Medicare Unveils Information On Dialysis Facility Care Quality

Armen Hareyan's picture
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The Centers for Medicare & Medicaid Services (CMS) today announced important additions to the Dialysis Facility Compare consumer Web site (http://www.medicare.gov/dialysis) that will give consumers even better insight into the quality of care provided by their local dialysis patient facilities.

The improvements include two new quality measures that demonstrate how well dialysis patients are treated for anemia (low red blood cell count) as well as updated information that will help patients better understand survival rates by facility.

Dialysis Facility Compare links consumers with detailed information about the 4,700 dialysis facilities certified by Medicare, and allows users to compare facilities in a geographic region. Users can review information about the size of the facility, the types of dialysis offered, the facilities’ ownership, and whether the facility offers evening treatment shifts.

Consumers can also compare dialysis facilities based on three key quality measures— how well patients at a facility have their anemia under control, how well patients at a facility have waste removed from their blood during dialysis, and whether the patients treated at a facility generally live as long as expected. Dialysis Facility Compare also links users to resources that support family members and specialized groups of kidney patients.

“Dialysis Facility Compare is yet another tool that equips consumers with the tools they need to seek better, value-based health care,” said CMS Acting Administrator Kerry Weems. “Adding more information on the Dialysis Facility Compare Web site about anemia - a condition that affects many dialysis patients - and patient survival will help us all learn more about how well the country’s dialysis facilities are serving Medicare beneficiaries and the entire health care system.”

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Dialysis Facility Compare has featured information about anemia control since the Web site was launched in 2001. Historically, the Web site has shown the percentage of patients in a facility whose hematocrit levels were at 33 percent or more (or hemoglobin levels of 11 g/dL or more), based on clinical practice guidelines at the time. However, recent evidence about increased risk of certain adverse events associated with the use of erythropoiesis stimulating agents (ESAs), which are used to treat anemia, has raised concerns about patients who hemogloblin levels are too high as well as patients whose hemoglobin levels are too low. The Food and Drug Administration has responded by requiring manufacturers to develop a Medication Guide and to ensure that this information is provided to patients. As a result, Dialysis Facility Compare will now feature two anemia measures—one measure will show the percentage of patients whose hemoglobin levels are considered too low (i.e., below 10 g/dL) and a second measure will show the percentage of patients whose hemoglobin levels are considered too high (i.e., above 12 g/dL).

“These two new measures better reflect recent medical evidence about the challenges of managing anemia,” said CMS Chief Medical Officer and Director of the agency’s Office of Clinical Standards & Quality, Barry Straube, M.D. “Our new measures will help patients and health care providers to better understand how a facility’s patients are treated for anemia, a condition for which studies have shown that over- and under-treatment can affect patients’ health status and quality of life.”

In to adding new information about anemia treatment, CMS has also updated the way it reports patient survival rates on Dialysis Facility Compare. Since 2001, CMS has reported survival rates by comparing a facility's expected patient survival rate to its actual patient survival rate. (The expected survival rate takes into account the patients’ personal characteristics, health, and dialysis history. The actual survival rate is the rate each facility reports to CMS about how many patients have survived in a given timeframe.) Facilities’ survival rates were then rated as belonging to one of three categories: “Better than Expected” (by 20 percent or more), “As Expected” or “Worse than Expected” (by 20 percent or more). This method of calculating patient survival resulted in a finding of “As Expected” for 94 percent of dialysis facilities nationwide, with only 3 percent in the “Better” or “Worse” categories, respectively.

To help consumers make better distinctions among facilities’ survival rates, CMS updated the statistical method it used to classify facilities in the three categories. While consumers will continue to see facilities placed into one of these categories, they will find fewer facilities in the “As Expected” category, and more facilities in the “Better” or “Worse” categories.

Today’s enhancements are only one part of CMS’ plans to improve the quality of care in America’s dialysis facilities. Earlier this year, CMS revised its conditions for coverage regulations for the first time in over 30 years, which updated the health and safety standards that dialysis facilities must meet to receive Medicare coverage.

A key element of this regulation was the development of a new Web-based data entry framework for dialysis facilities nationwide, which will eventually provide substantially more detailed information for consumers as part of Dialysis Facility Compare. CMS is also working to implement a value-based purchasing program to pay for dialysis services, which will reward facilities for providing high-quality, efficient, and effective care.

The Dialysis Facility Compare Web site can be viewed at www.medicare.gov/dialysis. Other provider compare Web sites are available through www.medicare.gov or directly at www.medicare.gov/HHCompare for information about home health agencies and nursing homes. For information on hospitals, visit www.hospitalcompare.hhs.gov. CMS also provides comparative resources about Medicare Advantage (www.medicare.gov/MPPF) and Medicare prescription drug plans (www.medicare.gov/MPDPF).

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