transplants is carved out of the payments for all ESRD patients.  The payment factor for a transplant is based on the average Medicare costs for transplant admissions and the two months subsequent to discharge.  When CMS is notified of a transplant, three monthly payments are made.  Instead of a dialysis risk factor being the basis for payment in those months, a transplant factor is used and applied to the dialysis rate book. After the three months, payment is made at the functioning graft rate or at the dialysis rate, as appropriate."


Transplant Calculations
,Kidney Only Dollars,Kidney plus Pancreas Dollars,Kidney Only Relative Factor,Kidney Plus Pancreas Relative Factor
Month 1,"$33,424 ","$50,136 ",7.51,11.266
Month 2,"4,523","6,785",1.016,1.525
Month 3,"4,523","6,785",1.016,1.525
Total,"42,470","63,705"


"Note: To compute the relative factors, the national mean of annual dialysis patient costs was converted to a monthly amount and the transplant monthly costs were divided by this number."

"Mean annual dialysis costs:          $53,404.31"
"Costs per month:                            $4,450.36"