Five-Star Dialysis Centers Not Tied to Quality of Care

Boston, MA - Additional stars in the rating system for dialysis facilities may not reflect increases in quality of care, according to an analysis presented at the National Kidney Foundation 2016 Spring Clinical Meetings.

The research examines the Dialysis Facility Compare (DFC) Star Program, a rating system developed by Medicare that assigns 1 to 5 stars to dialysis facilities based on the health and treatment of the patients in their clinics compared to patients in other dialysis facilities across the country. It is intended to help patients find and compare dialysis facilities.

Statistical analysis from Prima Health Analytics in Weymouth, MA, found that the dialysis centers that dramatically improved their star ratings likely benefitted from chance and reporting improvements, rather than improvements in clinical care.

“The facilities with the greatest improvement in star ratings may have achieved this with very little change in their actual clinical practices,” said Mark Stephens, Principal/Owner at Prima Health Analytics. “Most of the improvement was probably due to random chance, data reporting improvements, and statistical artifacts of the rating methodology.”

“The flip side of this, of course, is that facilities that are actually making real-world quality of care improvements may not see this reflected in their star ratings,” Stephens said.

Ten facilities were included in the case study; 6 went from 2 to 5 stars, 4 went from 1 to 4 stars. The three main drivers of these dramatic improvements, according to Stephens, were:

  1. Luck – The average improvement in standardized mortality (SMR), hospitalization (SHR) and transfusion (STrR) ratio scores was 38%. Only 3% of these standardized scores (pooled analysis across both years) had statistically significant odds of being different from the national average (p < 0.05).
  2. Better reporting – Two facilities improved their dialysis adequacy (Kt/V) scores from the lowest half-percentile nationally to above average scores in a single year. Better claims coding in 2014 may account for this dramatic improvement.
  3. Maturity – 5 of the 10 facilities were Medicare-certified after the beginning of the first star rating experience period (January 2010), resulting in missing measures in the first round of star ratings. The addition of high-ranking STrR and SMR scores helped 3 facilities score higher in round 2.

The analysis is one of a number of recent critiques of the current star rating methodology. The Centers for Medicare and Medicaid Services continues to review the Dialysis Facility Compare Star Rating system and will be adding new quality metrics in October 2016. However, one metric Stephens says is missing from the program is any measure of patient satisfaction.

“There is no patient input to the quality ratings being used by Medicare for dialysis centers. Quality ratings that at least partially consider patient satisfaction with their dialysis treatments might produce very different rankings,” Stephens said. “Our hope is that we can elevate the dialogue about fixing the problems in the system, and hopefully improve the education of both clinicians and patients about how to interpret these ratings.”

The NKF 2016 Spring Clinical Meetings are being held April 27 to May 1, in Boston, MA. For additional program information, visit

The National Kidney Foundation is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease. For more information, visit