Medicare Dialysis Facility Compare Star Ratings Set
to Debut in January
There are Star Ratings on Nursing Home Compare and
Physician Compare; CMS plans applying Star Ratings to Home Health
Compare and Hospital Compare in 2015
10, 2014 - The latest addition to the “Medicare compare” websites – the
Dialysis Facility Compare (DCF) Star Rating program - is expected to go
live in January 2015. The Centers for Medicare & Medicaid Services (CMS)
has finalized the methodology for the program and is releasing previews
of ratings to individual Medicare-participating dialysis facilities for
Facilities will have 15 days to review their
CMS presented the DFC Star Rating methodology
earlier this year, and provided a 30-day preview period during which
dialysis facilities had the opportunity to review their ratings. In
response to stakeholder concerns, CMS delayed rollout of the Star
Ratings on DFC from October 2014 until January 2015. This allows CMS to
receive comments, consider modification of the methodology, and respond
to the dialysis community’s comments.
Upon careful consideration of comments provided to
us from the community, including dialysis facilities, consumer
advocates, patients, and interested professional societies, CMS has
decided to continue with the Star Ratings methodology presented
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 is adding Star Ratings to its Compare websites
with the goal of improving the salience and usability of comparative
quality information for consumers. The Star Rating System is intended to
enhance and supplement existing publicly reported quality information,
which will continue to be available.
Currently, there are Star Ratings on Nursing Home
Compare and Physician Compare. CMS also anticipates applying Star
Ratings to Home Health Compare and Hospital Compare beginning in 2015.
Reasons for the DFC Star Rating Initiative:
● To help consumers of dialysis services make
more informed health decisions.
● To release more transparent, easily
understandable and widely available public reporting through the
Affordable Care Act.
● To respond to the call to continue to use and
expand existing methods for providing quality measure performance
● To better understand how consumers use publicly
reported quality measures data which will serve as a key driver of
health care system improvement.
Overview of Dialysis Facility Compare Star Ra
The DFC Star Ratings represent the quality of care
provided by dialysis facilities and will make it easier for consumers to
use the information on the Compare website and spotlight excellence in
health care quality. CMS developed and applied a methodology to produce
a summary star rating for dialysis facilities. Of the 11 publicly
reported quality measures, the DFC Star Rating is based on the following
● Standardized Mortality Ratio (SMR) (NQF #0369)
● Standardized Hospitalization Ratio (SHR) (NQF
● Standardized Transfusion Ratio (STrR)
● Percentage of adult hemodialysis (HD) patients
who had enough wastes removed from their blood during dialysis (NQF
● Percentage of pediatric hemodialysis (HD)
patients who had enough wastes removed from their blood during dialysis
● Percentage of adult peritoneal dialysis (PD)
patients who had enough wastes removed from their blood during dialysis
● 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, an analytic method was applied 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
● “Other Outcomes 2 (Kt/V, hypercalcemia)” which
includes a combined dialysis adequacy (Kt/V) measure, and hypercalcemia
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
Changes to DFC Measures for January 2015
In addition to introducing the Star Ratings CMS
will stop publicly reporting two quality measures from the DFC website,
the URR dialysis adequacy measure and the Hemoglobin greater than 12 g/dL.
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 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.
CMS is providing all Medicare-participating
dialysis facilities a 15 day preview period to review their data and
star rating before they are posted on Dialysis Facility Compare in
January 2015. Facilities will have the opportunity to submit questions
about their ratings if they believe their ratings are inaccurate. In
addition to the star ratings, updated data on individual DFC measures
will be posted simultaneously in January 2015 as part of the ongoing
quarterly refresh schedule.
In the coming months, CMS will release a public
call for nominations for participation in our annual DFC Star Rating
Technical Expert Panel (TEP). The call for nominations will include
detailed information about the composition of the panel and the process
for nominating participants.
The TEP will be charged with evaluating the star
rating scoring methodology, considering the current star rating
measures, and suggesting potential future measures for the star ratings.
The TEP will then make recommendations to CMS for future modifications
or iterations of the star ratings system as necessary.
CMS is seeking ongoing feedback on the DFC Star
Rating System. Questions or comments about the quarterly Dialysis
Facility Compare preview reports and the DFC Star Ratings can be
submitted to the following email address:
The deadline for comments during the preview period
is November 24, 2014.
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