Two years of input from the kidney care industry have reshaped the five-star rating system for dialysis care, reducing its initial controversial impact, acknowledging more four- and five-star facilities, and making it a useful tool for patients looking to evaluate the quality of care at clinics throughout the United States. However, authors of a recently published review noted that the rating system needs continuous monitoring to ensure consumers are getting updated, quality data.

“To be useful to patients and caregivers, star ratings must accurately reflect quality,” co-authors Alyssa Pozniak and Jeffrey Pearson from Arbor Research for Health wrote in their review, which was published in the Clinical Journal for the American Society of Nephrology. “Although star ratings conveniently summarize information from multiple measures, they share many limitations of these measures. Therefore, the CMS measure development process is critical to ensuring the quality of star ratings, including regular external review by the National Quality Forum to ensure that measures are important and evidence based, scientifically acceptable (ie, valid and reliable), usable, feasible and not duplicative.”

The star ratings, meant to broadly duplicate those used to judge the quality of restaurants and hotels, were created for dialysis care out of the Dialysis Facility Compare (DFC) website launched by CMS in 2001.

“At the time, clinics had to only report on three quality measures; today, the DFC website reports 18 quality measures spanning a variety of outcomes relevant to patients on dialysis, including transfusions, infections, dialysis adequacy, vascular access, hospitalizations, and most recently, patient experience with care, for more than 6,500 Medicare-certified dialysis facilities,” the study authors wrote.

CMS later added a summary star rating to the DFC to make it easier for patients to evaluate the data from the DFC. The DFC star rating is based on information from multiple quality measures and assigns a rating between one and five stars. Nine of the 18 quality measures from the DFC are used in the star rating system. Other Medicare-funded health care systems also have star rating systems, including nursing homes, hospitals and home health agencies, as well as physicians who treat Medicare patients.

The authors acknowledged that only a small percentage of patients on dialysis use quality information to evaluate clinics.

“[However], this is likely to change as the dissemination of health care quality information is increasing in both quantity and quality,” they noted. “The continued expansion of the CMS Medicare Compare websites and star ratings as well as other public reporting efforts reinforce the need for continued research and careful policy in this area that allows flexibility to accommodate the context of each provider, while also ensuring that the information is useful to patients.”

“Patients often see multiple types of health care providers, with “no one central source for quality information,” the authors wrote. “Star rating methodologies need to be consistent across different health care providers to help patients using them make informed decisions.”

After dialysis providers initially complained about how the star rating’s “bell-shaped curve” methodology placed many clinics into lower star ratings, CMS updated the DFC star rating system in October 2015 and in October 2016 with more recent data and a change in the rating system. – by Mark E. Neumann

Pozniak A, et al. Clin J Am Soc Neph, 2017;doi:10.2215/CJN.11231017.

Disclosures: The authors and Arbor Research for Health receive funding from CMS to support the Medicare Compare websites.