Dialysis Center Five-Star Quality Rating System FAQs

The Centers for Medicare and Medicaid Services (CMS) launched its Five-Star Quality Rating System for dialysis centers in 2013. DaVita has been recognized as a clinical leader in Five-Star for five years straight and improving patients' quality of life is and always will be our focus. This year, the CMS Five-Star ratings are made up of two separate scores, the Quality of Patient Care Star Rating and the Patient Experience Rating.

The FAQs below should help shed light on Five-Star. We hope this transparency helps empower patients to make informed and educated decisions for their dialysis care.

Frequently Asked Questions

What is the Five-Star Quality Rating System?

The Five-Star Quality Rating System is a mechanism created by CMS to give consumers access to clinical quality information to help them make informed and educated decisions about where to receive health care. For the first time, these ratings are made up of two scores, the Quality of Patient Care Star Rating, and the Patient Experience Rating.

What is DaVita's position on the Quality of Patient Care Star Rating?

We are proud that since the inception of the program and for the fifth year in a row, DaVita has been recognized as a clinical leader.

What does the Quality of Patient Care Star Rating mean?

CMS is using a Quality of Patient Care Star Rating in an attempt to measure patient outcomes at dialysis centers in order to give consumers a better picture of how the center is performing. The standardized readmission ratio (SRR) will now be included. The following eight individual quality measures will be considered and rolled up to establish the rating:

  1. Standardized mortality ratio (SMR) - the ratio of the number of patients that expired compared to how many CMS expected would expire based on the patient mix at the facility
  2. Standardized hospitalization ratio (SHR) - the ratio of the number of patients that were hospitalized compared to how many CMS expected would be hospitalized based on the patient mix at the facility
  3. Standardized transfusion ratio (STrR) - the ratio of the number of patients that received a transfusion compared to how many CMS expected would receive a transfusion based on the patient mix at the facility
  4. Standardized readmission ratio (SRR) - the ratio of the number of patients that were readmitted compared to how many CMS expected would be readmitted based on the patient mix at the facility
  5. Kt/V - The percentage of total dialysis patients eligible for the measure who had enough wastes removed from their blood
  6. Hypercalcemia - the percentage of adult dialysis patients who had hypercalcemia
  7. Standardized fistula rate (SFR) - the standardized percentage of adult patients with an arteriovenous (AV) fistula
  8.  Long term catheter rate - the percentage of patients dialyzing with a catheter for more than 90 days

How is the Quality of Patient Care Star Rating calculated?

The eight measures referenced above are compared to performance in the baseline year. Then these measures are averaged together to determine a final score. This final score is compared to performance cutoffs to determine the star rating from one to five. Below is a table that outlines the average performance for 3-, 4- and 5-Star facilities, which can be used as a guideline.

 

3 Stars

4 Stars

5 Stars

HD Kt/V

95.5%

96.9%

98.0%

Standardized Fistula Rate

59.7%

65.1%

71.3%

Long-Term Catheter Rate

14.2%

10.7%

7.7%

Hypercalcemia (uncorrected calcium)

2.5%

1.5%

0.9%

Standardized Mortality Ratio (SMR)

1.044

0.982

0.892

Standardized Hospitalization Ratio (SHR)

1.063

0.956

0.820

Standardized Readmission Ratio (SRR)

1.070

0.977

0.840

Standardized Transfusion Ratio (STrR)

1.138

0.949

0.670

 

 

 

 

 

 

 

 

My center has received a one- or two-star Quality Patient Care Star Rating. Does this mean my care team and center isn't meeting certain standards?

No. All centers are required to meet a standard level of care. We are always looking to improve our centers and will continue to strive to do so.

Why did my center not receive a Quality Patient Care Star Rating?

If you are receiving care at a hospital or at a pediatric-only facility, those facilities do not receive a Five-Star rating by CMS. Facilities also need to be certified by Medicare by June 1 of the performance year to be eligible to receive a rating. Finally, each measure has different eligibility criteria, but typically a facility needs to have 11 patients to be eligible for a Quality of Patient Care Star Rating.

What is the Patient Experience Rating?

Patient Experience Ratings reflect patient experience scores from the CMS In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey.

  • The optional survey is given twice a year to eligible dialysis patients (patients who have received in-center hemodialysis at the center for at least 3 consecutive months, are at least 18 years old, and are not living in a skilled nursing facility or other long-term facility such as a jail or prison).
  • For a center to receive a Patient Experience Rating, at least 30 patients had to complete the survey between the Fall and Spring survey periods.

What is DaVita’s position on the Patient Experience Rating?

We currently track the industry in percent of three-, four-, and five- star centers. We hope the increased transparency through Five-Star will drive progress in patient experience the same way it has for quality of patient care, propelling the entire industry forward.

However, because the voice of our patients is so important to us, it’s disappointing that only 1 in 3 patients who were contacted completed the survey. This equates to 1 in 4 of our total patient population since many patients are not eligible to be contacted, including patients on home dialysis. We would like to get feedback from many more patients, and we look forward to working with CMS to improve the survey design to make that happen.

What does the Patient Experience Rating mean?

CMS is using a Patient Experience Rating in an attempt to measure the experience of in-center hemodialysis patients and to give consumers a better picture of how dialysis centers are performing on topics that are important to patients, such as how well their kidney doctors and dialysis center staff care for and communicate with them. The Patient Experience Rating is measured according to six measures:

  1. Rating of kidney doctors
  2. Rating of dialysis center staff
  3. Rating of dialysis center
  4. Kidney doctors’ communication and caring
  5. Providing information to patients
  6. Dialysis center staff, care, and operations

How is the Patient Experience Rating calculated?

The Patient Experience Rating methodology results from averaging the six overall patient experience measures. A dialysis center receives an individual star rating for each of the six measures, and then all six are averaged into one summary star rating for the dialysis center. Cutoffs for each star rating from one to five are determined based on how the rest of the industry performed during the same period.

My center has received a one- or two-star Patient Experience Rating. Does this mean my care team and center isn't meeting certain standards?

No. DaVita and your clinical team work hard to deliver a safe and comfortable experience for our patients in every center. The Patient Experience Rating is structured to drive improvement across the industry, and we believe we will get better.

Why did my center not receive a Patient Experience Rating?

For a center to receive a Patient Experience Rating, at least 30 of its eligible patients had to complete the survey over the course of the year. If your center did not receive a Patient Experience Rating, this means that the center had less than 30 eligible patients that completed the survey in 2017.

Get Free Kidney-Friendly Cookbooks

Explore Home Dialysis Options

Get to know the many benefits of peritoneal dialysis (PD) and home hemodialysis (HHD).

Kidney Care Begins with Kidney Smart®

Learn more and get your questions answered in a no-cost kidney education class.

Find a Dialysis Center

Call 1-800-424-6589 now to talk to one of our placement specialists.