Dialysis Patient Citizens, American Kidney Fund respond to launch of Dialysis Facility Compare star rating system

Updated Jan. 26 to include American Kidney Fund response.

Dialysis Patient Citizens said they are unhappy with the new CMS star rating system for dialysis clinics, and disappointed that the agency did not follow through on its promise to include language that better explains a one-star rating. CMS launched the Dialysis Facility Compare star rating system Jan. 22.

"We are extremely disappointed that CMS appears to have reneged on an important promise it made last October, to inform Dialysis Facility Compare visitors that 'a one-star rating does not mean you will receive poor care from a facility,'" Dialysis Patient Citizens said in a news release. "We cannot find this essential language anywhere on its website. It is critical that patients understand that all dialysis facilities provide life-sustaining treatment, and that they should not be alarmed or discouraged if higher-rated facilities are not available in their area."

The American Kidney Fund has also denounced the rating system. "The system provides a rating of one to five stars to a dialysis facility based on nine quality measures," the organization said in a Jan. 26 news release. "The system unfairly categorizes many facilities as low-performers, in large part because the system ranks all dialysis facilities on a bell curve, a methodology forcing some facilities into the lowest 1- or 2- star ratings even when these facilities may, in reality, provide excellent care." AKF said they will closely monitor patient responses to the five-star rating system, and will work with other organizations in the renal community to continue communicating concerns and recommendations for improvement to CMS.

In a news release announcing the launch of the rating system, CMS Administrator Marilyn Tavenner said, “Star ratings are simple to understand and are an excellent resource for patients, their families, and caregivers to use when talking to doctors about health care choices."

But Dialysis Patient Citizens said they do not agree that the system is easy to understand. "Today for the first time consumers are able to examine the new star ratings on Dialysis Facility Compare, which after initial review only reinforces Dialysis Patient Citizens’ concern over the effectiveness of this program in its current form. For example, a dialysis patient who searches for facilities in Charleston, W.V. will find that there are only one-star facilities within 50 miles, a situation that appears to have more to do with the fact that West Virginia ranks 49th among states in life expectancy than with the quality of care delivered in its dialysis clinics. In fact, to access the nearest five-star facility, this dialysis patient would have to travel out-of-state more than 74 miles three times a week to receive treatment. As a result, we do not believe that CMS’ current star rating methodology will empower consumers to act on quality information in a realistic manner."

Dialysis Patient Citizens said they urged CMS to assign star ratings using regional comparisons, rather than nationwide comparisons, so the ratings would reflect actual clinical quality and not a region’s underlying population health or other socio-demographic factors. The patient group also asked the agencny "to limit the assignment of one- and two-star ratings to facilities that should be avoided, so that Dialysis Facility Compare would leverage consumers’ prior experience with star rating systems for movies, hotels and other products and services. Unfortunately, CMS disregarded our requests, which in December led us to file a Request for Correction under the Data Quality Act seeking these modifications to Dialysis Facility Compare. CMS has not ruled on that petition."

Find all of NephrologyNews.com's coverage of the 5-star rating system for dialysis facilites