CMS de­lays dial­y­sis cen­ter rat­ings

Modern Healthcare - - NEWS - By Sabriya Rice

Un­der pres­sure from health­care in­dus­try groups, the CMS an­nounced it will de­lay un­til Jan­uary its launch of a five-star rat­ing sys­tem for kid­ney dial­y­sis providers in­tended to help Medi­care ben­e­fi­cia­ries com­pare qual­ity of care at cen­ters across the coun­try.

The rat­ing sys­tem, an­nounced in July, had been sched­uled to start next month, cov­er­ing more than 6,000 dial­y­sis cen­ters. That was met with angst by providers, who crit­i­cized the method­ol­ogy and said the pro­gram was likely to con­fuse pa­tients.

The CMS be­gan us­ing a five-star rat­ing sys­tem for nurs­ing homes in 2008, and ear­lier this year launched a sim­i­lar pro­gram for physi­cian groups. The agency has sig­naled vaguely in calls with providers that star rat­ings soon would be added for hos­pi­tals and home-care providers.

A CMS of­fi­cial said last week that the agency de­layed the rat­ing pro­gram for dial­y­sis fa­cil­i­ties to al­low ad­di­tional time for ed­u­cat­ing con­sumers, give dial­y­sis fa­cil­i­ties ex­tra time to re­view their rat­ings, and fine-tune the ver­i­fi­ca­tion and cor­rec­tion pro­cesses.

But Kid­ney Care Part­ners, a coali­tion of dial­y­sis providers, pa­tient ad­vo­cates and man­u­fac­tur­ers, said sim­ply de­lay­ing the pro­posed pro­gram isn’t enough. “No amount of pa­tient ed­u­ca­tion will fix what’s bro­ken in the Dial­y­sis Five-Star Pro­gram,” the coali­tion said in a writ­ten state­ment. “CMS should start over and de­velop a rat­ing sys­tem that is based on ac­cu­rate data and an ev­i­dence-based method­ol­ogy.”

Ac­cord­ing to the CMS, the method­ol­ogy re­lies on cur­rently re­ported qual­ity mea­sures, as­sign­ing stars based on how providers rank over­all. The mea­sures in­clude stan­dard­ized ra­tios for trans­fu­sions, mor­tal­ity and hos­pi­tal­iza­tions, and per­cent­ages for KtV val­ues, which show whether enough waste was re­moved from the pa­tient’s blood dur­ing dial­y­sis. There also are per­cent­ages for the num­ber of adult dial­y­sis pa­tients with high cal­cium lev­els. Some mea­sures will be weighted more heav­ily than oth­ers.

Fa­cil­i­ties scor­ing in the top decile will re­ceive five stars, mean­ing “much above av­er­age qual­ity.” Those in the next 20% will re­ceive four stars, mean­ing “above av­er­age qual­ity.” Those in the mid­dle 40% will get three stars, those in the next 20% will get two stars, and the bot­tom 10% will re­ceive one star, mean­ing “much be­low av­er­age qual­ity.”

Providers pre­viewed the method­ol­ogy and some ini­tial scores over the sum­mer and were not happy. They ar­gued that the end-stage re­nal dis­ease qual­ity in­cen­tive pro­gram and Medi­care’s survey process al­ready as­sess qual­ity, and that this ad­di­tional pro­gram would gen­er­ate con­flict­ing re­sults. The star-rat­ing method­ol­ogy could push a third of the good per­form­ers from the qual­ity in­cen­tive pro­gram into poor-per­form­ing cat­e­gories, a Kid­ney Care Part­ners spokesman said. “Pa­tients will have no idea what they are look­ing at.”

In an Aug. 15 let­ter to CMS Ad­min­is­tra­tor Mar­i­lyn Taven­ner, Glenn Hack­barth, chair­man of the Medi­care Pay­ment Ad­vi­sory Com­mis­sion, agreed that the star-rat­ing pro­gram con­flicts with other re­nal-care qual­ity-im­prove­ment pro­grams. “The dif­fer­ences in the meth­ods and mea­sures might re­sult in a fa­cil­ity scor­ing high un­der one pro­gram and low un­der the other pro­gram,” he wrote.

But the CMS told providers that the goal of the star rat­ing sys­tem is dif­fer­ent from the goal of the qual­ity in­cen­tive pro­gram, which is de­signed for Medi­care’s value-based pur­chas­ing pro­gram that of­fers per­for­mance­based fi­nan­cial in­cen­tives. In con­trast, the star-rat­ing pro­gram is de­signed to help pa­tients se­lect fa­cil­i­ties based on qual­ity, said Joel An­dress, the CMS lead for end-stage re­nal dis­ease mea­sure­ment de­vel­op­ment.

Some ex­perts have ques­tioned the ac­cu­racy and va­lid­ity of cur­rent health­care rat­ings mod­els. The New York Times re­cently re­ported that some nurs­ing homes with high star rat­ings from the CMS also had poor cus­tomer reviews or had been pe­nal­ized by state health of­fi­cials for sub­stan­dard care.

Still, some ar­gue that the gov­ern­ment should not slow the roll­out. De­vel­op­ing mea­sures for the di­men­sions of care that mat­ter to con­sumers is a com­pli­cated process that re­quires test­ing, val­i­da­tion and en­dorse­ment, said Tara Oak­man, a Robert Wood John­son Foun­da­tion pro­gram of­fi­cer with an ex­per­tise in per­for­mance man­age­ment. “There is the op­por­tu­nity for im­prove­ment and change over time,” she said.

“Provider wor­ries about the per­fec­tion of CMS’ plan should not im­pede progress to­ward full trans­parency,” said Leah Bin­der, CEO of the Leapfrog Group, which rep­re­sents large em­ploy­ers on qual­ity is­sues.

But Nancy Foster, vice pres­i­dent for qual­ity and pa­tient-safety pol­icy at the Amer­i­can Hos­pi­tal As­so­ci­a­tion, said in­com­plete or un­re­li­able in­for­ma­tion might be mis­guid­ing to pa­tients. The star-sys­tem method­ol­ogy “doesn’t have to be per­fect, but it has to be rea­son­ably re­li­able,” she said.

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