Joint Commission links surveys to outcomes
Agencies required to buy data sets
Describing today’s health care environment as one of accountability, Joint Commission President Dennis O’Leary, MD, in February announced the group’s plan to integrate outcomes measures into the accreditation process. The implications of this initiative are huge.
For the first time, hospitals and other health care organizations, including hospital-based home health agencies, will be required to submit data on outcomes of patient care as well as meet current standards. If an agency or its hospital fails to show improvement in any problem area, it could lose its accreditation.
In a nationwide telephone press conference, O’Leary told the audience of reporters and health care industry officials that while "the accreditation process remains a standards-based process, it is expected that organizations will use the outcomes data to improve." O’Leary added that "significant problems" exposed by performance measures must be addressed quickly. If a problem doesn’t improve in six to 12 months, the facility places itself at risk, he said.
"Demonstration of improvement will be a standard requirement. [A hospital] could loses its accreditation if it doesn’t demonstrate improvement," O’Leary said.
He said the initiative, called "ORYX: The Next Evolution in Accreditation," was needed because, "We have an environment today of accountability, and there is a demand for access to outcomes. All quality improvement begins with performance outcomes."
Listen to what they didn’t say
But what the head of the Joint Commission on Accreditation of Healthcare Organizations didn’t say was that hospitals would be required to purchase one of the 60 JCAHO-approved data collection sets, 19 of which are home care-focused.
Alice Brown, spokeswoman for the national accrediting organization, acknowledged after the press conference that even if home care agencies have their own performance measures in place, they must select from the Joint Commission’s list or submit their own systems for approval. (See list of 60 vendors/systems with the 19 home care-specific systems shaded, inserted in this issue.)
Although the American Hospital Association responded favorably to the plan, not everyone looked upon it positively.
Cindy Runner-Heidt, RN, MSN, director of patient care for Lehigh Valley Home Care in Allentown, PA, reacted with dismay. "I’m depressed," she said. "What does this mean? What is it going to cost us? We already pay $20,000 for surveys."
The Joint Commission sent out questionnaires to hospitals months before announcing the initiative, asking hospitals for cost estimates for ORYX compliance. O’Leary told the press conference that the average hospital estimate ranged from $10,000 to $11,000. O’Leary added that he thought the figure was low.
Kit Costello, president of the California Nurses Association, told The Associated Press, "New rules wouldn’t make much difference. It’s an absolute PR scam. The Joint Commission is not a public agency. It’s a private, regulatory scheme. This does not protect the public."
Whatever ORYX is, it still is a reality for any organization accredited by the Joint Commission. It will be supported by 60 measurement systems with which the Joint Commission has contracted. These systems were selected from among 71 reviewed by the organization last fall.
Countdown to kickoff
Hospitals and long-term care organizations must choose a performance measurement system from the contract list by Dec. 31, 1997, and select at least two clinical performance indicators from its measurement system that represent 20% of its patient population. They must begin submitting data no later that the first quarter of 1999.
Home care agencies, hospital-based and others, will be required to meet the same criteria by Dec. 31, 1998. Hospital-based entities, however, if accredited under the hospital, may choose a measurement system in 1997 if home care represents 20% of the hospital’s total patient population. But like their freestanding counterparts, hospital-based agencies will not be required to select a system until 1998. Home care agencies and other health care organizations, such as behavioral health, ambulatory care, and laboratories, will collect and send data to the Joint Commission in the year 2000.
A parallel group of requirements is being developed for integrated delivery networks, health plans, and provider-sponsored organizations. These groups must choose a minimum of 10 separate measures in 1997 from one or more of five specified consensus-based sets developed by the Foundation for Accountability’s FACCT for health plans, the National Committee for Quality Assurance’s HEDIS for health plans, the Joint Commission, the University of Colorado Health Science Center’s OASIS for home care services, and the University of Wisconsin, Madison’s long-term care services.
By 1998, the number of measures required will rise to 20, and by 1999, 30 will be required. During 1997, surveyed plans must show they have selected and are beginning to collect data on measures that are of the greatest relevance to their plans.
For hospitals engaged in measuring performance at levels well beyond ORYX, the Joint Commission offers an accelerated option, ORYX PLUS, which is voluntary. Available only to hospitals, ORYX PLUS uses a common set of acute care measures and carries with it a commitment to future public disclosure of meaningful performance data.
If you have questions about ORYX, call JCAHO directly at (630) 792-5085 or consult its Web page: http://www.jcaho.org.
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