A new report explains why the scores from Centers for Medicare & Medicaid Services' star rating system for dialysis facilities should be adjusted to account for underlying community characteristics. The report was written by the policy adviser, Alex Brill, of the law firm Hooper, Lundy & Bookman, which provides public policy and government relations services to Dialysis Clinics, Inc. and the Nonprofit Kidney Care Alliance (NKCA). Members of NKCA include Centers for Dialysis Care, DCI, Independent Dialysis Foundation, Northwest Kidney Centers, and The Rogosin Institute. NKCA provided financial support for the preparation of the report.

The report matches census tract-level data from the U.S. Census Bureau with the star-rating data using dialysis facility zip codes. These data were also matched with facility-level data from the 2011 Dialysis Facility Report dataset.

"CMS created the dialysis facility star-rating system to help patients find the best quality of care in the vital area of in-center dialysis treatment," Brill says in the report. "Improving consumer awareness and promoting health care quality are worthy goals, but the star-rating system as currently constructed may not be accurately directed toward those ends."

"In addition to legitimate concerns raised by other stakeholders about the preset distribution of the star ratings, and given the importance of patient demographics in predicting patient outcomes and health status, it is necessary to consider refinements to the star-rating system. This preliminary analysis suggests that the current system may be predicting local demographic factors in addition to facility quality metrics. Specifically, there are statistically significant differences in the average star rating for facilities located in lower-income census tracts and facilities in census tracts with higher-than-average black populations."

Download the full report.

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