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Aronoff's Point of View: CMS should use more meaningful measurements for rating system

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Aronoff's Point of View: CMS should use more meaningful measurements for rating system

Feb 11, 2015

Dr.-George-Aronoff.jpgLast week I posted about the Centers for Medicare and Medicaid Services (CMS) new Five-Star Quality Rating System that was recently added to the Medicare Dialysis Facility Compare (DFC) website. I pointed out that this new rating system has been severely criticized by dialysis providers and patient advocacy groups, because many of the measures used to rank dialysis units have little impact on patients' lives. For example, most of the nine factors that go into the star ranking are complicated, mathematical manipulations of blood test results. There is little support that these measures relate in any meaningful way to how long dialysis patients live or their quality of life.

Why did CMS choose these obscure calculations to rank dialysis clinics? The answer is because CMS requires dialysis units to report narrowly focused information about anemia, the amount of dialysis provided and other blood chemistries. Even important information about mortality, hospitalizations and transfusions is manipulated in such a way that it is nearly impossible to rate dialysis units.

It is time for CMS to collect reliable and meaningful quality measurements about dialysis units that lead to meaningful clinical outcomes and matter most to our patients. Let's collect and use clinical values that more directly relate to mortality, quality of life, and the patient's experience of care in the dialysis unit. We know that infection control, the management of other medical conditions like diabetes, and fluid management are all important factors that influence how long and how well our patients live. Should these measures not be part of a five-star rating system? Location, hours of operation, convenience, cleanliness, and customer service also matter to patients. Shouldn't these factors count in a five-star rating system?

I strongly support developing a five-star rating system to help Medicare beneficiaries make more informed choices about their dialysis care.  Rather than using less meaningful measures to rank dialysis units, because we can easily measure and report blood chemistries, let's encourage CMS to use meaningful measurements that matter to our patients and rate dialysis units in a way that really matters.

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.

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