ORYX PLUS: What you must know about JCAHO’s ‘accelerated option’

Critics say advanced initiative means high cost, more work

Although the March 2 deadline for preparing for the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) ORYX initiative is here, your hospital still has the option of upgrading to ORYX PLUS, ORYX’s big brother program. But should it?

Designed as an accelerated option for acute care hospitals that offers "opportunities for benchmarking and for performance comparisons by stakeholder groups," according to JCAHO, ORYX PLUS consists of a set of 32 performance measures. To participate, hospitals must select and report data every quarter on at least 10 of these measures and shell out $2,500 per year to JCAHO, in addition to the expense of purchasing and maintaining information systems capable of meeting ORYX PLUS’ requirements. On top of that, participating hospitals must agree to allow the Joint Commission to publicly release the standardized indicator rates they collect.

Given the added expense, fivefold increase in the number of performance measures you’ll have to collect and report, and risk of public disclosure, why bother?

The Joint Commission cites three main benefits to participating in ORYX PLUS:

• Because the measures and risk-adjusted methods are standard for all participating measurement systems, hospitals can be assured that they’re participating in a valid and reliable database.

• Consumers, employers, payers, and government bodies will quickly recognize hospitals that participate in ORYX PLUS "for their commitment to self-evaluation and accountability through their willingness to share information with the public," according to JCAHO.

• The Joint Commission "will provide special recognition to participating hospitals," JCAHO says.

Patrice Spath, ART, a consultant in health care quality and resource management based in Forest Grove, OR, questions whether ORYX PLUS provides any greater benchmarking opportunities than any other benchmarking program. Comparing the Joint Commission under ORYX Plus to the vendors approved for ORYX, Spath says, "You’re essentially talking about one vendor out of 80. As part of being an approved vendor, you have to have the capability of benchmarking hospitals in your system. Essentially, the Joint Commission is just one of many different choices that you have for a benchmarking project."

Spath argues that in evaluating whether to participate in ORYX PLUS, hospitals should use the same criteria they used in determining which vendor to select for ORYX. "[Your choice] should have a system in place to validate the data," she says. "It should have a risk assessment system, all of those things. The bottom line is, you have 80 choices. ORYX Plus is one of those choices. You should ask, ‘What can it give me that the other ones can’t?’ And I don’t think it gives you anything more than what you can get from 40 or 50 others, like the Maryland Hospital Quality Indicator Project."

Nell Wood, director of marketing and communications with the Maryland Hospital Association’s Quality Indicator Project in Luthersville, MD, disagrees: "I think that on the surface of it, yes, you should make your decision with the same criteria — what’s important to us. However, ORYX PLUS requires collection on more indicators and on a greater percentage of your population."

Spath also contradicts the notion that participation in ORYX PLUS will have a public relations benefit for participating hospitals. "There’s a plus to saying that you’re in a voluntary disclosure program?" she asks. She points out that many institutions are already disclosing performance measures on a statewide basis, independent of JCAHO. "I don’t think you have to turn to the Joint Commission to be in a system where you get your data reported to the public."

Another consideration is that there’s little evidence to suggest that the public is impressed by — or even understands — the quality data hospitals release, adds Judy Homa-Lowry, RN, MS, CPHQ, director of quality improvement at the Delta Group in Greenville, SC, and Hospital Case Management’s consulting editor. In addition, having comparative data published can represent risk as much as it can represent opportunity, Wood acknowledges.

With regard to the Joint Commission’s rather vague assertion that it will give participating hospitals "special recognition," Deborah Nadzam, PhD, RN, vice president for performance measures at JCAHO, says participating hospitals will receive a certificate recognizing their willingness to disclose data to the public and "be held accountable. It’s not a certificate acknowledging exceptional quality," Nadzam says.

Does ORYX PLUS confer ‘extra credit’?

The only possible advantage Spath sees in participating in ORYX PLUS is that "special recognition" might also mean increased consideration in JCAHO surveys. "When the surveyors come and see you’re sending $2,500 to the Joint Commission rather than to Maryland Hospital or somebody else, they might give you extra points. Hopefully that’s not the case."

Nadzam denies that participation in ORYX PLUS will be tied to accreditation decisions. "They’re data, just like any other organization’s data, that we will review and use to potentially focus the regular survey," she says. But, she also adds, "Participating hospitals will have initially perhaps five times as many measures that we’re looking at — 10 as compared to 2 for ORYX. But there’s no extra credit, so to speak, for participating in ORYX PLUS when it comes to scoring standards. At least not to date."

Wood says she believes many hospitals are ready for more than what’s required in the standard ORYX initiative, but she says that for ORYX PLUS to get off the ground, it will have to include measures that appeal more to smaller hospitals. "[The ORYX PLUS measures] lend themselves well to larger hospitals," she says. "But smaller hospitals really can’t take advantage of a lot of them, so ORYX PLUS consequently ends up not even being an option for them."

Nadzam admits that many of the measures in ORYX PLUS "read like tertiary care center measures," and that "if a small hospital, or any hospital, hasn’t yet participated in comparative measurement activities — and our own field readiness surveys indicate that about 30% haven’t — they may not be as comfortable with this accelerated option."

But she denies that there are blanket criteria that would make it wrong for any hospital to participate. "One might argue that if they’re going to get into comparative measurement activity, they should do it this way from the beginning," she says.

Nadzam also adds that the Joint Commission has plans to include in ORYX PLUS more measures relevant to smaller hospitals. To that end, it will begin a demonstration project soon to assess the cost to smaller hospitals (those with a daily census of less than 50) of participating in ORYX PLUS. The Joint Commission also will ask these hospitals about how useful various ORYX measures are to them. In the meantime, the Joint Commission is compiling a list of specific performance measures suggested by small hospitals during a recent mail-based survey. "We’re trying to come up with a grid of performance measures that very small hospitals have told us are relevant and are likely to be feasible to collect from a cost perspective," she says.

The Joint Commission won’t release the number of hospitals that have signed up for ORYX PLUS so far, but they have acknowledged that only 21 of the 208 vendors approved for ORYX are under contract to offer ORYX PLUS. There’s also no timetable yet for the addition of more core measures, although Nadzam says new measures probably won’t be added "until later this year." Similarly, no timetable has been set for the public release of ORYX PLUS data. However, Nadzam speculates that nothing is likely to be published before 1999.

For more information about ORYX PLUS, call the Joint Commission’s ORYX Information Line at (630) 792-5085.