The Centers for Medicare & Medicaid Service’s announcement that it would delay the implementation of its five-star rating system for dialysis facilities until January has drawn criticism from renal groups that had hoped CMS would work to re-design the rating system and accept more input from the community.

CMS announced Sept. 10 that it would delay the implementation of the rating system to “allow more time for consumer education about appropriate use of the ratings for making decisions about treatment,” the agency said in a memo.

“Contrary to CMS’ announcement, a delay alone is not responsive to the concerns expressed by stakeholders and certainly not to those expressed by DPC,” Dialysis Patient Citizens said in a statement.  “While CMS said it was ‘partnering with the ESRD community,’ it has instead declined to consider input on how to design patient-friendly ratings, and ignored DPC’s requests to see consumer testing materials and the geographic distribution of star assignments,”

In a letter to CMS sent last month, the dialysis patient advocacy group had expressed concern about the bell curve scoring methodology and its alignment with the ESRD Quality Incentive program. “We believe this is the first time that patients have faced the same payer issuing more than one rating to the same health care provider,” the DPC letter said.

Kidney Care Council, which represents 12 dialysis providers in the United States, also expressed criticism of CMS’ delay. “The dialysis Five Star program, as proposed, includes inappropriate measures based on inaccurate data compiled using a flawed methodology,” said Cherilyn Cepriano, KCC Executive Director. “Had CMS worked with patients, physicians and providers in the kidney community, these flaws could have been addressed. But today’s announcement makes clear that CMS has no willingness to do so. Delaying publication of incorrect ratings from October to January, without ensuring they are meaningful and accurate, will not make them any less incorrect or any less confusing for patients.”

The announcement of the delay also drew a harsh response from Kidney Care Partners, which represents dialysis providers, manufacturers and supplies, pharmaceutical companies, and patient groups. “There is no indication that CMS plans to correct flaws in the program, despite the serious concerns raised collectively and individually by patient advocates, physician and nursing organizations, dialysis providers, as well as policy makers, including the Medicare Payment Advisory Commission (MedPAC),” said KCP chairman Edward Jones. “Kidney Care Partners believes that no amount of patient education will fix what’s broken in the Dialysis Five-Star Program and by changing the implementation date, CMS has done little more than kick the can down the road. Instead of simply changing the implementation date, CMS should start over and develop a rating system that is based on accurate data and an evidence-based methodology…This Five-Star program simply should not move forward given its numerous flaws.”