Dialysis Facility Compare Star Ratings and Data Release
January 2015
The Centers for Medicare & Medicaid Services (CMS) has finalized the methodology for its Dialysis Facility Compare (DFC) Star Rating program and is releasing previews of ratings to individual Medicare-participating dialysis facilities. Facilities will have 15 days to review their ratings. We expect to post ratings to Dialysis Facility Compare in January 2015. CMS presented the DFC Star Rating methodology earlier this year, and provided a 30-day preview period during which dialysis facilities had the opportunity to review their ratings. In response to stakeholder concerns, CMS delayed rollout of the Star Ratings on DFC from October 2014 until January 2015. This allowed CMS to receive comments, consider modification of the methodology, and respond to the dialysis community’s comments.
Upon careful consideration of comments provided to us from the community, including dialysis facilities, consumer advocates, patients, and interested professional societies, CMS has decided to continue with the Star Ratings methodology presented previously. The posted star ratings will use the same data previewed by facilities during the July 2014 preview period, and this data will be updated on an annual basis beginning in October 2015.
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 applying Star Ratings to Home Health Compare and Hospital Compare beginning 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 public reporting through 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 better understand how consumers use publicly reported quality measures data which will serve as a key driver of health care system improvement.
Overview of Dialysis Facility Compare Star Ratings Methodology
The DFC Star Ratings represent the quality of care provided by dialysis facilities and will make it easier for consumers to use the information on the Compare website and spotlight excellence in health care quality. CMS developed and applied a methodology to produce a summary star rating for dialysis facilities. Of the 11 publicly reported quality measures, 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, as these patients are systematically excluded from the vascular access measures in the Other Outcomes 1 domain.
Changes to DFC Measures for January 2015
In addition to introducing the Star Ratings CMS will stop publicly reporting two quality measures from 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 as a means of monitoring future trends in facility performance.
CMS will be adding the Standardized Readmission Ratio (SRR) to the outcome quality measures. 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
CMS is providing all Medicare-participating dialysis facilities a 15 day preview period to review their data and star rating before they are posted on Dialysis Facility Compare in January 2015. Facilities will have the opportunity to submit questions about their ratings if they believe their ratings are inaccurate. In addition to the star ratings, updated data on individual DFC measures will be posted simultaneously in January 2015 as part of the ongoing quarterly refresh schedule.
In the coming months, CMS will release a public call for nominations for participation in our annual DFC Star Rating Technical Expert Panel (TEP). The call for nominations will include detailed information about the composition of the panel and the process for nominating participants. The 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
CMS is seeking ongoing feedback on the DFC Star Rating System. Questions or comments about the quarterly Dialysis Facility Compare preview reports and the DFC Star Ratings can be submitted to the following email address: dialysisdata@umich.edu. Alternatively, questions may be directed to Elena Balovlenkov at Elena.Balovlenkov@cms.hhs.gov or Joel Andress at Joel.Andress@cms.hhs.gov. The deadline for comments during the preview period is November 24, 2014.
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