Economic Incentive to Begin an Intra-Company Kidney Donation Program

This is the link from CMS which discusses how long private health plans need to insure someone with ESRD until Medicare becomes the primary insurer - 30 months!!! Medicare is only the secondary insurer during this time frame so there is a huge window of time and therefore a huge economic incentive for an astute Medical Director or Benefits Manager at a large corporation to try to start an intra-company kidney donation program to save the company health plan a tremendous amount of money while saving/improving the lives of employees with ESRD.


In short: In dollar$ and cents...If a health plan is spending ~$100,000 annually per person with ESRD, then in the 30 months before the person is transferred to Medicare the cost comes to ~$250,000. Cost of kidney transplant ~$25,000 plus budget $1,000 per month for the best anti-rejection meds on the market. In the same 30 months, assuming you can do transplant during the first month, costs to the health plan would be $25,000 for transplant + $30,000 for 30 months of anti-rejection meds + throw in even $30,000 (high estimation) for complications ($1,000 per month for 30 months) for check ups with urologist/nephrologist, scans, etc. and you are still at only $85,000.
This comes to approximately a savings to the health plan of $165,000 in the 30 month time frame before the person is transferred to Medicare (and hopefully, they live that long).
Multiply that time 10 or 100 in a large health plan and we are beginning to talk about some real money.


The following is the pertinent text from Centers for Medicare and Medicaid Services Website:
"Medicare is the secondary payer to group health plans (GHPs) for individuals entitled to Medicare based on ESRD for a coordination period of 30 months regardless of the number of employees and whether the coverage is based on current employment status. Medicare is secondary to GHP coverage from COBRA or a retirement plan. Medicare is secondary during the coordination period even if the employer policy or plan contains a provision stating that its benefits are secondary to Medicare."

Increase the supply of kidneys: Is it possible?

For a couple of years I have been mulling over an idea to increase live donor donations. I have one mechanism that would only work in a very large setting - like in a large corporation.
Companies that pay for health coverage have an incentive to keep costs down. I forget the exact details (nor do I really care) but I think companies are required to keep ESRD (kidney failure) patients on their on health plans for a certain period of time until they can be transferred to Medicare (where ESRD is covered for people of any age.)
If these large companies can arrange healthy, willing employees to donate kidneys to other people in the company in need of a kidney, it would probably save them a lot of money, create tremendous good-will among employees, and probably make for great PR campaign, as well.
Again, large corporations' ESRD costs are astronomical so they have a large financial incentive to keep them in check - and what better way than making a sick employee healthy.
See this old post for this astronomical amount of money that could be saved by utilizing transplants instead of dialysis.

The Scourge of our Kidney Transplant Waiting List

Today I was with a friend at the Jesse Brown VA Medical Center (and btw, if you covet socialized medicine, go there to see it personally and get mugged by reality -it will be enlightening.)
My friend had an appointment with the vascular surgery unit. By fate, I was sitting in one corner with 3 middle aged-older black males. Two are on the kidney transplant waiting list. One received a transplant 15 years ago. The two remaining gentlemen were discussing being on the waiting list and related things like how often they go for dialysis. I can see that both suffered from various co-morbidities and bodies are ravaged by effects if the ailment. I also know that the chance of older, sickly men receiving transplants in the urban Chicago area is not great at all. But they live with hope. Or, perhaps, ignorance is bliss. But I saw firsthand the terrible human toll of our dysfunctional organ donation system It is immoral!!!

How To Incent People Into Organ Donation: Possible Solution to Legal Conundrum

I've been thinking of a possibly legal way to encourage people to donate kidneys. Basically, people should be given the net present value of their donation around the time of their donation. This is to get around the legal problem of paying someone any "valuable consideration" for an organ donation. You are certainly legally allowed to pay for costs related to the organ donation process such as medical expenses, missed work, travel, etc.
I propose that paying everyone around the time of their kidney donation the lifetime expected value of medical costs relating to their kidney donation. For example, let's assume the costs related to the surgical removal of the kidney and related costs of missing work, etc. come to $20,000. Then let's say the person still has 30 years of life expectancy remaining. Also, assume that an annual CT scan, kidney function exam (creatinine level), and trip to specialists such as a urologist or nephrologist come to $2,000. Over the 30 years of the person's life that equals $60,000. Now add that to the $20,000 in costs for the time of the donation itself and you can give someone $80,000 and not really give them any "valuable consideration."
The economic underpinning of this plan is that people always discount the future. If I offer someone $1 today or $1 a year from now, it is rational for the person to take the money now because of reasons such as either of the people may be dead by then, the cost of uncertainty, and inflation.
Of course, purely altruistic donations are always welcomed, but we see that they cannot supply the levels of kidneys needed for the population.