The Dialysis Facility Compare Five-Star Rating System at 2 Years

Pozniak, Alyssa; Pearson, Jeffrey

doi:10.2215/cjn.11231017

Cited by 5 publications

(9 citation statements)

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“…[13][14][15] Some in the dialysis community have questioned the value of including the dialysis adequacy and hypercalcemia measures in public reporting and the star ratings because they are already at high levels of achievement and not as meaningful as outcomes like mortality and hospitalization. 10,11,16,17 Nissenson has argued that, while performance on certain intermediate outcomes has been high, it has not resulted in demonstrable improvements in primary outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] Some in the dialysis community have questioned the value of including the dialysis adequacy and hypercalcemia measures in public reporting and the star ratings because they are already at high levels of achievement and not as meaningful as outcomes like mortality and hospitalization. 10,11,16,17 24 In contrast, one study reported that the Hospital Compare star ratings were associated with a better experience of care, lower risk-adjusted mortality, and lower readmission rates. 25 Clearly there is a fair amount of variability within and across star rating programs, something that has been reported across the Hospital, Nursing…”

Section: Ta B L Ementioning

confidence: 97%

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Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare

Salerno

Dahlerus

Messana

et al. 2020

Health Services Research

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Objective To examine which factors are driving improvement in the Dialysis Facility Compare (DFC) star ratings and to test whether nonclinical facility characteristics are associated with observed longitudinal changes in the star ratings. Data Sources Data were collected from eligible patients in over 6,000 Medicare‐certified dialysis facilities from three annual star rating and individual measure updates, publicly released on DFC in October 2015, October 2016, and April 2018. Study Design Changes in the star rating and individual quality measures were investigated across three public data releases. Year‐to‐year changes in the star ratings were linked to facility characteristics, adjusting for baseline differences in quality measure performance. Data Collection Data from publicly reported quality measures, including standardized mortality, hospitalization, and transfusion ratios, dialysis adequacy, type of vascular access for dialysis, and management of mineral and bone disease, were extracted from annual DFC data releases. Principal Findings The proportion of four‐ and five‐star facilities increased from 30.0% to 53.4% between October 2015 and April 2018. Quality improvement was driven by the domain of care containing the dialysis adequacy and hypercalcemia measures. Additionally, independently owned facilities and facilities belonging to smaller dialysis organizations had significantly lower odds of year‐to‐year improvement than facilities belonging to either of the two large dialysis organizations (Odds Ratio [OR]: 0.736, 95% Confidence Interval [CI]: 0.631‐0.856 and OR: 0.797, 95% CI: 0.723‐0.879, respectively). Conclusions The percentage of four‐ and five‐star facilities has increased markedly over a three‐year time period. These changes were driven by improvement in the specific quality measures that may be most directly under the control of the dialysis facility.

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Section: Discussionmentioning

confidence: 99%

“…[13][14][15] Some in the dialysis community have questioned the value of including the dialysis adequacy and hypercalcemia measures in public reporting and the star ratings because they are already at high levels of achievement and not as meaningful as outcomes like mortality and hospitalization. 10,11,16,17 24 In contrast, one study reported that the Hospital Compare star ratings were associated with a better experience of care, lower risk-adjusted mortality, and lower readmission rates. 25 Clearly there is a fair amount of variability within and across star rating programs, something that has been reported across the Hospital, Nursing…”

Section: Ta B L Ementioning

confidence: 97%

Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare

Salerno

Dahlerus

Messana

et al. 2020

Health Services Research

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“…The summary star rating was added to the DFC in 2015, and now, each dialysis unit has two star ratings: one rating for the clinical measures and a separate patient experience star rating based on the ICH-CAHPS. 45 The star rating system inherits the strengths and limitations of its incorporated measures. Therefore, CMS makes efforts to ensure that star ratings accurately reflect quality by incorporating regular external review by the National Quality Forum.…”

Section: Dialysis Facility Compare (Dfc) and Five-star Rating Systemmentioning

confidence: 99%

“…Further, there are ongoing efforts to encourage patient engagement with quality information and to align the DFC star rating with other CMS star ratings and other public reporting initiatives. 45…”

Section: Dialysis Facility Compare (Dfc) and Five-star Rating Systemmentioning

confidence: 99%

Incorporating patient‐reported outcomes (PROs) into dialysis policy: Current initiatives, challenges, and opportunities

Umeukeje

Nair

Fissell

et al. 2020

Seminars in Dialysis

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Governments at national and state levels regulate dialysis care in the United States to ensure safe practices, and continually elevate the quality of care. An objective of these regulatory policies is the independent evaluation of dialysis unit outcomes by patients, caregivers and the community to facilitate choices as well as to advance equal access to high quality dialysis care. These polices recognized decades ago that it was fundamental to include the patient perspective in the assessment and evaluation of dialysis care quality by requiring both individual and aggregate patient reported outcomes (PROs). Although there is support for integrating the patient perspective, concerns persist about the implementation of these polices including selection of PRO measures, administration timing and reach, as well as interpretation of results including benchmarking to permit comparisons across organizations. The experience from the early adoption of PROs into dialysis policies in conjunction with advances in electronic health records, personal data capture and monitoring, and analytics is poised to address these concerns. The dialysis community has the opportunity to lead the way in innovation related to PRO implementation not only in kidney disease care, but also for other healthcare conditions or contexts such as oncology, surgical and acute care.

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“…Since the inception of the ESRD program, federal legislation and policies (Table 1) have focused on the refinement of care for patients with kidney failure (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Although pioneering the first disease-specific capitated system and pay for performance in Medicare, most policies addressing payment have primarily affected dialysis organizations rather than nephrology practices.…”

Section: Introductionmentioning

confidence: 99%

Keys to Driving Implementation of the New Kidney Care Models

Kshirsagar

Weiner

Mendu

et al. 2022

CJASN

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Contemporary nephrology practice is heavily weighted toward in-center hemodialysis, reflective of decisions on infrastructure and personnel in response to decades of policy. The Advancing American Kidney Health initiative seeks to transform care for patients and providers. Under the initiative’s framework, the Center for Medicare and Medicaid Innovation has launched two new care models that align patient choice with provider incentives. The mandatory ESRD Treatment Choices model requires participation by all nephrology practices in designated Hospital Referral Regions, randomly selecting 30% of all Hospital Referral Regions across the United States for participation, with the remaining Hospital Referral Regions serving as controls. The voluntary Kidney Care Choices model offers alternative payment programs open to nephrology practices throughout the country. To help organize implementation of the models, we developed Driver Diagrams that serve as blueprints to identify structures, processes, and norms, and generate intervention concepts. We focused on two goals that are directly applicable to nephrology practices and central to the incentive structure of the ESRD Treatment Choices and Kidney Care Choices: (1) increasing utilization of home dialysis, and (2) increasing the number of kidney transplants. Several recurring themes became apparent with implementation. Multiple stakeholders from assorted backgrounds are needed. Communication with primary care providers will facilitate timely referrals, education, and comanagement. Nephrology providers (nephrologists, nursing, dialysis organizations, others) must lead implementation. Patient engagement at nearly every step will help achieve the aims of the models. Advocacy with federal and state regulatory agencies will be crucial to expanding home dialysis and transplantation access. Although the models hold promise to improve choices and outcomes for many patients, we must be vigilant that they not do reinforce existing disparities in health care or widen known racial, socioeconomic, or geographic gaps. The Advancing American Kidney Health initiative has the potential to usher in a new era of value-based care for nephrology.

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The Dialysis Facility Compare Five-Star Rating System at 2 Years

Cited by 5 publications

References 1 publication

Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare

Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare

Incorporating patient‐reported outcomes (PROs) into dialysis policy: Current initiatives, challenges, and opportunities

Keys to Driving Implementation of the New Kidney Care Models

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