JCAHO adds computerized outcomes measures to mandatory standards

Hospitals, long-term care providers must comply by the end of the year

If your facility isn’t collecting and tracking outcomes with a computerized system, you may be in trouble at accreditation time. As early as December 1997, some rehabilitation providers must use an approved outcomes measuring system to be accredited by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL.

Hospitals and long-term care organizations seeking accreditation must incorporate an outcomes measuring system into their operating procedures before the end of the year. They must begin collecting data in 1998 and submit them to the Joint Commission by the first quarter of 1999. The same requirements for organizations accredited under home care, behavioral health care, clinical laboratories, and ambulatory care go into effect a year later.

ORYX: The Next Evolution in Accreditation was announced by Joint Commission president Dennis S. O’Leary, MD, at a news conference Feb. 18.

JCAHO must approve measuring system

At the same time, the Joint Commission released the names of 60 performance measuring systems which have signed contracts to participate in the initiative. The systems were among 71 that submitted screening criteria last fall to the Joint Commission’s Council on Performance Measures. The list includes performance measures for all aspects of health care now accredited by the Joint Commission.

A manual insert that profiles each of the approved measuring systems was scheduled to be sent to affected organizations in March. (See the list of approved performance measuring systems, inserted in this issue.)

Other measuring systems will be added to the approved list "on an ongoing basis," O’Leary says. Some 20 systems have submitted data for consideration at the Council on Performance Measurement meeting in April, he adds.

To meet the Joint Commission’s initial screening criteria, vendors were required to demonstrate the following:

• the presence of performance measures;

• technical capability for data collection and transmittal;

• checks for accuracy and reliability;

• strategies for risk adjustment and severity adjustment;

• feedback to participating health care providers;

• collection of data and measures that are relevant to the accreditation process.

Electronic data requirements

When the new mandates take effect, the Joint Commission will not take outcomes measuring information directly from the organization seeking accreditation. Rather, it will receive the data electronically on a quarterly basis through systems that meet the Joint Commission criteria.

This means your organization must be aligned with one of the systems that meets the criteria, or you must get your proprietary system approved by the Joint Commission.

Although accreditation will remain standards-based, organizations will be required to use the performance measurement data in the continuous quality improvement process and demonstrate program improvement, O’Leary says.

"The clear expectation is a demonstration of improvement. It will place their accreditation in jeopardy if they are not able to show it," he adds.

Eventually, the Joint Commission will be able to review your performance measurement data on a continuous basis and make the accreditation process more of an ongoing process instead of something that happens only every three years, says Deborah Nadzam, PhD, RN, director, Indicator Measurement of the Joint Commission.

And consistently poor outcomes indicators could put an organization’s accreditation at risk, O’Leary warns.

For instance, if a performance indicator starts to drop, the Joint Commission would either call the health care organization or send a team to the site, depending on the severity of the problem. The organization would be given several months to analyze the data, make corrections, and show improvements, O’Leary says. "We are looking at a six to 12 months time frame."

Initially, organizations must track at least two indicators that cover at least 20% of their patient populations. The number of indicators and percentage of patients covered will increase annually, becoming 100% in five years.

If you’re not already aligned with one of the Joint Commission-approved vendors, the new requirement is likely to increase costs by at least $10,000 a year.

Hospitals and long-term care organizations replying to a survey last summer reported an average start-up cost of less than $10,000 for a performance measuring system and a cost of less than $11,000 a year to maintain it, the Joint Commission announced.

Vendors will pay the Joint Commission an annual fee of $5,000 to participate in the initiative, as well as a fee of $10 per indicator per quarter per health care organization. These fees are likely to be passed on to the health care providers.

Hospitals also will have the opportunity to participate in ORYX PLUS, an expanded national database that will track a common set of acute care measures that will eventually lead to a national benchmarking system.

Hospitals participating in ORYX PLUS must agree to have their data released to the public. More details will be available on ORYX PLUS later this spring.

In a few years, when the Joint Commission has compiled enough data to make a decision, the Council on Performance Measure will probably identify common outcomes measures that must be embedded in all outcomes measuring systems, O’Leary says.

[Editor’s Note: for more information on ORYX, call the Joint Commission at (630) 792-5085. Or visit its webpage at http://www.jcaho.org.]