Measuring Quality: The 5-Star System

Position of Dialysis Patient Citizens on

Implementing Star Ratings for Dialysis Facility Compare Website


Dialysis Patient Citizens (DPC) has taken the lead in seeking improvements to the Dialysis Facility Compare star rating system. Under the current methodology, all dialysis clinics across the U.S. are ranked against one another, with stars assigned by dividing the facilities into five tiers. Under this system, the bottom 10 percent are given one star, and those in the next twenty percent (11th percentile to 30th percentile) given two stars.

DPC objects to this methodology for several reasons.

First, a nationwide competition  among all facilities that gives considerable weight to health outcomes (such as hospitalizations and mortality) disfavors facilities in places where, in general, patients are less healthy. Dialysis Facility Compare star ratings are most favorable to clinics in healthy states, such as Hawaii and Colorado, but unfavorable to clinics in places like West Virginia. This discourages investment in clinics in places that need them the most.

Second, consumers associate one- and two-star symbols with poor quality, such as bad movies or budget motels. CMS did not draw upon consumers’ existing experience with star ratings, instead substituting its own bell-curve system that stigmatizes providers who don’t deserve it.

Finally, most observers, including the Medicare Payment Advisory Commission, believe quality ratings should be based upon absolute standards, not tournaments among providers. DPC is committed to working with other kidney care stakeholders to develop an alternative system for assigning stars.

The links below will take you to documents that more fully describe the Dialysis Facility Compare star rating system and its limitations.



Dialysis Patient Citizens
1012 14th Street, NW, Suite #1475
Washington, DC 20005

Toll free: 1-866-877-4242
Fax: 888-423-5002