ORYX implementation deadline draws near
ORYX implementation deadline draws near
System selection tips for private duty providers
The Joint Commission on Accreditation of Healthcare Organization's (JCAHO) ORYX: The Next Evolution in Accreditation implementation looms closer for private duty providers. All home care organizations must select ORYX systems and two performance measures by Dec. 31. With only five short months left, providers who have not already done so should soon begin reviewing vendor systems and identifying possible performance measures for their organization, sources say.
The ORYX initiative, which integrates outcomes and other performance measures into the accreditation process, will require health organizations to collect performance data on outcomes of patient care and submit the data to JCAHO on a continuing quarterly basis. The individual organizational data and its comparison with that of other providers are expected to provide objective, quantifiable performance data that demonstrates each organization's relative patient care outcomes.
JCAHO-accredited hospitals and long-term care facilities selected performance measures by December 1997 and began submitting data in July. After selecting ORYX systems and performance measures this December, home care providers will submit data starting in March 2000.
With so many performance measurement systems to choose from (as of June 17, 66 home care performance measure systems had met JCAHO initial screening criteria) private duty providers may find the selection process daunting. (See list of approved systems, inserted in this issue.)
"It will be a challenge, but it is important to take time and make appropriate decisions for your organization," says Jan Potts, RN, BSN, MBA, an associate of The Corridor Group, an Overland Park, KS-based home care consulting firm.
Maryanne Popovich, RN, MPH, executive director of the JCAHO Home Care Accreditation Program agrees that providers have a lot of information to wade through, but adds that "if they start now, they will have enough time to explore systems and measures and possibly negotiate new measures with vendors."
· Identify possible performance measures.
Your choice of organizational performance measures and ORYX performance systems are closely related. Each performance system may have up to 25 JCAHO-approved clinical, patient perception of care, or health status performance measures. At least initially, JCAHO will only compare the performance of providers who use the same performance measures from the same performance measurement system, Popovich says. "We want to make sure we are comparing apples to apples and not put our providers in a bad comparison mode," she adds.
Create meaningful information
So it is important to have "some vision of what [you] want to measure," Popovich suggests. "We don't want this to be a very expensive compliance exercise that doesn't give [organizations] anything, [so we urge them] to use measures that will create meaningful information," she adds.
Private duty providers must choose at least two, but not more than five, performance measures that address at least 20% of the organization's patient population. "Consider the most problematic, the highest volume, or the indicators of high-risk patients," advises Potts. The organization's total duplicated annual admissions determine its base patient population.
Choosing a system that has already incorporated performance measures important to your organization in its logic may put you ahead of the game. If a vendor who otherwise meets your selection criteria does not now compile data on your ideal performance measures, you may be able to negotiate inclusion of those elements, according to both Potts and Popovich. However, you should also consider whether other organizations will use the same measures and vendor, Potts cautions.
· Consider your own information system sophistication.
Your organization's existing information system sophistication may have large bearing on your ORYX system choice, sources advise. Vendors have different data transmission requirements. Some will accept paper submissions from which they subsequently enter data for computer processing. Others require modem transmittals. Your organization's ability to comply with these requirements depends on its information system sophistication.
"There is a wide range of sophistication in home care systems," says Potts. "Some of the smaller companies do [everything] by hand and have nothing automated. Others have billing only [automated]. Some have billing and some operations [computerized], and some have point-of-care systems where they have electronic medical records," she adds. Evaluate your place on the data sophistication continuum as you review systems.
· Evaluate alongside OASIS requirements.
Both Medicare-certified and non-certified providers may use Outcomes Assessment Information Data Set (OASIS) measures. While it is the Health Care Financing Administration's chosen outcomes measurement system for Medicare patients, OASIS may work equally well for private duty providers.
If participating in both ORYX and OASIS, you may want to use the same vendor for both services, or at least plan for implementation at the same time, Potts advises. "The data capture and transmission issues are similar, she adds.
· Ask about the vendor's data and clients.
"One of the first questions [private duty providers] should ask vendors is whether they have any hourly patient data," says Potts. Many vendors are now more focused on skilled intermittent visits of the Medicare OASIS project, she adds.
Find out how many other home care and private duty providers are participating in the vendor's data and look at the mix of diagnoses they are now tracking. Ask for a reference list and speak with other providers using or planning to use the system, Potts advises.
Also look at the system's risk adjustment capabilities, i.e., how it takes into account other issues with patients such as multiple comorbidities. Outcomes for a large chronically ill patient population will vary from one with more acutely ill patients with the same diagnoses, she advises.
Providers should also ask how the system checks data accuracy and whether they will be able to correct and re-submit data if errors surface, says Potts.
· Determine system's reporting capabilities.
Because ORYX's ultimate purpose is to quantify companies' performance against like organizations, private duty providers should determine each system's report production capabilities, Potts advises. Check for report frequency, standard report format, and data elements; what report interpretation assistance will be available; and whether the system will allow demand or ad-hoc reports, she adds.
· Consider your affiliated hospital's choice.
While hospital-affiliated private duty providers must have their own clinical performance information, they should work closely with the hospital and ensure that theirs and the hospital's ORYX systems are compatible, Potts advises. "It would be ideal to have the same vendor if possible," she adds.
· Make a selection grid.
To help with your decision process, Potts suggests using a selection grid that lists the "must have" vs. "desirable" criteria. Rating all vendors against all the criteria will clarify not only the most important system elements but also the vendors who best meets your needs.
· Consider the organizational impact of any system.
Depending on the system selected, you may need someone to enter collected outcomes data into the information system, or you may instead purchase a scanner. In addition to the capital outlay to purchase the scanner, providers may face a higher ORYX system initial set-up charge. However, the monthly charge for scanable systems may be lower, and providers should weigh each system's capital costs with its impact on organizational productivity, Potts advises.
· Evaluate vendor support.
Look at the level of implementation and on-going support the vendor will provide, Potts advises. What kind of implementation training can you expect? What type of ongoing user help and interfaces will be available?
· Use JCAHO resources.
JCAHO has a wealth of ORYX selection information available for home care providers. Its Internet home page at www.jcaho.org lists all approved vendors and also provides vendor profiles, including information about system performance measures. The Web site also includes information JCAHO considered when evaluating potential ORYX systems. This may help individual providers with their selection process.
Regardless of the ORYX system you select, include all staff to make the implementation successful, Potts advises. "Get everyone involved. Show them that this will help identify how patients are doing and what can be done to [provide better care]."
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