Have any concerns about ORYX? Joint Commission provides answers

It’s been a smooth transition for some agencies

Home care agencies surveyed by the Joint Commission for Accreditation of Health Care Organizations (JCAHO) of Oakbrook Terrace, IL, began this year to collect data for two measurement systems: The Outcome and Assessment Information Set (OASIS) as a Medicare requirement; and data for the ORYX performance measurement system, which is a new requirement for accreditation.

The fact that home care agencies must collect for both measurement systems raises the question of what benefit ORYX will be to them. "Our ORYX indicators accepted by the Joint Commission are the same as the OASIS indicators," says Noelle Zuidema, RNC, quality management coordinator for Colorado River Homecare in Fort Mohave, AZ. The agency serves the northwestern part of Arizona and part of California from a second office in Needles, CA.

Plus, the Baltimore-based Health Care Financing Administration (HCFA) has mandated that home care agencies receive reports from their states on their OASIS data and how it compares to their peers.

"So why are we doing ORYX?" Zuidema asks.

Homecare Quality Management asked this and other questions to Frank Zibrat, associate director of the ORYX implementation for JCAHO. (See story on answers to questions about ORYX, p. 27.)

Some duplication inevitable between OASIS and ORYX

Zibrat acknowledges that there is some duplication between data collecting for ORYX and OASIS, although not all agencies will use the same indicators for ORYX that are collected for OASIS. He offers these examples of benefits of the ORYX performance measurement system:

• Depending on which performance measurement service an agency selects, the ORYX reports will have benchmarking data from home care agencies nationwide, whereas the OASIS data may only be benchmarked among agencies within a particular state.

• ORYX reports will be issued beginning this year, and OASIS reports are expected to be delayed for a couple of years.

• Some performance measurement systems will offer risk adjustment in their reports, which will give agencies a more accurate picture of how an agency of their size, with their type of patient population, compares to peer agencies.

• ORYX reports will be issued quarterly, giving agencies plenty of time to improve deficits before a JCAHO survey.

Still, JCAHO is well aware that some home care agency staff might be unhappy with a dual requirement of collecting data for both OASIS and ORYX, which is why it is continuing to review options that will address this concern, such as using the OASIS data for both purposes, Zibrat says. "This is at a very preliminary stage as to how we might conceive conceptually the goals of the ORYX initiative and what’s being done at the state level [for OASIS]."

Home care agencies already can use their OASIS tool to collect information that will fulfill the ORYX requirement. Colorado River Homecare’s OASIS vendor is also an approved ORYX performance measurement system; when the company sends in its OASIS reports, the information is used for both purposes, Zuidema says.

All the agency had to do to fulfill ORYX requirements was select four indicators from the OASIS report, which will be sent to JCAHO and used for ORYX benchmarking and internal comparison reports.

"There were certain OASIS indicators that were acceptable for ORYX, also, and we chose the ones that we thought we’d like to see with benchmarking for our agency," Zuidema says.

The agency selected these indicators:

• readmissions to an acute care facility;

• discharges to the community;

• improvement of surgical wounds;

• medication management.

Not all indicators must be same as OASIS

Some home care agencies have selected indicators that are entirely separate from OASIS indicators. For example, Advanced Home Care in High Point, NC, has decided to use four indicators that pertain to customer satisfaction.

The agency is surveyed regularly by Press Ganey Associates of South Bend, IN, so these indicators come right off the patient satisfaction surveys, says Carolynn Rice, RN, BSN, MBA, director of quality improvement for the agency, which serves North Carolina through six offices. The agency also has a durable medical equipment (DME) business — half of the indicators pertain to DME services.

The agency’s indicators are:

1. How well did the nurse teach you to care for yourself?

2. How well did the nurse explain how to use your IV medications?

3. How well did the medical equipment delivery person answer your questions?

4. Did you receive adequate information about your oxygen setup?

The agency wanted to incorporate its customer satisfaction data with improving overall performance, Rice says. "We just feel that our patient care is the reason we’re here, and that’s what we want to focus on and make sure we’re doing a good job with that."

Since the agency already was using Press Ganey to collect patient satisfaction information, it was very easy to use the same company to collect ORYX indicators, Rice says, adding, "It’s been pretty seamless."

Atlanta vendor already providing ORYX reports

Illinois Valley Community Hospital Home-Based Services of Peru, IL, has already received its first ORYX report from its performance measurement system, Patient Care Technologies in Atlanta. The company issued an initial report based on third-quarter data of 1999, as a sort of baseline report, says Debbie Caresio, RN, performance improvement and information management supervisor for the hospital-based agency, which serves a rural area in north-central Illinois.

JCAHO did not require home care agencies to begin collecting data until Jan. 1, 2000.

The agency’s indicators are:

• Home care patients whose ambulation/locomotion stabilizes.

• Home care patients whose ambulation/locomotion improves.

• Home care patients whose management of oral medications stabilizes.

• Home care patients whose management of oral medications improves.

The agency selected those measures because while patients often become stable, not as many improve the way the staff thought they should, Caresio explains. "Now we’re really glad we chose those indicators, because those are the areas we will get good data out of."

Caresio says the ORYX reports will be useful for both internal goal setting and benchmarking with peers. "Our comparisons against ourselves are very important, too because that’s our goal to always keep improving

The only problem Caresio has with the ORYX indicators her agency has chosen is that since they are pulled from the OASIS tool, they define improvement the same way that OASIS defines it. For example, the OASIS tool does not acknowledge that a patient has improved in ambulation/ locomotion when the patient progresses from using a walker to using a cane.

"As far as OASIS data looks, that’s no improvement," Caresio says. "That still is an assistive device, and that’s where ORYX indicators will pull from. That bothers me, because the patient has improved, even though he is using a device."

For an agency that has a large number of patients who are age 80 or more, this type of definition could be a problem. Older patients might not be expected to improve to a point where they can walk without a cane, whereas younger patients should achieve that much independence. This discrepancy could leave one agency looking much worse than another.

That’s where risk adjustment plays an important role. JCAHO doesn’t require, but has encouraged, performance measurement systems to offer some type of risk adjustment, Zibrat says. "The one thing we stress is the issue of risk adjustment. We believe that in order to have fair and equitable measures of health care organizations, if a measure can be risk adjusted to account for a difference in patient populations, severity of illness, and comorbid conditions, it should be risk adjusted."