Contractors for the Centers for Medicare and Medicaid Services (CMS) restricted access to tests for transplant patients that could detect early signs of organ rejection despite expert physicians recommending the opposite, as indicated by a new report.
The Health Equity in Transplantation Coalition (HEiTC) declared Friday that a Freedom of Information Act request revealed that Medicare contractors limited access to blood tests even after the recommendations from the government-chosen panel of medical experts.
Al B. Sure!, executive chairman of HEiTC, expressed being “incredibly alarmed” by the findings.
“Instead of listening to these experts and considering what these tests meant to 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 an overwhelmingly Black and Brown transplant community, which for the last year has lived with more anxiety than they should.”
“It’s never been more important that these cutbacks are reversed and coverage without any tie to a biopsy is restored,” he added.
The FOIA request detailed that contractors failed to disclose and then ignored the near-unanimous advice of expert physicians, selected 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 testing had significant clinical benefits, including for routine testing.
But in March 2023, the contractor issued a new “billing article” that drastically reduced Medicare coverage for such tests. Instead, organ transplant recipients who depend on the federal health insurance program can only access these noninvasive tests for routine surveillance in place of a biopsy.
HEiTC argues that this significantly compromises the ability to detect organ rejection before it actually occurs.
The coalition, which was founded by music artist Al B. Sure! and the Rev. Al Sharpton following the billing article, said the change disproportionately affected Black and Brown transplant recipients.
Black, Hispanic and Latino Americans make up 40 percent of transplant recipients in the nation, according to the coalition, and 50 percent of those on the 100,000-person transplant waiting list.
But the issue has become bipartisan, with 14 members of the House, 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 just this month, more than two dozen leading transplant clinicians sent a letter to CMS Administrator Chiquita Brooks-LaSure.
The clinicians detailed the negative impacts of the policy change, including an increase in rejection events among organ transplant recipients, which they believe to be linked to the restrictions.
CMS will spend the next few weeks determining whether the cutbacks will remain permanent.
