Published by Bloomberg BNA
December 19, 2014

Development: Group files challenge with CMS about facility quality measures, saying ratings are distorted by social and demographic factors.

A group representing patients has filed what it called a challenge to the CMS’s dialysis facility quality measures.

Dialysis Patient Citizens announced Dec. 16 its challenge filed with the Centers for Medicare & Medicaid Services. The group said its action, which it also called a petition or request for correction, was based on the Data Quality Act.

Among the group’s complaints is that the “star ratings” methodology fails to satisfy federal requirements for objectivity and utility in presenting information to the public.

DPC Director of Government Affairs Jackson Williams said in the group’s statement, “We felt this challenge was necessary in light of CMS'[s] continued refusal to acknowledge that its quality ratings are distorted by socio-demographic factors.”

Williams added, “As is the case with Medicare Advantage star ratings and the hospital readmissions penalty, a clear geographic pattern is evident: New England, the Upper Midwest and Pacific regions score the highest, and the South and Greater Appalachia score the worst.”

However, he said, the pattern with dialysis facilities “is more exaggerated than in other quality programs, probably because dialysis facilities draw patients from more concentrated service areas.”

Regional Disparities Ignored

The group’s filing with the CMS said the star ratings don’t consider “regional disparities in mortality due to socio-demographic factors, and therefore are systematically biased so as to disseminate artificially low scores in places where, in general, mortality is higher than average, and artificially high scores in places where mortality is lower than average.”
Williams told Bloomberg BNA Dec. 18 that there is no judicial review available for the dialysis quality ratings system, hence the group’s use of the data quality law. The Data Quality Act, also known as the Information Quality Act, was a provision of a fiscal 2001 appropriations measure (Pub. L. No. 106-554).

In a 2006 report (GAO-06-765), the Government Accountability Office said the Information Quality Act required the Office of Management and Budget to issue governmentwide guidelines to “ensure and maximize the quality, objectivity, utility, and integrity of information, including statistical information,” disseminated to the public.

Dialysis Facility Compare Site

In November, the CMS announced final methodology for the Dialysis Facility Compare Star Rating program (217 HCDR, 11/10/14). The agency’s Dialysis Facility Compare website allows users to find and compare Medicare-certified dialysis facilities.

At that time, the CMS said it expects to post the ratings to Dialysis Facility Compare in January. On Dec. 18, a representative of the CMS confirmed that the agency “plans to launch star ratings on Dialysis Facility Compare around late January.” The agency didn’t respond to a request for comment on the group’s filing with the CMS.

The patient group filed its challenge Dec. 2 with the agency. In the text of the document, DPC said the Data Quality Act and the Department of Health and Human Services Information Quality Guidelines “promulgated pursuant to the Act have been in existence for approximately as long as CMS has collected and reported quality measures. Over the past decade, no stakeholder has ever filed a Request for Correction with CMS pertaining to quality measurements.”

The patient group’s filing with the CMS said, “We take no joy in being the first, but we feel that the circumstances surrounding the formulation of this program—the lack of stakeholder input, the failure to conduct cognitive testing, the departures from best practices for quality measure reporting as enumerated by CMS’ own experts, and expanding the use of the nationwide tournament format even as consensus acceptance of that practice has collapsed—merit our taking this unfortunate step.”

In the Dec. 16 statement, the DPC said the day after the CMS was served with the complaint, the agency “conceded it should have conducted cognitive testing of this system on consumers, reversing a position the agency had defended for nearly four months.”

The group provided a link to a brief memo that said researchers at the University of Chicago are working with the CMS to make improvements to the Dialysis Facility Compare website.

“We plan to conduct discussions with users or potential users of this website to inform changes and improvements CMS is making,” the memo said.

The DPC said it has a membership of more than 27,000 dialysis and pre-dialysis patients and their families.