Consumers can now evaluate the quality of care at more than 5,500 dialysis facilities online with a five-star rating system the CMS rolled out Thursday.
The program is part of a broader federal initiative to boost transparency and help Medicare beneficiaries compare quality in various healthcare settings. But kidney-care providers remain concerned that the current structure of the program will create more confusion than clarity for consumers and called the results “distorted.”
Of the 5,580 dialysis facilities to receive a star rating, 565 were “much above average quality” and received the full five stars, while 545 were “much below average quality” and received one star. This is consistent with the methodology outlined by the CMS, which noted only facilities in the top decile would receive the full set of stars, while the bottom 10% would receive one. Those in the next 20% received four stars; those in the middle 40% got three stars and those in the next 20% will get two stars.
The CMS generated the ratings based on a methodology that included nine publicly reported quality measures—such as 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. The ratings also reflect percentages of adult dialysis patients with high calcium levels.
Kidney-care providers who reviewed the original methodology last fall immediately criticized the program and asked the CMS to delay the rollout, which was originally schedule for October. The CMS announced in November that it would move forward, and the results were posted Thursday on the CMS' Dialysis Facility Compare website.
In response, Kidney Care Partners and Dialysis Patient Citizens issued statements of disappointment and reiterated their original concerns.
“The calculation of the scores is based on a forced bell curve, which distorts the actual facility performance,” said the statement from Kidney Care Partners , a coalition of patient advocates, dialysis professionals, care providers and manufacturers. “The results mislead patients and misrepresent the quality of care provided,” they said.
Likewise Dialysis Patient Citizens, a not-for-profit, patient-led organization, noted that a dialysis patient in Charleston, W.Va., for example, would only find one-star facilities within 50 miles. The nearest five-star facility is more than 74 miles away and in a completely different state. But that situation may have more to do with that state ranking 49th in life expectancy than with quality of care. The rating system will not “empower consumers to act on quality information in a realistic manner,” the group said.
Despite the criticisms, the CMS said it will update the dialysis facility star ratings on an annual basis, beginning in October. The agency also plans to add standardized readmission-ratio measures to the site.
Follow Sabriya Rice on Twitter: @Sabriyarice