The Centers for Medicare & Medicaid Services announced Nov. 7 that it has finalized the methodology for its Dialysis Facility Compare Star Rating program and is releasing previews of ratings to individual Medicare-participating dialysis facilities. Dialysis facilities will have 15 days to review their ratings. CMS said it expects to post ratings to Dialysis Facility Compare in January 2015.

The agency said it has decided to continue with the Star Ratings methodology presented previously, despite protest from the renal community. 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, CMS said.

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)

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.

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 Dialysis Facility Compare Measures for January 2015
In addition to introducing the Star Ratings CMS will stop publicly reporting two quality measures from the Dialysis Facility Compare website, the URR dialysis adequacy measure and the Hemoglobin greater than 12 g/dL. CMS said that 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 as a means of monitoring future trends in facility performance.

CMS said it 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.