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Aronoff's Point Of View: CMS rating system is flawed

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Aronoff's Point Of View: CMS rating system is flawed

Feb 05, 2015

Dr.-George-Aronoff.jpgThis month the Centers for Medicare and Medicaid Services (CMS) added a Five-Star Quality Rating System to the Medicare Dialysis Facility Compare (DFC) website. The new rating system has been severely criticized by dialysis providers and patient advocacy groups. DFC was originally launched in 2001 to help consumers, their families, and caregivers compare dialysis units more easily. DFC provides general information about dialysis clinics, best clinical practices, hospitalizations and deaths. Unfortunately, DFC has not been as useful as it was originally hoped. Studies of DFC indicate that many patients and their families find it difficult to understand the descriptions of quality measures on the main web pages. I have been told that the DFC website is accessed more often by dialysis providers than dialysis patients.

Developing a five-star rating system to help Medicare beneficiaries make more informed choices about their dialysis care is a good idea. Many of us use similar ratings to choose restaurants, hotels, and even consumer products. Rating systems provide useful information when they accurately report information about those factors that are most important to our decisions about a product. For example, we expect that a five-star restaurant would have food that tastes better than a three-star restaurant and that the service at a five-star restaurant would be excellent.

Major criticisms of CMS's five-star dialysis unit rating system focus on whether CMS is accurately measuring factors that are important to dialysis patients and reporting them fairly. CMS has chosen to use data that were collected for far different purposes than to compare the quality of care among dialysis clinics. Many of these measures have little impact on patients' lives or their experience of care in a dialysis clinic. In addition, CMS has used very complicated methods to analyze the information making it almost impossible for individual clinics or patients to understand that there may be no real difference between a three-star dialysis unit and a five-star dialysis unit or even a one-star unit. Similar criticism has been leveled at other CMS five-star rating systems and has limited their usefulness to beneficiaries.

With all these flaws, I would still congratulate five-star units. They probably are doing something right. At the same time, I would encourage one- and two-star units to try to understand how the data that CMS used might have fallen short and how they might improve their patients' care and dialysis experience. A dialysis unit rating system could be helpful to our patients and their families. It is disappointing that CMS didn't take the opportunity to get this right.

Dr. George Aronoff is the Chief Medical Officer at Renal Ventures Management.  Dr. Aronoff comes from the University of Louisville School of Medicine, where he served as the Chief of the Nephrology Division for 23 years and as the Vice Chair of Medicine for Clinical Affairs. He currently holds the position of Professor of Medicine and Pharmacology there. Dr. Aronoff has 30 years of experience in designing and performing clinical research in hemodialysis, peritoneal dialysis, transplant and CKD patients.

- Read Dr. Aronoff's thoughts about how the CMS rating system can be improved

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