The Centers for Medicare and Medicaid Services (CMS) recently updated the star ratings for dialysis centers, which were somewhat controversial when released in January 2015. Detractors did not like the points of measurement or bell curve upon which centers are rated, but they can come in handy for physicians and dialysis providers alike. Experts offer tips on how to manage and use the ratings.

Dialysis centers 

Robert Provenzano, MD, vice president of medical affairs at DaVita HealthCare Partners Inc., said his organization initially had some misgivings about the processes of developing the ratings, but has since learned to embrace them. At the highest level, the ratings can be used to categorize facilities. They can also indicate which facilities may need more resources.

“I don’t accept that the ratings do not reflect quality,” Dr. Provenzano said. “If 2 people are taking a test and one gets an A with a 91% and the other a B% with an 89%, they are equally bright. But if one gets 91% and the other a 20%, there is a meaningful difference.”

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Public metrics may not be perfect, but they are definable and measurable, so doctors and dialysis centers have to take ownership of them, he said. If ratings are low, it is imperative that facilities know this and are able to account for what they are doing to improve.

At the very least, dialysis centers should have information on their website about the rating system and what it means, said Kim Fox, vice president of the healthcare marketing firm Jarrard Phillips Cate & Hancock, Inc., of Brentwood, Tenn. It is important to convey to patients that ratings are just a single aspect of quality.

Fox said she also recommends going beyond the website to create a handout for referring specialists. The handout can discuss why an organization’s ratings are good, and, if they are not, what corrective action is being taken to change them. A center with low ratings can underscore aspects that are not measured but are being done well. For instance, ratings do not take into account patient satisfaction, staff friendliness, and facility cleanliness.

“Patients look at quality much differently than doctors do,” Fox said. “A patient thinks quality is when they [staff] are really nice to me there, take really good care of me, are friendly, clean, and they know my name,” she said.


Referring physicians should understand and use the ratings mainly because the industry is moving rapidly toward integrated kidney care, Dr. Provenzano said. “If you are going to enter into a risk contract, do you think you want to do it with a 1- or 2-star facility?” he said. “Every single provider needs to wise up and look at it from a patient’s perspective.”

Physicians can choose to work only with high-rated facilities or continue to work with 2- or 3-star facilities if they understand what is unique in those facilities resulting in lower ratings and the relationship to actual quality, Dr. Provenzano said. He recommends using these ratings as a way for nephrologists to open a dialogue and get to know your dialysis providers, and drive improved quality.

If ratings are low, physicians should call the medical director to find out why. They will usually be honest, and let you know, for example, that they are short-staffed or have high turnover that is causing problems, Dr. Provenzano said. The facility administrator also can give a good sense of what is happening. The important factor is that all the care providers and support teams transparently communicate to drive higher quality. It is, and will always be, a moving target.