JCAHO: Failed program taught useful lessons
Core measures made it easier to end program
The small number of participants opting for the ORYX Plus program was a "contributing factor" in the decision to end the program, "but, more importantly, it’s part of our move toward core measures," says Janet McIntyre, a spokes person for the Joint Commission on Accredita tion of Healthcare Organizations (JCAHO) in Oakbrook Terrace, IL.
"The valuable lessons learned by the Joint Commission, hospitals, and performance measurement systems as the result of the ORYX Plus experience will be used as we move toward core measures," says Jerod M. Loeb, PhD, JCAHO vice president in the department of research and evaluation and performance measures.
Hospitals currently participating in ORYX Plus will be issued full refunds of their fees, and performance measurement systems will be issued refunds for 50% of their annual fees. Despite the fact that the initiative is being phased out, the measures will continue to be available to measurement systems and hospitals to use, and participating hospitals still will be allowed to continue to collect data on all or some of the ORYX Plus measures if they choose.
The Joint Commission will provide limited support for the use of ORYX Plus measures through May 31 and will support the risk-adjustment methodology for measures through the end of fourth quarter 1999 data — those transmitted to the Joint Commission by April 30, 2000.
"ORYX Plus has given the Joint Commission good information about using the same measures across multiple systems," says Chris McGreevey, RN, MS, the performance measurement manager in the Joint Commission’s ORYX department of performance measurement. "It also has given us input on how to help multiple measurement systems employ a single risk-adjustment methodology so that national comparisons can be made accurately. However, as ORYX Plus was underutilized by hospitals, and what with the Joint Commission movement towards core measures, the Board of Commissioners felt that the option would only need a limited time span."
"The Joint Commission embarked on the ORYX Plus initiative in good faith," says McIntyre. "We, too, committed a great deal to it in time and resources."
So what’s ahead for ORYX? "Unlike ORYX Plus, which is a voluntary program, the ORYX initiative is a requirement for hospitals to be accredited," explains McIntyre. "The intention of ORYX is to integrate outcomes and performance measurement into the accreditation process so that the accreditation process becomes more continuous." Facilities will collect and report data on a quarterly basis rather than being surveyed every three years, giving the Joint Commission a complete, ongoing picture of how an organization is performing.
"The Joint Commission has more than 500 standards," McIntyre says. "If a hospital is following those standards, patients are more likely to receive good care, and it’s less likely that bad things will happen." Performance measurement (PM) provides evidence for what is actually happening. "In order to improve, you have to measure and figure out where you are now and how to get to a future point," she continues. "We’re living in an age of accountability, and performance measurement is about accountability."
There are no firm costs’
To be a part of the ORYX program, you must select a PM system and collect information on a set number of measures. What does that cost? "There are no firm costs," says McIntyre. "Fees are worked out between the facility and the system it chooses." When JCAHO introduced ORYX in 1997, it ran a survey of hospitals. Most were already doing some type of PM then, and most reported costs of $10,000 or less to do so.
In the early 1990s, JCAHO developed the Indi ca tors Measurement (IM) System with the intention of it being the vehicle for introducing PM. But many hospitals told JCAHO they were already measuring performance and using their own PM systems. They didn’t want to be required to use the IM System; they wanted a choice.
In response, JCAHO backed off. The agency set up criteria for all PM systems and said, "If you can meet those criteria, you can use your own systems," says McIntyre. "We gave facilities some flexibility. We were in a beginning stage, and the idea was to get everyone on the measurement train. We said, You can choose a system that meets our criteria and also choose what measures you want to look at.’"
IM System was intermediate step
But, while being flexible was a good thing, that concept didn’t allow for comparisons. If you have a number of hospitals measuring C-section rates, for example, unless all the hospitals are using the same PM system, they are probably not calculating their outcomes in the same way. And the multiple systems didn’t adjust for risk, she explains.
"We knew that down the road there would be core measures — standardized measures that allow for comparison," says McIntyre. "And ORYX Plus was the first effort at core measures. ORYX Plus served as a basis for the evolution toward core measures that is now occurring in the ORYX initiative."
The Joint Commission has been working with the state hospital associations to come to an agreement on some initial focus areas for the core measures and to select measures for each of the focus areas. (See article on core measures, p. 121.) "The initial focus areas identified by the task force, however, do not necessarily correspond with those used as part of ORYX Plus," she says.
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