How many levels will you need to build in the kidney transplant reimbursement model?

• A. Two
• B. Four
• C. One
• D. Three

Answer: (B)

Capturing costs across the patient care pathway in a kidney transplant reimbursement model requires four levels. This structure mirrors the care journey from initial evaluation through long-term follow-up, and each level covers distinct cost components and reimbursement drivers. The first level handles pre-transplant evaluation and donor workup, where scheduling, testing, and clearance costs accumulate. The second level covers the transplant procedure itself and immediate hospitalization, reflecting operative costs, anesthesia, and the acute post-op period. The third level addresses the early post-transplant phase, including short-term follow-up, early complications, and potential readmissions within the first weeks to months. The final fourth level encompasses long-term post-transplant management—ongoing immunosuppression, routine surveillance, and late complications that influence ongoing costs and reimbursement.

Four levels are best because they align with the care pathway and separate the different cost structures and reimbursement rules, enabling more accurate modeling and budgeting. Using fewer levels tends to merge phases with different resource use, while more levels can complicate the model without providing proportional clarity.