Quality Measurement in Wonderland: The Curious Case of a Dialysis Readmissions Measure.

The standardized readmission ratio is a new quality measure for dialysis facilities that will affect public reporting and payment beginning in 2017. Like all quality measures affecting public reporting and payment, the standardized readmission ratio was vetted by a process that included a technical expert panel convened by the US Centers for Medicare and Medicaid Services, and, then, the National Quality Forum. Unlike previous measures, standardized readmission ratio followed a tortuous path that exposed problems in the development and endorsement process. Although it is acknowledged that processes in the dialysis facility can be improved to decrease readmissions, multiple objections to the implementation of the standardized readmission ratio measure existed. This review discusses the standardized readmission ratio measure and issues related to quality metric development that are important for the nephrology community to consider.