Dialysis Facilities

End-stage renal disease (ESRD) is permanent kidney failure — the kidneys can no longer filter waste and excess fluid from the blood on their own. For the roughly 560,000 Americans on dialysis,¹ treatment is not a recovery plan. It is a permanent, ongoing medical necessity.

Most dialysis patients visit an outpatient center three times a week for hemodialysis — a process where a machine performs the function the kidneys can no longer do, filtering blood over the course of three to four hours per session. Some patients are trained to perform dialysis at home, either through home hemodialysis or peritoneal dialysis, which uses the lining of the abdomen as a filter. A minority of patients receive a kidney transplant and are removed from dialysis entirely.

Because nearly all ESRD patients are covered by Medicare — regardless of age, a unique provision in federal law — the federal government has both visibility and financial incentive to closely track what happens in these facilities.

CMS publishes a Five-Star Quality Rating for each dialysis facility through the Dialysis Facility Care Compare (DFCC) program. The rating compresses a wide range of performance data into a single score.

The Five-Star rating captures survival, patient experience, and dialysis adequacy — but the full dataset goes further. These measures track aspects of care that matter clinically and operationally, and appear in the underlying data regardless of what the composite rating shows.

The ESRD Quality Incentive Program (QIP) is Medicare's payment accountability mechanism for dialysis facilities. Each year, CMS evaluates facility performance across up to 17 measures and calculates a Total Performance Score (TPS) from 0 to 100. Facilities that score below the payment reduction threshold receive a cut to their Medicare reimbursement — up to 2% — applied to every dialysis session for an entire fiscal year.

Unlike the Five-Star rating, QIP scoring combines both achievement (absolute performance) and improvement (change since the baseline period). A facility that starts from a lower baseline and improves significantly can still earn a strong score — a design intended to reward progress, not just incumbency. The higher of a facility's achievement or improvement score for each measure counts toward the TPS.

Dialysis facility quality data flows from two parallel CMS programs. The Dialysis Facility Care Compare (DFCC) dataset — produced by the University of Michigan Kidney Epidemiology and Cost Center on behalf of CMS — covers the Five-Star rating, all standardized ratios, lab measures, and ICH CAHPS results. This dataset is updated quarterly and covers over 7,600 active dialysis facilities.

ESRD QIP data is published separately through the CMS Provider Data Catalog and reflects each facility's annual performance scores and payment adjustment calculations. Because nearly all ESRD patients are covered by Medicare, the claims-based measures in both programs have unusually high completeness.

Most clinical measures use a rolling 12-month data collection window. The standardized mortality, hospitalization, readmission, and transfusion ratios typically reflect one to two years of data and use risk-adjustment models that account for patient age, diagnoses, time on dialysis, and dialysis modality — making cross-facility comparisons meaningful even when patient populations differ significantly.