ORYX: How will it affect you?
New indicator reporting requirement may have serious implications
You may have some new concerns now that the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, has instituted its new indicator reporting requirement. If you don’t comply with ORYX and provide timely outcomes information, your facility will automatically receive a special Type I recommendation.
Left uncorrected, the blemish on your record could lead to conditional status and ultimate loss of accreditation. And there’s more: The new requirement is a move toward continuous monitoring of accreditation status, and that could trigger an interim survey at any time the submitted data don’t pass muster.
ORYX not an acronym, but the name of a breed of gazelle is the name given by the Joint Commission to its initiative that integrates performance measures into the accreditation process. When first announced in February, ORYX was a source of confusion for those having to comply. Gradually, however, as details are beginning to sink in, some quality assurance personnel are feeling more comfortable, especially those already measuring performance. (See related story on specific requirements of ORYX, p. 42.) Most hospitals have little to fear from the first stage of the new requirements, as they do little more than ask for information your facility is likely to already have.
Indun Whetsell, RN, quality improvement coordinator at the Regional Medical Center of Orangeburg and Calhoun Counties in Orangeburg, SC, says ORYX may not be as daunting as it looks at first.
"Most hospitals are already benchmarking their performance. If a hospital is already involved in some type of comparative project, such as South Carolina’s Quality Indicator Project or the Maryland Hospital Quality Indicator Project, that reporting system needs only to be blessed by the Joint Commission, and a hospital can continue doing what it’s doing." (See related story on South Carolina’s performance measurement systems, p. 43.)
That sentiment is echoed by Jayne Bassler, RN, quality manager at Volusia Medical Center in Orange City, FL. "This won’t change things much for us, because we’ve been monitoring indicators anyway," Bassler says. "Other than submitting information, we’re already there."
Do you have $100,000 handy?
Others are less comfortable with the new requirement, however. Patrice Spath, ART, BA, consultant in health care quality and resource management in Forest Grove, OR, and consulting editor for Hospital Peer Review, puts it this way: "The Joint Commission is saying, in effect, Every three years we come and survey you and charge $10,000 for that, and now we want you to spend nearly $100,000 to join a performance measurement system.’"
Starting up ORYX, the Joint Commission says, will cost hospitals about $10,000 on average, and that doesn’t include the hidden costs of adopting a new system. You may need to hire new personnel or at least train current staff to perform this function. Ongoing maintenance costs should range near $11,000 annually.
"Some of the approved systems are relatively inexpensive," comments Spath. "Others cost up to $100,000. But costs go beyond buying hardware and software. Running them is resource-intensive. Someone has to collect and format and submit the data. This could result in a significant economic burden on hospitals."
"We anticipate that what we charge hospitals will increase now," says Karen Reeves, RN, vice-president of professional services for the South Carolina Hospital Association in Columbia, "because the Joint Commission will have specific requirements for data transmission and analysis. A couple of years after South Carolina’s Quality Indicator Project started, we were charging hospitals $400 per year to participate in the acute care indicators. Today we charge $800 per year
"But tomorrow? I don’t know exactly what we’ll have to charge because the contract we executed didn’t specify all the future programming changes that may be required for data submission. We’ve been trying to ascertain exactly what the Joint Commission will be requiring of participants." Will the Joint Commission be responsible for developing charts, graphs, and reports, or will hospitals? None of that is outlined in the contract."
Costs will be passed on
"We did commit to payments of $5,000 per year over the next three years," says Reeves, "in order to be considered on the list of 60 systems that met the initial screening criteria. We’ll have to pass on some of those costs to our participating hospitals."
Dennis S. O’Leary, MD, president of the Joint Commission, says ORYX should not trigger survey fee increases by itself, but he does warn hospitals that the Joint Commission has gone three years with no survey fee increase, and some change is likely.
Can accreditation be denied based on performance measures? With ORYX, the Joint Commis sion will be reviewing performance data quarterly, so the evaluation process will be more continuous. At first the performance data will be compared in the context of a system-defined cohort that is, among other hospitals using the same system.
We’ve raised the crossbar’
The Joint Commission expects hospitals to use the gathered data for performance improvement. "There’s a clear expectation of a demonstration of improvement," says O’Leary. "We’ve raised the crossbar. We’ll be looking at trend lines, and when we see one going in the wrong direction, we’ll ask for a written analysis of the problem. Ultimately, we’ll send out a team to investigate." The Joint Commission will expect evidence of improvement within six to 12 months of data collection.
Some professionals are questioning how all of these data will affect patient care in an already tight financial environment.
"How is the ORYX initiative actually going to improve patient care?" asks Spath. "In this environment of cost containment, we can’t afford to spend dollars on things that are meaningless. I’m all in favor of individual providers having comparative benchmarking data to evaluate their performance. At the local level, those data has a real impact on patient care improvement. But how will sending those data to the Joint Commission improve patient care quality?
"If, for example, one facility’s C-section rates are higher than another’s, the QI personnel know that," Spath says. "The facility may have higher-risk patients. What action can the Joint Commission take on that issue? Will ORYX prevent sentinel events? Most sentinel events occur in low-volume patients. By definition, that population wouldn’t be a part of one of our indicators for the Joint Commission."
Eventually, according to the Joint Commission, specific indicators will be standardized nationally so everyone is comparing apples to apples. But is that task possible?
"As I see it, the crux of the problem is trying to compare apples to oranges," Spath says. "If the Joint Commission takes measures from, for example, the Maryland Quality Indicator Project and bundles them with measures from another project, the outcome will be unreliable data because different projects maintain different data definitions. We would like to think that every indicator project defines, for example, patient falls the same way. But they don’t. If I’m counting patient falls and using the definition applied by my project, my number of patient falls is not comparable to those of another project using a different data definition."
Data quality will be audited
As if in response to Spath’s concern, O’Leary addresses the seemingly insurmountable problem of comparables. "The approved measurement systems have been reviewed by us, and an important part of that review has to do with data quality. The systems and the Joint Commission will conduct periodic data quality audits. That should minimize anticipated problems. ORYX PLUS will contain a single set of core measures, all of which have been tested for reliability, validity, and discrimination capability." (See related story on ORYX PLUS, p. 45.)
Is there a need to go beyond what the Joint Commission is doing now? QI personnel have recently criticized the triennial survey as lacking teeth. "I see ORYX as a positive step," says Michelle Bell, RN, assistant vice-president of Memorial Hospital-Memorial City in Houston. "It’s a way to measure what you’re doing. The overall triennial survey score really doesn’t tell you much. It depends on the surveyor and many subjective factors. Quality indicators do say a lot, however. I hope patient satisfaction scores can be included some day."
The Joint Commission seems headed in the right direction in wanting hospitals to use comparative data. All agree performance measures are essential for quality improvement. Facilities that implemented performance measurement systems years ago did so to gain useful information, and not with the intent of reporting to the Joint Commission.
Opinions vary, however, as to the initiative’s efficacy. Some QI personnel don’t see the necessity of creating the additional labor and mechanisms for reporting to the Joint Commission unless it results in some real gains.
What is the intent of the Joint Commission? What will be done with that data, both now and down the road? If the intent is purely regulatory to ensure that hospitals are monitoring indicators most have concerns that ORYX is creating unnecessary work.
Reeves sees ORYX as a positive move, but thinks the program could be managed more efficiently. "I’m happy that the Joint Commis sion is making an effort to eventually coordinate us. If they can accomplish that, this initiative will be helpful. I do think it could be done faster and cheaper, however. I’ve been on different Joint Commission task forces, including their IM System advisory council. The Joint Commission is a political body. ORYX is definitely a money-making initiative," says Reeves.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content