Commentary
How did we arrive at this impasse?
Looking back, one could argue that the Joint Commission should have anticipated major problems with ORYX, its electronic outcomes reporting system.
From the onset in late 1997, it was not entirely clear just what JCAHO wanted to accomplish with such a database, other than selling the data back to providers.
When those providers asked hard questions about who benefits, the Joint Commission talked about a national repository of risk-adjusted data for benchmarking, which it would administer.
But how was the Joint Commission going to guarantee the quality of those data when it did not impose any common standards on the vendors’ programs that collected and reported the data?
Providers were quick to see the problems that would arise from this massive flaw, and the call for remedial action recently issued by 17 state hospital associations is probably just the tip of the iceberg. Indeed, it was apparently the Joint Commission’s belated attempt to address this standardization issue — through a new requirement for 12 core measures — that sent the hospitals over the edge.
Everyone agrees that a national database for outcomes benchmarking is a laudatory goal, but the commission’s standards have long made benchmarking all but a requirement. Many hospitals are involved in benchmarking projects at the local, state, or national levels and are making improvements based on what they find.
So where’s the value for them in ORYX, they ask? With a months-long projected lag time before the commission’s analysis and feedback occurs, many question the value of ORYX given its lack of timeliness.
Then there’s the whole question of ORYX’s nebulous costs, which come in an era of downsizing, cutbacks, mergers, and several costly new dictums from the Joint Commission itself, such as the revised sentinel event policy and restraint policy. When resources are so scarce, many providers question the payback of the tens of thousands of dollars spent on ORYX, especially in terms of impact on patient care, and especially when managed care constraints already threaten the quality of that care.
Finally, why create another national repository when there are already dozens of sources, free from government agencies or for a fee from commercial companies, for the same type of information? For example, there is the MEDPAR data available from the Health Care Financing Administration. Every state government collects some type of outcomes and performance data on hospitals, and virtually all of it is free or available at low costs.
Compounding these problems, the Joint Commission has not answered — at least not satisfactorily, many providers say — pertinent questions about how the data will be used. Will facilities be measured against only those facilities that are participating in the same software system? Or will seemingly similar measures, such as medication errors, from various software programs be aggregated and analyzed? With no two vendor software packages having common definitions or methods of measurement, such an approach could have nightmarish consequences for providers.
Unfortunately, the Joint Commission also is fighting its own flawed track record in getting reporting systems up and going. Its IMSystem, an indicator measurement system developed in 1996 and funded by higher survey fees, has had little impact.
Now the Joint Commission is asking the industry to pay for another elaborate database, one that would certainly catapult the JCAHO into the top ranks of commercial data purveyors but would also provide questionable benefit for the providers who build it, according to many in the industry.
How the Joint Commission responds to providers that question its motives and its methods will determine the future of ORYX. If JCAHO can convince the hospitals of ORYX’s benefits and allay fears about poor methodology, then ORYX might work. If not, ORYX could become a major black eye for the accreditation body and a political albatross it can ill afford.
Susan Hasty
Executive Editor, Hospital Peer Review
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