Published by Bloomberg BNA
Brian Broderick and Michael D. Williamson
November 14, 2014

The Centers for Medicare & Medicaid Services announced Nov. 7 its final methodology for the Dialysis Facility Compare (DFC) Star Rating program.

The agency also released previews of ratings to individual Medicare-participating dialysis facilities. The facilities will have 15 days to review their ratings, according to the CMS.

The agency said the posted star ratings will use the same data previewed by facilities during the July preview period, and the “data will be updated on an annual basis beginning in October 2015.”

“We expect to post ratings to Dialysis Facility Compare in January 2015,” the agency added in its statement.

The CMS presented the DFC Star Rating methodology earlier this year and provided a 30-day preview period during which dialysis facilities could review their ratings. In response to stakeholder concerns, the CMS delayed rollout of the Star Ratings on DFC from October 2014 until January 2015 (25 MCR 1118, 9/12/14).

The extra time allowed the CMS to receive comments, “consider modification of the methodology, and respond to the dialysis community’s comments,” the agency said.

“Upon careful consideration of comments provided to us from the community, including dialysis facilities, consumer advocates, patients, and interested professional societies, CMS has decided to continue with the Star Ratings methodology presented previously,” the CMS said.

The agency noted it is adding Star Ratings to its “Compare” websites with the goal of improving the salience and usability of comparative quality information for consumers. The star system is intended to enhance and supplement existing publicly reported quality information, which will continue to be available, the CMS said.

“Currently, there are Star Ratings on Nursing Home Compare and Physician Compare. CMS also anticipates applying Star Ratings to Home Health Compare and Hospital Compare beginning in 2015,” the agency said.

Among the reasons for the star ratings system, according to the CMS, are to “help consumers of dialysis services make more informed health decisions” and to “release more transparent, easily understandable and widely available public reporting through the Affordable Care Act.”

However, in a Nov. 10 statement, Edward Jones, the chairman of Kidney Care Partners, which represents dialysis patients, clinicians, care professionals, providers, researchers and manufacturers, said the agency dismissed their recommendations on improving the DFC website.

In particular, Jones said his group was surprised by the agency’s announcement “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.”

Similarly, the Kidney Care Council, a trade association for dialysis providers, said Nov. 10 it was disappointed the CMS “unexpectedly announced” the implementation of the DFC “Star Rating System in January 2015 without making any improvements to the program to ensure that patients and their families have access to the most accurate information about the quality of their dialysis care.”

Reported Quality Measures

The CMS said that, of the 11 publicly reported quality measures, the DFC Star Ratings are based on nine of them.

The agency said it is making changes to DFC measures for January. In addition to introducing the Star Ratings, the CMS will stop publicly reporting two quality measures from the DFC website: the URR (urea reduction ratio) dialysis adequacy measure and the Hemoglobin greater than 12 g/dL measure.

The agency explained that more than 99 percent of all patients achieve the thresholds set for these measures, “so they do not provide meaningful information for consumers who wish to compare quality at different facilities.”

The CMS said it will “be adding the Standardized Readmission Ratio (SRR) to the outcome quality measures” and described the SRR as a measure of care coordination, a domain of care critical to dialysis patients, who average almost two hospitalizations per year. But the SRR won’t be included in the Star Rating methodology at this time, the CMS said.

The CMS said it wants ongoing feedback on the DFC Star Rating System. Questions or comments about the quarterly Dialysis Facility Compare preview reports and the DFC Star Ratings can be submitted to dialysisdata@umich.edu. The deadline for comments during the preview period is Nov. 24.

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