CMS Launches Star-Rating System For Dialysis Facilities; Provider Groups Upset

January 22, 2015

Published by Bloomberg BNA
Michael Williamson & Brian Broderick
Jan. 22, 2015

Development: CMS adds star-rating system to the Dialysis Facility Compare website.

Additional Development: CMS will be making a public call for nominations for participation in a technical expert panel for the ratings system.

The Centers for Medicare & Medicaid Services Jan. 22 added a star-rating system to its Dialysis Facility Compare (DFC) website.

Provider groups quickly reacted harshly to the addition of the star ratings to the DFC website and said the CMS failed to adequately collaborate with them.

The agency said the star ratings summarize dialysis facilities’ performance data and “spotlight excellence in health care quality.” The ratings “are simple to understand and are an excellent resource for patients, their families, and caregivers to use when talking to doctors about health care choices,” CMS Administrator Marilyn Tavenner said in the statement.

The Dialysis Facility Compare rating system provides a rating of one to five stars to a dialysis facility based on nine quality measures, the statement said. The CMS first announced plans for the star ratings in a mid-2014 blog post (162 HCDR, 8/21/14), but delayed the launch after complaints from provider and patient groups.

In a Jan. 22 blog post, the CMS said that the compare websites “are the official source for information about the quality of health care providers, and star ratings are just one of many ways we’re working to make quality information easier to understand and compare.”

The CMS said the “Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one based on quality. Physician Compare has just started to include star ratings in certain situations for physician group practices. We’re planning on adding star ratings to Hospital Compare and Home Health Compare later this year.”

Technical Expert Panel

The agency also described its plan for enhancing the ratings system.

In a Jan. 22 fact sheet, the agency said its Technical Expert Panel (TEP) will be charged with evaluating the star rating scoring methodology, “considering the current star rating measures, and suggesting potential future measures for the star ratings. The TEP will then make recommendations to CMS for future modifications or iterations of the star ratings system as necessary.”

In a separate e-mail to Capitol Hill staffers, Zunaira Khalid, with the Office of Legislation at the CMS, said Jan. 22 the CMS plans to update the star ratings on DFC “on an annual basis beginning in October 2015.”

Khalid said the agency “will be making a public call for nominations” for participation in the TEP, but didn’t specify when the agency would make the call for nominations.

Criticism of CMS’s Move

The start of the star ratings for dialysis providers quickly drew reaction from provider groups. Kidney Care Partners (KCP) criticized the methodology the CMS used for the star ratings in a Jan. 22 statement, saying the methodology “distorts the actual quality performance of dialysis facilities.”

“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,” KCP Chairman Edward Jones said in the statement. “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” and proceed with launching the site, Jones said.

KCP—which includes patient advocates, dialysis professionals, care providers and product manufacturers—said it provided recommendations to the agency to eliminate distortions in the results “that will mislead patients and misrepresent the quality of care provided in dialysis facilities nationwide.”

Concerns about the agency’s methodology for the star ratings, which the CMS announced in November 2014 (217 HCDR, 11/10/14), have been raised in the past. KCP criticized the final methodology for the DFC star ratings shortly after the CMS announced it.

Likewise, Dialysis Patient Citizens (DPC), an advocacy group for people needing dialysis treatment, Jan. 22 said in a statement it also had problems with the DFC star-rating methodology. “We do not believe that CMS’ current star-rating methodology will empower consumers to act on quality information in a realistic manner,” DPC said.

The group also said the CMS didn’t include promised information on the website. “We are also extremely disappointed that CMS appears to have reneged on an important promise it made last October, to inform Dialysis Facility Compare visitors that ‘a one-star rating does not mean you will receive poor care from a facility,’ ” the DPC said.

According to the group, “this essential language” can’t be located anywhere on the DFC website. “It is critical that patients understand that all dialysis facilities provide life-sustaining treatment, and that they should not be alarmed or discouraged if higher-rated facilities are not available in their area,” the group said.

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