Understanding Dialysis Facility Compare: Driving Informed Decision Making

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Nathaniel Walters
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1 Understanding Dialysis Facility Compare: Driving Informed Decision Making Elena K Balovlenkov Joel Andress Stephanie Glier Celeste Lee February 4, 2015

2 Overview Background Dialysis Facility Compare (DFC) Current information and features Introduction of star ratings What star ratings mean for consumers Responses from consumer group representatives 2

3 Background: the Compare websites Official CMS source for information on health care provider quality Quality measures based on established scientific standards of rigor and accuracy Five different sites: Nursing Home Compare (1999) Dialysis Facility Compare (2001) Home Health Compare (2005) Hospital Compare (2005) Physician Compare (2010) 3

4 Star Ratings Response to calls for increased sharing of information and more effective public reporting Currently used on: Nursing Home Compare Medicare Plan Finder Physician Compare (for certain group practices) Upcoming: Dialysis Facility Compare Hospital Compare Home Health Compare 4

5 Dialysis Facility Compare Features data from 6,000+ dialysis facilities nationwide Allows consumers to compare facilities based on location, services, and quality of care Provides guidance on: Understanding quality data, including why quality measures are important How to use the information on the website Where to find local resources 5

6 What information is currently on Dialysis Facility Compare? Quality information on best treatment practices, including how facilities: Manage anemia Deliver adequate dialysis treatment Use different vascular access types Data on hospitalizations and deaths: Rate at which patients are admitted to the hospital Rate of patient deaths 6

7 What other information is on Dialysis Facility Compare? Dialysis facility name & address Whether facility has evening hours Number of hemodialysis treatment stations Types of dialysis offered Facility ownership type (for-profit or non-profit) Name and address of facility director or management Date that facility was certified (or recertified) by Medicare to provide dialysis 7

8 Star Ratings: Why add them? Make quality information more consumer-friendly for dialysis patients: Decrease technical detail and amount of information a website user needs to read through to understand facility performance Familiar icon helps consumers to more easily use and compare quality information 8

9 Star Ratings: What are they based on? 1. All Kt/V Rate: 3 Kt/V measures are combined into a single measure Percentage of adult hemodialysis (HD)* patients who had enough waste removed from their blood during dialysis (higher is better) Percentage of pediatric** hemodialysis (HD) patients who had enough waste removed from their blood during dialysis (higher is better) Percentage of adult peritoneal dialysis (PD)*** patients who had enough waste removed from their blood during dialysis (higher is better) --The analysis combines the three Kt/V measures (#4-adult HD, #5-pediatric HD, and #6-adult PD) into a single All Kt/V measure. The resulting All Kt/V measure is the percentage of the patient population who had enough wastes removed from their blood * process that cleans blood in a dialyzer machine ** patients less than 18 years old *** process that cleans blood in a special membrane within patient s abdominal cavity 9

10 Star Ratings: What are they based on? 2. Standardized Transfusion Ratio: rate of transfusions (lower is better) 3. Standardized Mortality Rate: patient death rate (lower is better) 4. Standardized Hospitalization Rate: rate of hospital admissions (lower is better) 10

11 Star Ratings: What are they based on? 5. Percentage of adult dialysis patients who had a high level of calcium in their blood over the past three months (lower is better) 6. Percentage of adult patients who received dialysis through arteriovenous fistula (AVF)* (higher is better) 7. Percentage of adult patients who had a catheter** left in a vein longer than 90 days, for their regular hemodialysis treatment (lower is better) * One way to make blood vessels bigger so that a patient s blood can be cleaned. To get an AVF, a surgeon joins an artery to vein under the skin of a patient s leg or arm ** Narrow plastic tube 11

12 Star ratings on Dialysis Facility Compare: What are they based on? An overall star rating is calculated using existing Dialysis Facility Compare quality measures The methodology uses established scientific methods The score combines information about different aspects of facility quality such as: The use of best treatment practices* The rate at which patients are admitted to the hospital** The website contains detailed guides that explain exactly how this score is calculated * Measures 1-2 and 5-7 on slides 9-11 ** Measures 3 and 4 on slides

facilities Facilities fall into a normal distribution, with most facilities

13 Star Ratings: How are they assigned? Once a final score is calculated, it is compared to the final scores of all other facilities Facilities fall into a normal distribution, with most facilities falling in the middle and about equal numbers of facilities better or worse than average Cut points are created and stars are assigned 13

14 Star Ratings: What do they mean? Facilities can earn between one and five stars The more stars a facility has, the higher the quality compared to other facilities A one star facility does not mean you will receive inadequate care The stars are just one way of comparing one facility with another 14

15 Why do some facilities lack a star rating? A dialysis facility may not have a star rating because: It is small (not enough data for an accurate calculation) It is a new facility or a facility that has changed ownership and thus data submission is incomplete or delayed at the time star ratings are calculated It only provides care to certain patient groups (for example, pediatric patients) It has too few Medicare claims Data are incomplete Not being rated does not necessarily mean that a facility did not report data on a measure(s) 15

16 Helping consumers use star ratings to select facilities When comparing dialysis facilities: The star rating only uses quality information reported on the DFC website Star ratings are a measure of the quality of clinical care, not patient satisfaction Star ratings provide a comparison of one facility to all the others Star ratings should be used in combination with other information 16

17 Important things to remember Testing the star ratings with users or potential users of Dialysis Facility Compare (dialysis patients, their families) showed that consumers: May use the stars ratings as a starting point Generally view other factors (facility features, or experience while visiting) as more important than the star ratings Want to understand how CMS calculates star ratings 17

18 Helping consumers make decisions Encourage consumers to use star ratings as an important piece of information In addition, encourage patients to: Visit the facility and ask questions Talk with a doctor or other health care provider Talk with other patients undergoing dialysis Look at other data about the quality of care at a facility 18

19 Consumer Perspectives Stephanie Glier, Senior Policy Analyst for the Consumer- Purchase Alliance About Consumer-Purchaser Alliance How can we make choosing a dialysis facility easier for patients? What information is most important? What other factors matter? 19

20 Consumer Perspectives Celeste Castillo Lee, Program Manager for Patient and Family Centered Care at the University of Michigan Health System 33 Year Vasculitis End Stage Renal Disease Patient Patient and Family Centered Champion 20

21 Consumer Perspectives, Celeste Lee Star Ratings can help patients: Get an idea of where facilities land on quality and safety Engage in their care ESRD patients and their caregivers should: Take advantage of using the DFC website and star ratings Use available information, including star ratings, to understand their illness and how to care for themselves or a loved one 21

22 Questions related to this presentation may be submitted to: 22

23 Questions? 23

Quarterly Dialysis Facility Compare - Preview for April 2018 Report DFC Dialysis Facility State: XX Network: 99 CCN: SAMPLE

Quarterly Dialysis Facility Compare -- Preview for April 2018 Report This Quarterly DFC Preview Report includes data specific to CCN(s): 999999 Purpose of the Report This report provides you with advance