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The FreedomWorks Foundation's Regulatory Action Center (RAC) submitted formal comments to the Center for Medicare Services (CMS) to urge greater oversight of Organ Procurement Organizations (OPO). These OPOs essentially have a government-granted monopoly on organ recovery. However, they routinely waste taxpayer dollars and leave many struggling to receive organs that should have easily been obtained.
The proposed rule represents a great step forward for bringing OPOs back into compliance by increasing federal oversight. Yet, the proposed rule presents us with only a single remedy to an issue that spreads across many organizations and systems. Although the proposed rule will surely provide greater incentive to increase the efficiency of organ procurement, much still needs to be addressed before organ donation advocates can rest easy.
Historically, CMS has demonstrated themselves to be unwilling to strictly enforce the standards they set, refusing to decertify underperforming OPOs. The abrogation of their corrective role has left CMS between a rock and a hard place where effective oversight is difficult. Since OPOs are aware of the Catch-22, it can be even more difficult to secure compliance since the OPOs know that threats of decertification are all but empty. Fortunately, CMS has another tool at its disposal to intervene when OPOs underperform; they simply need to wield it properly.
Empirically, the single best action that can be taken to induce underperforming OPOs to improve their record has been to replace the CEO. Ultimately, the reason that so many of these organizations are underperforming is because they are being mismanaged. Taking advice from the private sector, several OPOs have recently found that changing executives is one of the least disruptive ways to reorganize and improve. When an OPO is habitually underperforming, replacing management should be a top priority and CMS should consider reforming existing practices to streamline the ability of the Department to monitor and control the management of these organizations.