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Dialysis Facility Compare Star Ratings DrawFirst Challenge To CMS Quality MeasuresUnder Data Quality ActSkewed geographic distribution of star ratings demonstrates program's flaws, says Dialysis Patient Citizens

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DECEMBER 16, 2014 03:32 PM EST READS: 105

WASHINGTON, Dec. 16, 2014 /PRNewswire­USNewswire/ ­­Dialysis Patient Citizens has filed the first challenge to a CMSquality program under the Data Quality Act, contending thatthe agency's Dialysis Facility Compare (DFC) star ratings

methodology fails to satisfy federal requirements for objectivity and utility inpresenting information to the public. The day after being served with the complaint,CMS conceded it should have conducted cognitive testing of this system onconsumers, reversing a position the agency had defended for nearly four months.

"We felt this challenge was necessary in light of CMS' continued refusal toacknowledge that its quality ratings are distorted by socio­demographic factors,"said Jackson Williams, Director of Government Affairs for Dialysis PatientCitizens. "As is the case with Medicare Advantage star ratings and the hospitalreadmissions penalty, a clear geographic pattern is evident: New England, theUpper Midwest and Pacific regions score the highest, and the South and GreaterAppalachia score the worst. However, the pattern with DFC is more exaggeratedthan in other quality programs, probably because dialysis facilities draw patientsfrom more concentrated service areas."

The Data Quality Act, enacted in 2001, spawned guidelines governing how eachfederal agency compiles its data. Dialysis Patient Citizens' complaint argues thatthe DFC star ratings fail the HHS Guidelines' objectivity requirement in that theyare heavily biased by the underlying population health of the area served by adialysis facility, as evidenced by 63 percent of West Virginia dialysis facilitiesgarnering 1­ or 2­star ratings, double the national average. At the other extreme, 74percent of Hawaii's facilities earned 4­ or 5­star ratings. West Virginia and Hawaiiare generally recognized as America's unhealthiest and healthiest state,respectively. A regression analysis found that 24 percent of the variation amongstates' proportions of 1­ and 2­star facilities is explained by the life expectancy of thestate's overall population.

Dialysis Patient Citizens' complaint also argues that the DFC star ratings fail theutility requirement by contradicting the public's understanding of what "one­star"and "two­star" symbols mean. CMS has assigned those ratings to the 30 percent offacilities that rank the lowest, while conceding that a one­star rating does not meana patient "will receive poor care from a facility." Dialysis Patient Citizens cites thework of health care transparency expert Judy Hibbard in arguing that CMS' refusalto apply the "inherent meaning" that consumers associate with 1­ and 2­star ratingswill result in patients being alarmed rather than informed.

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"The public associates 1­ and 2­star ratings with unacceptably low quality – theyindicate that a product or service is not worth the consumer's time or money," saidHrant Jamgochian, Executive Director of Dialysis Patient Citizens. "That is not thecase with dialysis, because the treatment is necessary to sustain the life of a patientwith kidney failure. As a result, 1­ and 2­star ratings should only be given to dialysisfacilities that should close their doors, not to an arbitrary 30 percent of providers."

A third section of the complaint contends that CMS did not follow proper proceduresin formulating the DFC star ratings. CMS' Information Quality Guidelines promisethat tools for public use will be developed through a "collaborative process involvingproviders, consumers, academicians, and policy analysts;" however, while CMS isinvolving stakeholders in the formulation of its Hospital Compare star ratings byconvening a Technical Expert Panel (TEP) with four consumer representatives, noTEP was convened for Dialysis Facility Compare star ratings.

Dialysis Patient Citizens (DPC) is America's largest patient­led organization representing dialysis patients. With a membership of more than24,000 dialysis and pre­dialysis patients and their families, DPC's mission is toimprove the quality of life of dialysis patients by engaging policy makers,providers and the public. Through patient education, empowerment andadvocacy, DPC works to increase awareness about kidney disease and promotefavorable public policy.

CONTACT: Hrant Jamgochian, (202) 215­1800,hjamgochian@dialysispatients.org

To view the original version on PR Newswire,visit:http://www.prnewswire.com/news­releases/dialysis­facility­compare­star­ratings­draw­first­challenge­to­cms­quality­measures­under­data­quality­act­300010716.html

SOURCE Dialysis Patient Citizens

Published December 16, 2014 – Reads 105 Copyright © 2014 SYS­CON Media, Inc. — All Rights Reserved. Syndicated stories and blog feeds, all rights reserved by the author.

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Exhibitor Info Please Call 201.802.3021 events (at) sys­con.com. Carmen Gonzalez, carmen (at) sys­con.com.

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