ORYX performance system selection
Tips for hospital-affiliated providers
The Joint Commission on Accreditation of Healthcare Organization's (JCAHO) ORYX: The Next Evolution in Accreditation implementation looms closer for home health providers. All home care organizations must select ORYX systems and two performance measures by Dec. 31 to meet standards established by JCAHO. With just five short months left, providers who have not already selected ORYX systems must begin reviewing vendor systems and identifying possible performance measures for their organization, sources say.
The ORYX initiative, which integrates outcomes and other performance measures into the accreditation process, requires health organizations to collect performance data on outcomes of patient care and submit the data to JCAHO on a continuous quarterly basis. The individual organizational data, and its comparison with that of other providers, is expected to provide objective, quantifiable performance data that demonstrate each organization's relative patient care outcomes.
JCAHO-accredited hospitals and long-term care facilities selected performance measures by December 1997 and began submitting data in July. After selecting ORYX systems and performance measures this December, home care providers will submit data starting in March 2000.
With so many performance measurement systems to choose from (as of June 17, 66 home care performance measure systems had met JCAHO initial screening criteria), home care agencies may find the selection process daunting. (See list of approved systems, pp. 128-130.) "It will be a challenge, but it is important to take time and make appropriate decisions for your organization," says Jan Potts, RN, BSN, MBA, an associate of The Corridor Group, an Overland Park, KS-based home care consulting firm.
Maryanne Popovich, RN, MPH, executive director of the JCAHO Home Care Accreditation Program, agrees that providers have a sea of information to swim through, but adds that "if agencies start now, they will have enough time to explore systems and measures, and possibly negotiate new measures with vendors."
Consider your affiliated hospital's choice
Hospital-affiliated agencies' ORYX system and performance measurement selections may be very closely or loosely related to those of their parent facility, sources say. Some providers may share both performance measurements and systems, while others may look only for hospital support in selecting their own.
"[While attending conferences] recently, I've heard round-table discussions in which [hospital-affiliated agency managers] have said,'I'm just going to figure out what the hospital's doing and use that,' but that is absolutely the wrong approach," says Prinny Rose Abraham, ART, CPHQ, associate of The Corridor Group and owner of Minneapolis-based Health Information Quality Management Consulting. "Instead of asking'what can I measure?' people should be looking at'what should I measure to improve organizational performance?'" she adds.
While the performance measurement systems of JCAHO-defined integrated delivery systems must talk to each other, some organizations intend to go a step further and use the same performance measurements throughout each system affiliate.
This can produce valuable information. However, Abraham cautions home care providers to consider whether such measures have meaning for their operations. For example, the hospital may choose a perception of care measure involving food and menu acceptability. Unless a significant part of home care services involve meal preparation, this measure would probably not be a good choice, she explains.
Those hospital-affiliated agencies not compelled to use the same performance measures as their parent facility may find the hospital has already chosen a system that either has no home care measures or includes home care measures not relevant to their operations. Faced with conducting a separate system search, agencies can at least gain from their affiliate's experience, sources say.
Take advantage of the hospital's selection tools and information systems, Abraham urges. Although home care may look at different performance measurements, the same system selection issues, such as reporting capabilities, set-up and ongoing costs, and the number of organizations using the same performance measures will also guide their selection process, she adds. After system selection, the usually more soph-isticated hospital information management department may help home care with data analysis and statistical process control reviews that accompany the performance measurement process, Abraham says.
Here's a nine-step method for selecting an ORYX system and measures to meet your needs outlined by our experts:
1. Identify possible performance measures.
Hospital mandates aside, your choice of organizational performance measures and ORYX performance systems are closely related. Each performance system may have up to 25 JCAHO-approved clinical, patient perception of care or health status performance measures. At least initially, JCAHO will only compare the performance of providers who use the same performance measures from the same performance measurement system, says Popovich. "We want to make sure we are comparing apples to apples and not put our providers in a bad comparison mode," she adds.
It is important to have "some vision of what [you] want to measure," Popovich suggests. "We don't want this to be a very expensive compliance exercise that doesn't give [organizations] anything, [so we urge them] to use measures that will create meaningful information," she adds.
Home care agencies must choose at least two, but not more than five, performance measures that address at least 20% of the organization's patient population. "Consider the most problematic, the highest volume, or the indicators of high-risk patients," advises Potts. The organization's total duplicated annual admissions determine its base patient population.
"You should select something you have control over. If you find a negative trend, you want to be able to do something about it," says Abraham. "You also want [something that's] cost-effective to collect, for example, not a measure that requires a whole new form and adds costs," she continues.
Even if your agency selects different measures than your affiliated hospital, the hospital's quality management or performance improvement department may be a good resource in determining performance measures, Abraham adds.
Choosing a system that has already incorporated performance measures important to your organization in its logic may put you ahead of the game. If a vendor who otherwise meets your selection criteria does not now compile data on your ideal performance measures, you may be able to negotiate inclusion of those elements, according to both Potts and Popovich. However, you should also consider if other organizations will use the same measures and vendor, Potts cautions.
2. Consider your own information system sophistication.
The sophistication of your organization's existing information system may have large bearing on your ORYX system choice, sources advise. Vendors have different data transmission requirements. Some will accept paper submissions, from which they subsequently enter data for computer processing.
Others require modem transmittals. Your organization's ability to comply with these requirements depends on its information system sophistication.
"There is a wide range of sophistication in home care systems," says Potts. "Some of the smaller agencies do everything by hand and have nothing automated. Others have only billing automated. Some have billing and some operations computerized, and some have point of care systems where they have electronic medical records," she adds. Evaluate your place on the data sophistication continuum as you review systems, Potts urges.
3. Evaluate alongside OASIS requirements.
Both Medicare-certified and non-certified providers may use Outcomes Assessment Information Data Set (OASIS) measures. While it is the outcomes measurement system for Medicare patients chosen by the Health Care Financing Administration in Baltimore, OASIS may work equally well for all agency patients.
If participating in both ORYX and OASIS, you may want to use the same vendor for both systems, or at least plan for implementation at the same time, Potts advises. "The data capture and transmission issues are similar," she adds. Or, you may want to select one system for OASIS measures and choose an ORYX system that allows you to compare the same performance measures as your affiliated hospital, Abraham advises.
4. Ask about the vendor's data and clients.
Find out how many other home care providers are participating in the vendor's data and look at the mix of diagnoses they are now tracking. Ask for a reference list and speak with other providers using or planning to use the system, Potts advises. Many vendors are now more focused on skilled intermittent visits of the Medicare OASIS project, so if your agency has a large private duty service, "one of the first questions you should ask vendors is whether they have any hourly patient data," she adds.
Also look at the system's risk adjustment capabilities, i.e., how it takes into account other issues with patients such as multiple comorbidities. Outcomes for a large chronically ill patient population will vary from one with more acutely ill patients with the same diagnoses, she advises.
Providers should also ask how the system checks data accuracy and whether they will be able to correct and resubmit data if errors surface, says Potts.
5. Determine the system's reporting capabilities.
Because ORYX's ultimate purpose is to quantify companies' performance against like organizations, you should determine each system's report production capabilities, Potts advises. Check for report frequency, standard report format and data elements, what report interpretation assistance will be available, and whether the system will allow demand or ad-hoc reports, she adds.
6. Make a selection grid.
To help with your decision process, Potts suggests using a selection grid that lists the must have vs. desirable criteria. Rating vendors against the criteria will clarify not only the most important system elements but also the vendors who best meets your needs.
7. Consider the organizational impact of any system.
Depending on the system selected, you may need someone to enter collected outcomes data into the information system, or you may need to purchase a scanner. In addition to the capital outlay to purchase the scanner, providers may face a higher ORYX system initial setup charge. However, the monthly charge for scanable systems may be lower, and providers should weigh each system's capital costs with its impact on organizational productivity, Potts advises.
8. Evaluate vendor support.
Look at the level of implementation and ongoing support the vendor will provide, Potts advises. What kind of implementation training can you expect? What type of ongoing user help and interfaces will be available?
9. Use JCAHO resources.
JCAHO has a wealth of ORYX selection information available for home care providers. Its Internet home page at www.jcaho.org lists approved vendors and also provides vendor profiles, including information about system performance measures. The Web site also provides information JCAHO considered when evaluating potential ORYX systems. This may help individual providers with their selection process.
JCAHO home care division staff are available to answer home care-specific ORYX-related questions and there is also an automated ORYX line for general information.
Regardless of the ORYX system you select, include all staff in the decision-making process to make the implementation successful, Potts advises. "Get everyone involved. Show them that this will help identify how patients are doing and what can be done to [provide better care]."
"Remember we're all just getting started [with this]. There's no decision that's forever. You can change what you're measuring. You must explain why, but it can be done," notes Abraham.
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