Before a controversial five-star rating system for dialysis facilities was released earlier this year, kidney-care groups across the nation seemed unified in their opposition to the system.
The coalition—which included representatives from the two largest providers, DaVita and Fresenius—wrote angry letters to the federal government. They complained about use of a forced bell curve. They said the quality benchmarks were not transparent and that the stars would ultimately be meaningless to consumers.
But what a difference a day—or rather, the data—makes. In a similar vein to the infamous “flip-flop" comment made in 2004 by then-presidential candidate John Kerry, perhaps some providers were against it … before they were for it.
When the CMS unveiled the five-star program in January, a Modern Healthcare analysis revealed that DaVita operated nearly six out of every 10 of the nation's highest-rated facilities, while competitor Fresenius operated nearly half of the lowest-scoring ones. Combined, the two providers represent about 60% of the more than 5,500 facilities that were rated.
Despite the initial brouhaha about the metrics, immediately after the ratings were released, DaVita issued a news release touting it's No. 1 ranking in clinical outcomes on government reports, including the five-star program. Though, to be fair, they did note—at the very bottom—concerns about “significant flaws” with the reports.
There's no mention of those flaws, however, in posts about outperforming the industry average by 138% in promotional materials, or in recent tweets from DaVita Healthcare Partners CEO Kent Thiry.
“@DaVita Kidney Care is an undisputed clinical leader in CMS Five Star ratings,” he wrote in one tweet. “DaVita is recognized by CMS' Five-Star Rating System and Quality Incentive Program for providing the best quality care for kidney patients,” he said in another.
At the time of this post, DaVita officials had not responded to e-mails or tweets asking if they had a change of heart on “What's wrong with the five-star rating system for the renal community.” They also didn't respond to questions about whether changes to the methodology could negatively impact the provider's high performance.
Fresenius expressed disappointment at seeing tweets that suggest support over the ratings. “It flies in the face of what the rest of the industry is saying,” said Robert Sepucha, senior vice president of corporate affairs.
In a post for consumers, DaVita says it will continue to work with the CMS to improve the measures. But, in the meantime, it seems any lingering concerns about methods aren't enough to stop campaigning on a rating system DaVita and others originally thought would be more likely to confuse than inform patients.
With or without the propaganda attempts, though, it remains unclear whether or not the more than 400,000 dialysis patients in the U.S. are indeed using ratings to make decisions about choosing a provider.
In an e-mail to Modern Healthcare, the CMS noted that through April 2015, it had logged only 16,000 visits per month to its Dialysis Facility Compare website. "In part due to the opacity of the information provided for patients, as well as an interface that could be more user friendly," the CMS spokesperson said.