Published by Inside Health Policy
John Wilkerson
November 11, 2014

Dialysis facilities and patients criticized CMS on Monday (Nov. 10) for sticking to a dialysis star-rating program that they say confuses patients, makes good facilities appear to be poor performers and disadvantages facilities in poor neighborhoods.

Industry and patient groups started criticizing the star-rating plan when it was described in a CMS blog in July. They dislike that the program is graded on a curve, which forces 30 percent of facilities into one and two-star ratings irrespective of their performance, and say its metrics are poorly designed and out-of-sync with the end-stage renal disease Quality Incentive Program that has been in place for more than a decade. They also complain that CMS created the program without going through public rulemaking, and even the Medicare Payment Advisory Commission criticized CMS for abruptly creating the program without input from dialysis facilities, patients and others.

CMS delayed the program shortly before it was supposed to take effect in October. The agency said it needed time to explain the program to the public and stressed that the delay did not indicate it was changing the program. CMS expects to post ratings on Dialysis Facility Compare in January.

Kidney Care Partners, which represents industry and patients, the Dialysis Patient Citizens, which represents patients, and the Kidney Care Council, which represents industry, all issued strongly worded statements in opposition to CMS’ latest announcement.

“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,” the industry and patient coalition stated.

Likewise, the Dialysis Patient Citizens complained that CMS is moving ahead with a performance-scoring methodology, even though agency officials acknowledge that many patients will misconstrue one- and two-star ratings as poor. Executive Director Hrant Jamgochian said star ratings are supposed to be easy for patients to understand, but the system that CMS developed is so confusing that his group is developing resources that explain the ratings to patients.

“We are particularly disheartened that CMS is introducing yet another quality measurement that forces providers in disadvantaged and less healthy regions into a nationwide competition, only a week after seeming to open the door to a more rational ranking system in the ESRD Final Rule,” the patient group states, referring to end-stage renal disease.
The Kidney Care Council Executive Director Cherilyn Cepriano said industry suggested fixes to the “fundamental flaws” of the program

“CMS listened, but has chosen to ignore every concern of the kidney community,” Cepriano said.

See the original article here.