Dialysis Facility Compare (DFC) star ratings and data release
November 7, 2014 (Updated, January 22, 2015)
On January 22, 2015, the Centers for Medicare & Medicaid Services (CMS) added star ratings to the Dialysis Facility Compare (DFC) website. For more information, please visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-01-22.html.
Overview
Star ratings can help consumers quickly identify differences in quality and make use of the reporting information when selecting a facility. In addition to summarizing performance, star ratings can help dialysis facilities identify areas for improvement. They are useful to consumers, consumer advocates, health care providers, and other stakeholders, when updated regularly to present the most current information available.
Background
CMS is adding star ratings to its Compare websites with the goal of improving the salience and usability of comparative quality information for consumers. The Star Rating System is intended to enhance and supplement existing publicly reported quality information, which will continue to be available. Currently, there are star ratings on Nursing Home Compare and Physician Compare. CMS also anticipates adding star ratings to Home Health Compare and Hospital Compare in 2015.
Reasons for the DFC Star Rating Initiative:
- To help consumers of dialysis services make more informed health decisions.
- To release more transparent, easily understandable and widely available data consistent with the authorization to pursue more public reporting of quality data under the Affordable Care Act.
- To respond to the call to continue to use and expand existing methods for providing quality measure performance information.
- To provide more patient and consumer-centric content, as described in the Administration’s Digital Government Strategy.
- To assist consumers in using publicly reported quality measures data which will serve as a key driver of health care system improvement through patient engagement with facility quality.
Overview of Dialysis Facility Compare Star Ratings Methodology
The DFC Star Ratings represent a summary of the quality of care provided by dialysis facilities on selected measures and will make it easier for consumers to use the information on the Compare website and to spotlight excellence in health care quality. CMS developed a methodology to produce a summary star rating for dialysis facilities. Of the 11 quality measures that were publicly reported in 2014, the DFC Star Rating is based on the following nine:
- Standardized Mortality Ratio (SMR) (NQF #0369)
- Standardized Hospitalization Ratio (SHR) (NQF #1463)
- Standardized Transfusion Ratio (STrR)
- Percentage of adult hemodialysis (HD) patients who had enough wastes removed from their blood during dialysis (NQF #0249)
- Percentage of pediatric hemodialysis (HD) patients who had enough wastes removed from their blood during dialysis (NQF #1423)
- Percentage of adult peritoneal dialysis (PD) patients who had enough wastes removed from their blood during dialysis (NQF #0318)
- Percentage of adult dialysis patients who had hypercalcemia (NQF #1454)
- Percentage of adult dialysis patients who received treatment through arteriovenous fistula (NQF #0257)
- Percentage of adult patients who had a catheter left in vein longer than 90 days for their regular hemodialysis treatment (NQF #0256)
To account for possible correlations among different measures that could exert undue influence of any one individual measure, an analytic method was applied that grouped the measures into three domains:
- “Standardized Outcomes (SHR, SMR, STrR)” which includes measures for transfusions, mortality and hospitalization
- “Other Outcomes 1 (AV fistula, tunneled catheter)” which includes the arteriovenous fistula and catheter > 90 days measures
- “Other Outcomes 2 (Kt/V, hypercalcemia)” which includes a combined dialysis adequacy (Kt/V) measure, and hypercalcemia measure.
In order to receive a Star Rating, CMS must have collected data from a facility for at least one measure in each domain. Pediatric facilities are not currently rated due to lack of sufficient data for one or more measures. Peritoneal dialysis-only facilities are rated using the weighted average of the Standardized Outcomes domain and the Other Outcomes 2 domain because peritoneal dialysis patients do not use vascular access, and these measures do not apply to them.
Changes to DFC Measures in January 2015
Unrelated to the star ratings, CMS will stop publicly reporting two quality measures on the DFC website: the URR dialysis adequacy measure and the Hemoglobin greater than 12 g/dL. More than 99% of all patients achieve the thresholds set for these measures, so they do not provide meaningful information for consumers who wish to compare quality at different facilities. CMS will continue to provide data on the hemoglobin measure through our downloadable databases on data.medicare.gov.
CMS will be adding the Standardized Readmission Ratio (SRR) to the outcome quality measures reported on the DFC website. The SRR is a measure of care coordination, a domain of care critical to dialysis patients, who average almost two hospitalizations per year. The SRR will not be included in the Star Rating methodology at this time.
Next Steps
The Technical Expert Panel (TEP) will be charged with evaluating the star rating scoring methodology, considering the current star rating measures, and suggesting potential future measures for the star ratings. The TEP will then make recommendations to CMS for future modifications or iterations of the star ratings system as necessary.
Feedback Opportunities
Questions or comments about the DFC Star Ratings can be submitted to the following email address: dialysisdata@umich.edu, or questions may be directed to Elena Balovlenkov at Elena.Balovlenkov@cms.hhs.gov and Joel Andress at Joel.Andress@cms.hhs.gov.
For more information on Dialysis Facility Compare, please visit: http://www.medicare.gov/dialysisfacilitycompare/#search.
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