CMS Dialysis Center Ratings Panned by Patient Groups

Ratings of dialysis centers are based on population health statistics that are often beyond the facilities' control and don't reflect quality measures important to patients, says an executive at the National Kidney Foundation.

The Centers for Medicare and Medicaid Services' new five-star rating system for kidney dialysis centers is getting one-star reviews from patient advocacy groups.

CMS rolled out the star rating for Dialysis Facility Compare website last week, grading more than 5,500 dialysis centers across the nation.

"Star ratings are simple to understand and are an excellent resource for patients, their families, and caregivers to use when talking to doctors about healthcare choices," outgoing CMS Administrator Marilyn Tavenner said in prepared remarks. "CMS has taken another step in its continuous commitment to improve quality measures and transparency."

The rankings are akin to CMS's Nursing Home Compare and Physician Compare websites, although the methodologies are dissimilar. DFC ranks centers on a bell curve based upon nine quality measures that include mortality, hospitalization, and transfusion ratios.

16 Medicare Advantage Plans Earn 5-Star Ratings

Those measures are creating frictions with advocates for kidney patients, who say CMS ignored their suggestions for creating a more accurate rating of the quality of care delivered by dialysis centers. Instead, the advocates say the DFC ratings from CMS will become a confusing and inaccurate resource for dialysis patients.

"It's great that CMS specifically is looking to make quality a little bit easier for patients to understand, but the way the program is laid out has oversimplified the situation," says Tonya Saffer, senior federal health policy director, government relations, at the National Kidney Foundation.

"This is going to be misleading to patients who are looking for a quick way to see how their facility is doing or how the facility they're considering going to might be doing. There is a lot of misleading information in these rankings."

Population Health Benchmarks
For starters, Saffer says, the dialysis centers are judged on population health statistics that are often beyond their control, such as population mortality and hospitalization rates.

"A lot of these star ratings can reflect things such as population health, and that is a big concern of ours," she says. "It is not necessarily that the dialysis facility itself is doing a poor job, but that there aren't enough community healthcare resources, or general population health in those areas is likely poor."

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Saffer also says the CMS ranks don't reflect quality measures that are important to dialysis patients, such as the cleanliness or physical condition of the facility, the attentiveness of the staff, and overall patient satisfaction.

And kidney patient advocates are concerned that the ratings rely on a bell curve, which they believe will unfairly penalize some dialysis centers and unfairly reward others.

"You have a set number of facilities and there is no set standard of care that they are being measured against," Saffer says.

The DFC star rating for more than 5,500 centers break down like this:

• 1-star — 545
• 2-star — 1,105
• 3-star — 3,399
• 4-star — 1,126
• 5-star — 565

"We know that by looking at the country, population health in different areas of the country is lower or higher. So, I don't think these rating provide a snapshot that can provide patients with an ability to make a decision off of a star rating. My fear is they will look at these and they will make decision."

The National Kidney Foundation's concerns were echoed by other kidney health advocacy groups, including Kidney Care Partners, and Dialysis Patient Citizens. Both groups complained after the DFC rollout last week, criticizing CMS for ignoring issued they'd raised about the ranking methodologies.

"We wanted the system to be reliable and meaningful to patients and to reflect the quality of care being delivered," KCP Board Chairman Edward M. Jones, MD, a nephrologist, said in prepared remarks. "The program as developed and now launched by CMS simply does not accomplish that goal."

Scores Favor Healthy States
DPC noted on its website that "a nationwide competition among all facilities that gives considerable weight to health outcomes (such as hospitalizations and mortality) [and] disfavors facilities in places where, in general, patients are less healthy. Dialysis Facility Compare star ratings are most favorable to clinics in healthy states, such as Hawaii and Colorado, but unfavorable to clinics in places like West Virginia. This discourages investment in clinics in places that need them the most."

Not everyone dislikes the rankings.

DiVita Kidney Care, the national for-profit chain of dialysis centers, issued a press release bragging about its high scores from CMS. "For 15 years clinical quality has always been the first order of business at DaVita," DaVita HealthCare Partners Co-Chairman/CEO Kent Thiry said. "It's gratifying to see those efforts positively reflected in the two government reports showing our national leadership in dialysis patient outcomes."