In a previous related post, I promised I would post more about the Davita position on this when I got it. So, here it is and it makes some good points. “What’s Wrong With the 5-Star Rating System for the Renal Community” by Mahesh Krishnan, MD, MPH, MBA, FASN from NephrologyNews.com
Davita mostly takes issue with the “bell-curve” as a part of the rating system. If you’ve had experience with the bell-curve, you know it forces some of the items at each end of the curve and places most of the items in the middle. So if the best score on a test was 60 out of 100, that score would be on the far left of the curve and, if the worst score was 10 out of 100, it would be to the far right. The balance of the scores, 59 to 11 would be placed in the middle of the curve. A 60 in this case would be 5-stars and the 10 would be a 1-star, the others would be 2, 3, and 4-stars.
The problem lies in the CMS application of “grading on a curve” as a teacher might do with an exam. It allows the exam scores to fall within a bell-curve but it actually rewards mediocrity. If a facility does really well and scores 100 out of 100 but another scores 50 out of 100, those with scores between the two will be awarded 2, 3, and 4 stars where they might actually be awarded 1 and 5 stars if there was a rigid grading system like 90-100 is 5 stars, 70-89 is 4 stars, 50-69 is 3 stars, 30-59 is 2 stars, and anything below that is 1-star.
DPC (Dialysis Patient Citizens) has responded to the CMS proposal and puts it rather well, better than I can. So, please read their posting about it. Comment below if you have something to add to this.
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