Tonya Saffer, MPH, Senior Health Policy Director
On January 1, 2016 the Centers for Medicare & Medicaid Services (CMS) revamped the dialysis facility compare (DFC) website to assign star ratings to dialysis facilities based on their comparative performance on a set of CMS mandated quality measures. CMS held a teleconference earlier this week to roll out updates to the star ratings, which were posted today. The DFC website was intended to help patients and caregivers make decisions about where they can receive the best care. Last September, the National Kidney Foundation (NKF) expressed disappointment with the program because it did not evaluate facilities on the quality of care they delivered according to issues important to patients, such as attentiveness of the dialysis facility staff. It also graded facilities on a curve (think high school test scores comparing you to your peers rather than your own performance).
Hearing concern from the patient community about the lack of usefulness of the star ratings in helping to make informed decisions about where they can receive the best care, CMS convened a technical expert panel (TEP) made up of highly educated statisticians, chief medical officers of large dialysis organizations, and a separate panel of patients and patient organizations. I served on the patient panel on behalf of NKF. As reflected in the CMS TEP report, the patient panel wanted to see changes made to the dialysis five star rating. Specifically, patients and patient organizations wanted additional quality measures that reflected areas patients valued most. They also wanted the ability to customize the website to filter for items that mattered to them, and a new methodology that more fairly evaluated dialysis facilities included in the star ratings program. It did not matter to the patients on the panel if all facilities received 3 stars or higher. More important is that the facilities received those stars based on how well they delivered care. Currently, the star rating methodology forces 10% of facilities to receive 1 star or 5 stars, and 20% of facilities to receive 2 stars or 4 stars, when the margin of performance between the 2 star and 4 stars may not differ much from those given 3 stars.
NKF sees much promise in helping patients and family caregivers make informed decisions through a star rating system. However, that system should evaluate each dialysis facility based on their individual performance on the factors most important to patients. This program has not achieved that to date. NKF will continue to partner with CMS and encourage the agency to change its methodology and quality measures in the future. NKF does appreciate CMS’s willingness to explore improvements. For now, those of you wondering how to choose the best dialysis facility, I leave you with these helpful resources and tips.
If you choose to visit the dialysis facility compare website let us know what you think by commenting here. Do you agree with NKF and the patient TEPs recommendations? What ideas do you have to improve this site?