CMS Decision to Proceed with Flawed Dialysis Facility Ranking System ‘Deeply Troubling,’ Says Nation’s Leading Kidney Care Coalition

Stakeholder Groups Disturbed by Agency’s Rejection of Efforts to Collaborate Prior to Implementation

WASHINGTON, DC  – Kidney Care Partners (KCP) expressed deep concern over the surprise announcement last week by the Centers for Medicare and Medicaid Services (CMS) to hold firm on use of a methodology that distorts the actual quality performance of dialysis facilities when the Agency launches its star-based ranking system in January.

“KCP has long supported quality measurement and transparency as a means to drive improvement in patient outcomes,” said Chairman Dr. Edward Jones, a practicing nephrologist. “As a community, we have walked the walk by developing quality measures, launching care improvement initiatives, and supporting the first true pay-for-performance system. So, we find it deeply troubling that CMS officials would signal their willingness to work with us on short-term improvements to this star-based ranking system and then summarily dismiss our recommendations – all without the benefit of discussion.”

In response to encouragement by CMS officials to make recommendations for incorporation into the Dialysis Five Star System, KCP convened community leaders, quality measurement experts, and academicians to develop and present recommendations to eliminate distortions in the CMS system that could mislead patients and misrepresent the quality of care provided in dialysis facilities nationwide. “We want the system to be reliable and meaningful to patients and to reflect the quality of care being delivered,” added Dr. Jones. “The program as developed by CMS simply does not accomplish that goal.”

Dr. Jones underscored the fact that KCP’s recommendations were focused on methodological improvements that could be made before the Agency’s January 2015 launch deadline. Additional serious problems with data integrity and measure specifications would have to be addressed post implementation.

In recent months, the Medicare Payment Advisory Commission (MedPAC), the independent Medicare advisory committee to Congress, criticized the methodology used by CMS in its ranking system. Additionally, MedPAC questioned the need for the new ranking system altogether, especially since Medicare’s ESRD program already has a fully transparent quality program mandated by Congress, called the Quality Improvement Program (QIP). The QIP provides publicly available information on quality performance that is inconsistent with the new CMS star program.

In response to public criticism of the Dialysis Five Star methodology, CMS delayed implementation of the program. At the time, CMS indicated it would use the delay to seek additional input from the community and allow for more “patient education” about the planned program.

“KCP felt then, and we believe now, that no amount of patient education will fix what’s broken in the Dialysis Five Star program,” concluded Dr. Jones. “Our government would never knowingly put a consumer product or service into the public marketplace if it was know to have serious problems, and it should be the same with the CMS Five Star program. The program is intended to provide a helpful, usable source for patients. Given its widespread criticism from numerous experts including the broader community, CMS owes it to patients to get it right first.”

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