About

Which reports are counted

Cohort rule: cost reports whose fiscal period ends in the calendar year. One report per filer per period, settled preferred over as-submitted. Each figure names its own count of filers on its chip.

What the hash covers

Each release carries a sha256 hash computed over its figures, written in one fixed order so the same figures always produce the same hash. Every citation on this site names the release and that hash, so a figure read here today can be matched against the same release years from now. A published release is not edited. A correction is a new release with a new hash.

The two counts

The OPO reports how many organs it found usable. The transplant hospital reports how many it acquired from OPOs. Both counts are for the calendar year, weighted where a filer's year overlaps two calendar years, and the citation states that basis. The counts can be compared nationally. The dollars cannot, because the hospital reports a pooled cost with no line for the amount reimbursed to the OPO.

A usable organ can go unrecorded as acquired by a hospital for several reasons. The hospital's fiscal year does not line up with the calendar year. An organ can be transplanted at a hospital that does not file this worksheet. And an organ moved between OPOs can appear in both filers' counts, because the line that counts organs recovered counts local and imported organs together.

The hospital side

The hospital figures come from Worksheet D-4 of the hospital cost report, one worksheet per organ program, for hospital fiscal years ending in the year shown. Hospital years and OPO years are both period-end, and neither is a calendar year.

How the picture is drawn

The flow on the home page and on Explore is the same picture: what came in on the two lines that record it, what the organizations spent in total, and the blocks of Worksheet A that add up to that total to the dollar. A ribbon between two bands says they are connected, which the filings document, and its width says nothing at all. Every ribbon on the picture is exactly the same width for that reason.

How many blocks there are is a property of the release rather than of this page. One decode of the same federal files partitions the printed lines and gathers every sub-line a filer added into a block of its own. Another folds those sub-lines into the printed blocks they sit under. Both add up to Worksheet A line 26 exactly, they reconcile to each other to the dollar, and the site draws whichever partition its release carries.

The bars are where size means something. A bar is drawn to scale only where the release carries the figure behind it, and those bars are gold. A bar with no figure is drawn at a fixed size, the same as every other bar with no figure in its column, and it prints the word blank and the reason. Sizes can be compared down a column and not across columns, because one column counts organs and another counts dollars.

These totals cover the OPOs that file their own cost report with Medicare. 7 more OPOs are run inside a hospital and report within that hospital's cost report, so they are not included here. Histocompatibility laboratories file the same form and are excluded from every figure here.

An OPO that is run inside a hospital does not file an OPO cost report. Its costs are part of the hospital's own cost report, the CMS-2552-10, so none of its figures can be read from the filings this site reads. These are the organizations in that position:

Four counts of four different things, and a caption has to say which one it means. The filings can outnumber the independent OPOs in a year: when a merger takes effect mid-year, two provider numbers cover one service area and both file, whether one organization was absorbed or two combined into a new one.

The laboratories file the same form and are excluded from every organ figure. The hospital-based OPOs above are legible on the hospital cost report, and reading them is the next piece of work. Until it lands, a total on this site is the filing cohort and says so.

Worksheet A-5 line 5 is a choice. An OPO may offset tissue costs there, and few do, because most hold tissue in a cost center Medicare does not reimburse, so nothing is owed back. Three counts are often confused and measure different things: the OPOs that chose the line 5 offset, the OPOs that wrote the word TISSUE anywhere on Worksheet A-5, and the OPOs that received tissue income on Worksheet S-1 line 8. Each carries its own chip.

Text lives in one file, numbers in another

CMS publishes each year of OPO cost reports as three files: a numeric file, an alpha file and a report file. The filer's own words, including every write-in label, are in the alpha file. The amounts are in the numeric file. The two join on report record number, worksheet, line and column. A label read from the numeric file, or a number read from the alpha file, is a join error.

Fiscal years and calendar years

A cost report covers the filer's own fiscal period. On this site a report belongs to the calendar year its period ends in. A filer whose year ends in June 2024 is fiscal 2024 here, and its dollars are half calendar 2023. The one exception is the two counts, which are stated on a calendar basis with overlap weighting, and the chip states the basis.

Superseded filings and the status filter

A provider can have several reports for one period: as submitted, settled, reopened, amended, audited. Summing them counts the same money more than once. Each period carries one report here, settled preferred, and the Data sources page lists every report record with its status so the choice can be checked.

Direct cost and fully allocated cost

Worksheet A-2 line 23 is direct cost. Worksheet B column 11 is fully allocated cost, after overhead. Dividing one by the other, or mixing them in a share, produces a number over one hundred percent that describes nothing.

Line 9 counts organs and tissues together

Line 9 column 1 counts organs and tissues together and filers count tissue differently, so its counts are not comparable across filers. Column 3 is dollars and is what the distribution uses.

Acquisition cost per kidney

The standard acquisition charge divides total kidney acquisition cost (Worksheet C Part I line 4) by kidneys reported viable (line 1), which gives what it cost to recover each kidney. Case mix, geography, transport distance, the share of donors after circulatory death and the filer's own cost allocation all move it. It is a figure. This site does not rank it.

Releases and years

A CMS release is a file cut on a date. It carries reports from many fiscal years, and a later release can carry a corrected copy of an earlier report. The release stamp on every page names the file the figures came from. The year control names the fiscal year the figures belong to. The two are different things.

The OPTN join

An OPO's cost report is joined to its OPTN identity on the provider number and the center type, OP1 or IO1. Histocompatibility laboratories file the same form and are excluded from every organ figure by that rule.

The files in the release this site reads, and the date CMS last changed each one.

This site is not the first reading of these filings. Where published research has already measured something this site measures, it is named here, with what that work covered and what this site does differently.

The hospital acquisition pool

Cheng and colleagues measured organ acquisition cost from the cost reports of Medicare-certified transplant hospitals for 2012 through 2017. The instrument is theirs. What this site adds is the later years its release carries, and the whole recorded pool rather than the portion Medicare paid.

The total they published is Medicare's share, and it rose from $0.95 billion in 2012 to $1.32 billion in 2017. The receipts figure on the home page of this site is a different quantity, read from a different form, for a different period. The two cannot be compared, including where they round to the same number.

A correction is a new release with a new hash. Published releases stay as they are. Write to hello@meira.life with the figure key, the release tag and the hash on the chip.