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.
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.”