The Centers for Medicare & Medicaid Services has released a document that provides responses to the questions and issues about the Dialysis Facility Compare Star Rating System raised by the ESRD community.

"CMS believes that the Star Rating System will empower consumers with additional quality information," the agency said in the document.

Following are the concerns CMS addressed in the document, and excerpts from some of the agency's responses:

1.     The Kidney Community was not consulted properly before designing the ESRD star rating system

2.     Methodological concerns about the bell curve and the use of percentiles

3.     The DFC Star Ratings do not align with other programs

"While QIP and DFC Star Ratings both provide information about quality performance, these programs have clearly distinctive objectives," CMS said in the document. "The QIP, a value based purchasing program mandated by the 2008 Medicare Improvements for Patients and Providers Act (MIPPA), incentivizes achievement and improvement by linking quality scores to payment. On the other hand, the DFC Star Rating System provides summary performance information for patients and other consumers to allow comparison of dialysis facilities based on current national-level performance data. "

4.     The quality measures were not properly vetted

5.     The patient perception of star ratings

"Our results have confirmed that providers differ in the quality of care they give," CMS said in the document. "Quality ratings can help consumers make more informed health care decisions and may actually reduce patients’ anxiety when comparing and selecting facilities."

6.     Patient confusion between Star Ratings and QIP

"We developed four separate technical guidance documents of varying levels of complexity, from a broad basic overview to more detailed technical guides for consumers wanting more information on the measures. CMS believes in serving the needs of patients with varying levels of knowledge and experience."

7.     National comparisons being used rather than stratification by state/region/comparable facilities

"National comparisons of performance are consistent with facility performance measures implemented in many quality programs at CMS for other settings. Several measures used in the construction of the final facility score have been risk adjusted, which have accounted for the differences in the underlying health of populations served by particular facilities."