In January, the Centers for Medicare and Medicaid Services (CMS) will be rolling out its second major 5-star rating system, Dialysis Facility Compare.

The site will tabulate publicly reported quality measures including transfusion rates, mortality and hospitalizations, blood calcium levels and Kt/V values to create a ranking system for dialysis providers. Some suspected it might be delayed, but CMS recently announced they will be moving forward with the January 1 publication.

The industry has been dissatisfied with the rating system – much like nursing homes were with theirs when it was launched – but it appears to be here to stay. Here’s what you need to know about the rankings and how they can be managed.

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Problematic equations

Edward Jones, MD, chairman of Kidney Care Partners, said the idea of rating providers isn’t inherently a bad idea, but there are a few critical faults with CMS’ system. The major one is its bell curve, which requires at least 30% of facilities fall in the 1-star and 2-star categories even if there are only minor differences separating them with higher-ranking peers.

Other ratings systems, like the ESRD Quality Incentive Program (QIP), allow any number of facilities that meet performance standards to rank highly. For instance, more than 70% of facilities have typically succeeded in meeting or exceeding set benchmarks.

Jones said there is a better way to measure and rate these facilities because the data are not reliable, and some measures are not actionable by facilities. Jones said his practice has a mortality rate that approaches zero and their accuracy measurements on dialysis range from 80% to 90%. Still, his group, Delaware Valley Nephrology and Hypertension in Philadelphia (that he describes as a Cadillac of dialysis units) has only 3 stars on the rating system.

“There is no reason you can’t have 50% to 60% get 5 stars when they earn it,” Jones said. “You are forcing output into a bell-shaped curve … and it sends a mixed message to patients and that is our concern.”