CMS delays dialysis center ratings

Under pressure from healthcare industry groups, the CMS announced it will delay until January its launch of a five-star rating system for kidney dialysis providers intended to help Medicare beneficiaries compare quality of care at centers across the country.

The rating system, announced in July, had been scheduled to start next month, covering more than 6,000 dialysis centers. That was met with angst by providers, who criticized the methodology and said the program was likely to confuse patients.

The CMS began using a five-star rating system for nursing homes in 2008, and earlier this year launched a similar program for physician groups. The agency has signaled vaguely in calls with providers that star ratings soon would be added for hospitals and home-care providers.

A CMS official said last week that the agency delayed the rating program for dialysis facilities to allow additional time for educating consumers, give dialysis facilities extra time to review their ratings, and fine-tune the verification and correction processes.

But Kidney Care Partners, a coalition of dialysis providers, patient advocates and manufacturers, said simply delaying the proposed program isn't enough. “No amount of patient education will fix what's broken in the Dialysis Five-Star Program,” the coalition said in a written statement. “CMS should start over and develop a rating system that is based on accurate data and an evidence-based methodology.”

According to the CMS, the methodology relies on currently reported quality measures, assigning stars based on how providers rank overall. The measures include standardized ratios for transfusions, mortality and hospitalizations, and percentages for KtV values, which show whether enough waste was removed from the patient's blood during dialysis. There also are percentages for the number of adult dialysis patients with high calcium levels. Some measures will be weighted more heavily than others.

Facilities scoring in the top decile will receive five stars, meaning “much above average quality.” Those in the next 20% will receive four stars, meaning “above average quality.” Those in the middle 40% will get three stars, those in the next 20% will get two stars, and the bottom 10% will receive one star, meaning “much below average quality.”

Providers previewed the methodology and some initial scores over the summer and were not happy. They argued that the end-stage renal disease quality incentive program and Medicare's survey process already assess quality, and that this additional program would generate conflicting results. The star-rating methodology could push a third of the good performers from the quality incentive program into poor-performing categories, a Kidney Care Partners spokesman said. “Patients will have no idea what they are looking at.”

In an Aug. 15 letter to CMS Administrator Marilyn Tavenner, Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission, agreed that the star-rating program conflicts with other renal-care quality-improvement programs. “The differences in the methods and measures might result in a facility scoring high under one program and low under the other program,” he wrote.

But the CMS told providers that the goal of the star rating system is different from the goal of the quality incentive program, which is designed for Medicare's value-based purchasing program that offers performance-based financial incentives. In contrast, the star-rating program is designed to help patients select facilities based on quality, said Joel Andress, the CMS lead for end-stage renal disease measurement development.

Some experts have questioned the accuracy and validity of current healthcare ratings models. The New York Times recently reported that some nursing homes with high star ratings from the CMS also had poor customer reviews or had been penalized by state health officials for substandard care.

Still, some argue that the government should not slow the rollout. Developing measures for the dimensions of care that matter to consumers is a complicated process that requires testing, validation and endorsement, said Tara Oakman, a Robert Wood Johnson Foundation program officer with an expertise in performance management. “There is the opportunity for improvement and change over time,” she said.

“Provider worries about the perfection of CMS' plan should not impede progress toward full transparency,” said Leah Binder, CEO of the Leapfrog Group, which represents large employers on quality issues.

But Nancy Foster, vice president for quality and patient-safety policy at the American Hospital Association, said incomplete or unreliable information might be misguiding to patients. The star-system methodology “doesn't have to be perfect, but it has to be reasonably reliable,” she said.

Follow Sabriya Rice on Twitter: @sabriyarice