Rating systems are one of the most ubiquitous and easiest ways that consumers can understand quality of care. Yelp allows diners and shoppers to rate restaurants and stores; Amazon allows online shoppers to rate every kind of product, from books to mattresses to clothing to cleaning supplies; and when the Centers for Medicare & Medicaid Services created its five-star rating system, health care providers were next in line to get the ranking treatment.

“The five-star rating system was implemented a few years back for skilled nursing facilities and hospices,” notes Mike Staffieri, the chief operating officer for DaVita Kidney Care. “This is really an ongoing trend where CMS is trying to create transparency, and we’ve been pushing this for a long time.

“If you go online to book a hotel, you can see if the hotel has one, two, three, four or five stars,” Staffieri continues. “It’s easy for consumers to rate the quality of care.”

Staffieri explains that CMS places every dialysis center (or nursing home, or other facility in a specific category) on a forced bell curve based on nine quality measures, including standardized outcomes, vascular access, calcium adequacy, pediatric dialysis and more.

The ratings for kidney care were just rolled out in March of this year -- just in time for Marlene Cox, whose husband, Rick, requires dialysis, to discover the benefits of using a rating system to find appropriate care for his health issues. Marlene notes that initially, they weren’t given a choice of where to go for Rick’s dialysis, nor were they shown any brochures regarding different centers they could choose from while Rick was in the hospital.

“They said, ‘Here’s the center you want.’ And it was 20 miles away, in the building where his nephrologist worked. He has to go three times  a week, and 20 miles each way, sometimes in rush hour -- we didn’t like it.”

A hospital staff member then changed Rick’s dialysis location to a kidney center that was eight miles away from their home -- still a long way in rush hour traffic, Marlene felt.

“They assigned Rick a Tuesday/Thursday/Saturday schedule,” Marlene continues. “When we asked if we could switch to a Monday/Wednesday/Friday schedule, they told us not right now, and they’d put us on a list. That didn’t thrill us, either. It seemed like it was more for the physician’s comfort. We never got options, and we didn’t get a lot of information, which didn’t really impress us.”

After Rick was released from the hospital, they began talking to a home care specialist and were told that there were more dialysis providers available.

“I got on the computer and found other centers, and I found a five-star kidney center, and the one we were using was two-star. I don’t know about you, but I don’t care if it’s a restaurant, a hotel, a doctor -- when I see five stars, that kind of perks my interest because you have to be doing something right to earn that kind of rating.”

Marlene found a dialysis center just three miles away from her home and asked about a different schedule for her husband’s dialysis.

“They said, ‘We can work with you on that,’” she notes.

She had to transfer Rick’s care from one center to the other, but she says that the new center helped her with the transition.

“We could no longer keep our regular nephrologist,” she says. “He didn’t come out to their facility. But there was a nephrologist who was on site, and Rick would see the doctor every Monday. It was so convenient.”

Since transferring, Marlene Cox has had to reschedule Rick’s dialysis appointments twice due to medical emergencies resulting from his chronic conditions, and both times, she says, the staff accommodated her request.

“I definitely feel the five-star rating is accurate,” she says. “Location was a key factor, and so was the scheduling. For some people it doesn’t matter, but with us, it kind of did. We have a group son who visits when his work schedule permits, and I try to help my parents -- 89 and 90 -- on weekends. We didn’t want to be doing dialysis for four hours and tying up the day.”

Marlene notes that some centers haven’t been open long enough to collect the data required for a CMS star rating and suggests that other dialysis patients (or caregivers of loved ones with dialysis) ask the following questions when vetting a dialysis center:

  1. How long have you been open? “If they’ve only been open six months, that would tell me a lot -- maybe they deserve a good rating but haven’t had the time to get the full accreditation,” says Marlene. “If they said, ‘We’ve been open for 18 years,’ that would make me wonder.”
  2. How many technicians work there, and how many seats are available? “You don’t want a staff that’s spread thin,” she notes.
  3. Is there a doctor on-site? “If there’s a problem and they have to call the doctor, and he or she has to come from 15 miles away, that’s not ideal,” she says.
  4. How often does the physician see the patients? “I like having a doctor that comes around at least once a week to talk to patients, ask if they have questions, and go over the medical records and dialysis results,” she explains.
  5. What other resources are available? “It’s an eye-opener what you can and can’t do with kidney disease,” Marlene says. “You have to watch your potassium, your salt. On my kitchen door, you will see a whole list of ‘can eat’ and ‘cannot have.’
  6. Do they have classes where they can educate you about what to eat, or recipes you can use? That’s something that’s kind of minor, but it’s still good to know.”

“With everything we’ve had to deal with, they’ve exceeded the bar,” says Marlene Cox. “I can leave my husband there, and for four hours, I can breathe. I don’t have to worry about him, because he’s in good care, he’s convenient to get to if I have to, and the doctor is right there. He’s not just a person sitting down in a chair and hooked up to a machine there.”

“Improving the experience of care and the overall health of the population while reducing costs is often referred to as the ‘triple aim’ of health care,” Staffieri says. “And five-star ratings go right to the core of that.”