Despite cost and risk, ORYX PLUS offers benchmarking bonanza
Despite cost and risk, ORYX PLUS offers benchmarking bonanza
Standardized measurement, risk adjustment are part of package
If you want a glimpse into the future of performance measurement, look into the Joint Commission’s crystal ball of accreditation: ORYX PLUS. The resulting national database from this voluntary initiative could be a benchmarking bonanza because it calls for health care organizations to use a standardized set of performance measures, which are then risk-adjusted with a common model.
Sound too good to be true? The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, is working hard to make it reality. Unlike previous initiatives, the timing could be right for this one. The ORYX PLUS project coincides with two imperatives driving the health care industry: 1) automation of information systems to track outcomes and costs across an episode of care, and 2) consumer demand for more information about health care services.
ORYX PLUS is an attractive tool to meet both objectives because it offers a standardized methodology for tracking and reporting outcomes, as well as a credible portal to the consumer for publicizing those outcomes.
Performance reports based on the data will be issued to the public, explains Deborah Nadzam, PhD, RN, vice president of performance measurement at the Joint Commission. Although ORYX PLUS was developed as an accelerated option for acute care hospitals that wanted "an approach to help them meet both JCAHO requirements and the growing demand for data by the public and payers," its potential is much greater.
"It is also a vision of where we expect to eventually be in all our accreditation programs," she says. "In the future, when we have developed standardized measurements for each [JCAHO accreditation] program, we will have a reliable data base through which data can be released to the public in a meaningful manner."
Toward data-driven accreditation
ORYX-PLUS is a sort of big brother to ORYX, the Joint Commission’s incremental, electronic outcomes reporting program set to begin this year. The intent of both ORYX and ORYX PLUS is to integrate outcomes and other performance measurement data into JCAHO’s accreditation process through quarterly reviews of data, rather than surveys every three years, Nadzam explains. (For more information on ORYX, see Healthcare Benchmarks, April 1997, pp. 54-55.)
"The goal is to achieve a more continuous, data-driven, and comprehensive accreditation process that not only evaluates a health care organization’s methods of compliance with standards, but the outcomes of these methods as well," Nadzam says.
Yet because the PLUS option uses a common set of measures, it may offer more benchmarking potential for its $2,500 annual price tag than the basic ORYX. (This JCAHO fee is in addition to hospital and vendor costs to gather, analyze, and transmit data.) Because of the complexity and minimum number of outcomes included in the PLUS package, hospitals that already have advanced information technology systems are best positioned to use ORYX PLUS.
For example, under ORYX, which is required of all hospitals and long-term care facilities seeking accreditation, organizations must select by March 2 (the deadline was extended from Dec. 31, 1997) at least two but no more than five clinical measurements that affect 20% of its population.
"The 60-day extension was in response to growing concerns expressed by health care organizations regarding the significant numbers of measures that would have been needed to address the targeted 20%," Nadzam says.
Last fall, after reviewing individual performance measures in the approved systems, JCAHO determined that many measures were not suitable for application in the accreditation process.
"Most of the rejected measures were global in nature and thus did not lend themselves either to meaningful external or internal benchmarking," she explains. However, when global measures such as overall hospital mortality were eliminated, it made meeting the 20% target increasingly difficult, even with the use of multiple measures.
"This led to the executive committee’s action to cap the number of measures required at five," she says. "The action taken is consistent with the Joint Commission’s intent to keep the initial ORYX requirements simple and at a modest level."
Focus on improvement
Almost all of the measures approved focus on performance improvement activities for specific patient populations. With the ORYX PLUS option, however, hospitals will select and report on 10 measures out of a standardized set of 32, Nadzam explains.
The initial set of measures includes indicators from perioperative, obstetrics, cardiovascular, trauma, oncology, medication use, and infection control. "But we fully expect to add other measures in the future," she says. (See list of ORYX-PLUS measures, pp. 16-17.)
Yet JCAHO acknowledges that any data disclosed to the public must be carefully collected, analyzed, and released. "These measures are the best out there," says Jill Egger, MS, ED, RN, performance measurement analyst with JCAHO. "They were developed by task forces of clinical experts from many different disciplines and tested for reliability and validity in hundreds of hospitals."
To maintain data integrity throughout the reporting process, JCAHO also is requiring more stringent requirements from ORYX PLUS vendors. As of February, only about 20 of the 208 vendors approved for ORYX are also under contract with the JCAHO to offer ORYX PLUS. (See list of approved vendors, p. 18.)
"These vendors signed a rider to their original contract that is specific to ORYX PLUS. That means they have added at least 10 measurements according to Joint Commission specifications," Nadzam says. "We will be evaluating their additions to make sure they were done correctly."
For example, JCAHO has provided detailed programming specifications and allowable values for every data element as well as the allowable values for each indicator, Egger says. "The system must set up its data collection activities following those specifications."
Vendors also must use JCAHO’s model of risk adjustment. "They will apply this model to patient-level data received from the hospitals and submit that risk-adjusted data to the ORYX accreditation data base," Nadzam says.
She adds that the Joint Commission also will evaluate the vendors’ process of risk adjustment. "We want everyone to be adjusting the data using the same coefficient."
Only when the vendors under contract satisfy the Joint Commission with the addition of performance measurements as well as application of the risk adjustment model will JCAHO "indicate they are truly ORYX PLUS systems," she says.
Hospitals considering the PLUS option should make it as productive as possible, Egger and Nadzam agree.
"First, re-evaluate your measurement needs before you do anything. Who is asking you for what? Then look at your patient population and choose your 10 measurements wisely," Egger says.
Next, match your measurement needs with the capabilities of the vendor’s system. "Talk with vendors to first find out which indicators the system is set up to track because an ORYX PLUS contract does not mean vendors must offer all 32 measures," she says.
Then ask them for tips and suggestions as to how relevant data elements should be collected to meet JCAHO specifications. For example, the hospital may record birth weights in pounds and ounces, but the obstetrical measure calls for it to be collected in grams.
If disclosure makes you uncomfortable . . .
Such precautions could mean a benchmarking boon for those organizations that choose the option because they will create an environment where the proverbial "apples to apples" comparison can flourish.
Yet some health care organizations have expressed concerns about public disclosure. "Early participants will have the benefit of working with us to design and test the actual format [of the public disclosure report]. That’s one advantage in electing ORYX PLUS now. We’re still in the initial stages of developing it, so participants will have a voice in its creation," Nadzam says.
ORYX PLUS participants also will receive an annual certificate of recognition that could be used as a marketing tool with payers and the public, she suggests. "This is not a notice of quality but one of willingness to participate in a national comparative effort that includes disclosure."
Depending on the number of PLUS participants and the volume of data each one submits, JCAHO could start releasing data by 2000.
"First we have to prove to potential participants that we take public disclosure seriously and will not do it without careful thought and evaluation of both the data and the report format," Nadzam says.
For more information on ORYX PLUS, visit the Joint Commission’s Web site at http://www.jcaho.org or call the ORYX information line at (630) 792-5085 and select option 0 to speak with a staff member.
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