About the CMS Dialysis Facility Compare Star Rating program methodology

For the Dialysis Facility Compare Star Rating program, the Centers for Medicare & Medicaid Services applies a methodology based on nine publicly reported quality measures to produce a summary star rating for dialysis facilities. The system assigns one to five stars to dialysis facilities by comparing the quality measure outcomes to other dialysis facilities across the country.

CMS said it adopted the Dialysis Facility Compare Star Rating program to help dialysis patients make more informed decisions about where to get health care.

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“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,” said CMS Administrator Marilyn Tavenner in a press release. “CMS has taken another step in its continuous commitment to improve quality measures and transparency.”

How the Dialysis Facility Compare Star Rating program methodology works

Overview of Dialysis Facility Compare star ratings methodology

CMS developed and applied a methodology to produce a summary star rating for dialysis facilities. The Dialysis Facility Compare Star Rating is based on the following nine publicly reported quality measures:

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)

CMS has added the following three new measures to the Dialysis Facility Compare rating system, which will become effective in October 2016:

Bloodstream Infection in Hemodialysis Outpatients (NQF #1460)

CAHPS (Consumer Assessment of Healthcare Providers) In-Center Hemodialysis Survey (NQF #0258)

Pediatric Peritoneal Dialysis Adequacy: Achievement of Target Kt/V (NQF #2706)

To account for possible correlations among different measures that could exert undue influence of any one individual measure, CMS said it applied an analytic method 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.

-by Rebecca Zumoff