New ORYX measures mean more work for you

Measures reflect those already used by PROs

At its Feb. 4-5 meeting, the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) Board of Commissioners approved 25 new core performance measures as part of the organization’s troubled ORYX initiative. While the dust hasn’t settled yet, some observers are already concerned that the process-level measures will increase the burden on quality managers charged with collecting ORYX data.

The core measures, grouped into the five focus areas the Joint Commission identified last year, include: eight measures under acute myo car dial infarction; seven under community-acquired pneumonia; five under heart failure; three under pregnancy and related conditions; and two under surgical procedures and complications. (See a breakdown of the new core measures, p. 33.)

"A large number of these measures are the same ones used by the peer review organizations that contract with the Health Care Financing Admi ni stration," says Becky Miller, director of performance measurement and quality at the Missouri Hospital Association (MHA) in Jefferson City. "On one level, I think that’s good, because it means we’re not reinventing the wheel with these measures. But these are process-level measures, which means they’re a little more difficult to collect."

The MHA and a coalition of other hospital associations have been in talks with the Joint Commission about phasing the new measures in slowly, with some of the easier-to-collect measures phased in first. "I think that would help," Miller says. "But there are a lot of details that aren’t entirely ironed out. I do think that we’re continuing to have an open dialogue [with the Joint Commission] to discuss these issues. They seem to be responsive, from my perspective."

Even so, Miller is concerned about the number of measures staff might have to collect at one time. "And also the resources that will be required to get medical record-level data. We don’t have all the questions answered yet."

Despite that concern, even the strongest critics of the Joint Commission’s ORYX initiative have recently tempered their attacks. Only a year ago, 17 hospital associations, including the MHA, sent a fiery letter to the Joint Commission expressing their dissatisfaction with ORYX and threatening to halt participation in the initiative unless the organization listened to their demands and took input from individual hospitals. (See "Joint Commission Jettisons ORYX Plus in favor of core measures reporting," Hospital Peer Review, August 1999, p. 117.) As a result of that letter, JCAHO president Dennis O’Leary formed a nationwide Core Mea surement Implementation Task Force to offer recommendations regarding ORYX measures.

"[The task force] has met periodically and has provided a significant amount of input to the Joint Commission," Miller says. And to its credit, "the Joint Commission seems to have listened to them. I think the group has been able to impact some of the decision making there."

Miller says one of the most positive developments to come out of the state hospital associations’ talks with the Joint Commission has been the appointment of five pilot states in which to test new core measurements. "Missouri is one of those pilot states," Miller says. "We’re pleased because this will give us a small group to work on these measures before they’re taken out across the whole United States."

Hospitals will have until September 2001 to select two of the new measurement sets, after which they won’t have to collect any more data on non-core measure requirements. (Until now, hospitals participating in ORYX were required to collect data on up to six non-core measures.)

After September 2001, hospitals will have four months to collect data on a subset of care measures within the two measurement sets they’ve selected. By Jan. 1, 2003, hospitals must have collected data on all of the core measures in the measurement sets they chose.