Kidney Care Partners Spotlights Important Quality Gains in Dialysis Care
April 26, 2018
Coalition Urges CMS to Improve Approach to Performance Tracking
WASHINGTON, DC– Kidney Care Partners (KCP), a multi-stakeholder coalition, including patient groups, physician and nursing organizations, dialysis providers, and manufacturers, today spotlighted data showing significant gains in dialysis quality provided since 2001.The announcement was in response to the federal government’s release of data tied to its Five-Star Program which KCP believes needs significant improvement.
According to the United States Renal Data System (USRDS) 2017 Annual Data Report Highlights, overall mortality rates among ESRD (dialysis and transplant) patients have consistently declined over the last 15 years, down close to 30 percent between 2001 and 2015, the most recent year for which data are available. Specifically, the net reductions in mortality from 2001 to 2015 were 27 percent for hemodialysis patients and 41 percent for peritoneal dialysis patients.
“The good news is that Americans with kidney disease, kidney failure and transplants are receiving better care, experiencing improved outcomes, and having greater hope for a healthier future,” said KCP Chairman Allen R. Nissenson, MD, FACP. “Working with our nation’s policymakers, the kidney community will continue to advance policies that improve care coordination, reduce hospitalizations, improve patients’ experience of care, and focus more resources on research and innovations with the goal of making a real difference for individuals with kidney disease, and for those who rely on dialysis or have undergone transplants.” At the same time, KCP urged the Centers for Medicare and Medicaid Services (CMS), the developer of the Five-Star Program, to improve its approach to quality performance tracking.
KCP has a long, successful history of working collaboratively and constructively to improve quality care and deliver patient outcomes. In addition to supporting the creation of Medicare’s first true value-based purchasing program, the Quality Improvement Program (QIP), KCP introduced its own improvement programs: The Kidney Care Quality Alliance (KCQA) and the Performance, Excellence, and Accountability in Kidney Care (PEAK) initiative.
The KCQA, funded by KCP, was created in 2005 as an independent organization with the sole purpose of developing quality measures for use in the dialysis care setting. KCQA is guided by a steering committee and has a broad-based membership of leading stakeholders in kidney care.
PEAK was a voluntary, community-driven initiative designed to highlight proven patient care practices with the goal of improving the survival of kidney failure patients new to dialysis. This community-led initiative activated in 2009 convened a series of expert panels focused on clinical as well as patient and family engagement “best practices” that, if implemented consistently, could help improve survival ratesin the first 90-days and the first year of dialysis. The final report, prepared by Brown University researchers and released in 2013, showed a reduction of 13.6 percent in first-year mortality and 25 percent in 90-day mortality is quite substantial. The latest USRDS data show even greater advances since the kidney community’s voluntary launch and embrace of these best practices.
While reflective of this positive momentum – the CMS data show an increase in the number of dialysis centers receiving three-, four-, and five-stars – KCP believes the Five-Star Program for Dialysis Providers has deep flaws that make it unreliable.
KCP believes that the Five-Star Program does not provide the full picture of the high-quality care being delivered at the individual facility level, and, therefore, cannot be used reliably by patients or their families to evaluate dialysis facilities. While CMS has made some improvements over time in the methods used to determine the star ratings, the program remains problematic because of outstanding, issues related to methodology, measure validity and actionability of information by dialysis facilities. These systemic flaws can mislead patients and the public.
“Notwithstanding the Program’s shortcomings, we believe CMS has made improvements in the ranking system that may more closely reflect our community’s commitment to and success in improving quality care for dialysis patients,” said Nissenson. “While good ratings are important, our true focus – and what has made overall quality improvement possible – is our community’s willingness to strive to deliver the highest quality patient care.”