Welcome to the Next Level (In Accreditation, That Is)

Welcome to the Next Level (In Accreditation, That Is)

Welcome to the Next Level (In Accreditation, That Is)

managed care

It isn’t a bird; it isn’t a plane; and it isn’t an antelope, either. It’s the Joint Commission’s ORYX Initiative.

ADVANCE Assistant Editor

What exactly is ORYX?
If you are a trivia buff, you might answer, “an oryx is a type of antelope.” If you are a health information management (HIM) professional, however, you’d better have another answer on the tip of your tongue if somebody asks.

To those in health care, the term should call to mind “ORYX: The Next Evolution in Accreditation.” This is the full name of an initiative launched by the Joint Commission on Accreditation of Healthcare Organizations—the largest standards-setting and accrediting body in health care—to integrate performance measures into the accreditation process.

According to Sharon Sprenger, MPA, RRA, project manager for the Joint Commission’s department of research and evaluation, the ORYX initiative is the last component of more than a decade’s worth of work that began in 1986 with the Joint Commission’s Agenda for Change. “The Agenda for Change was designed to make the accreditation process more relevant and meaningful,” Sprenger stated.

“The Joint Commission realized there was a growing demand for objective comparative information about the performance of health care organizations,” she explained. “To continue assuring the public and other interested stakeholders that continuous attention was being given to the care provided by health care facilities, the Joint Commission’s current triennial, onsite survey process had to evolve.”

By collecting and comparing scientifically valid data on performance measures and outcomes from each accredited facility, the Joint Commission will be able to determine how each organization uses such information to analyze processes and outcomes and improve patient care. It can then map trends across different organizations and discover anomalies at particular facilities, especially when data from organizations using the same performance measurement system and the same clinical measures are compared.

For example, under the ORYX initiative, a health care institution might decide to examine the link between its perioperative practices and its mortality rate during surgeries. “Facility A might seem to have an irregularly high intrahospital mortality rate on paper,” said Frank Zibrat, associate director of the Joint Commission’s department of performance measurement. “But an examination of all relevant data might reveal that Facility A operates on much older or more critically ill patients than the other facilities it is being compared against. When you factor this information into the equation, Facility A’s mortality rate might not seem so high.”

Another benefit of the ORYX initiative is that it will allow the Joint Commission to “stay in touch” with its accredited organizations on a much more frequent basis. “The current survey process is like a snapshot,” Sprenger explained. “It provides a brief glimpse, based on standards compliance, of each accredited facility once every three years.”

While the accreditation process will still remain standards-based, accredited organizations also will be required to submit performance data to the Joint Commission on a quarterly basis. “This will allow us to develop a more continual relationship with each accredited facility,” Sprenger elaborated. “In this manner, the accreditation process will become more like a continuous motion picture than a still-life photograph.”

The Requirements
The Joint Commission’s Board of Commissioners approved the initial accreditation requirements for the ORYX initiative in January 1997. At first, the mandates of ORYX will apply only to accredited hospitals and long-term care organizations.

By December 31, these organizations must select and enroll in one or more performance measurement systems that meet the Joint Commission’s initial requirements for inclusion. Then, each facility must select from its performance measurement system(s) at least two clinical measures that relate to at least 20 percent of its patient or resident population.

Finally, each accredited facility must begin submitting data relative to its selected measures no later than March 31, 1999. Thereafter, monthly data points are expected to be submitted on a quarterly basis.

“The ORYX initiative was designed to be flexible and affordable for participating institutions,” Sprenger noted. “We are phasing in the requirements slowly in an effort to accommodate the real-world capabilities of our accredited organizations.”

Further expansions of the basic ORYX program will require hospitals and long-term care organizations to increase the number of measures for which they are collecting data. By Dec. 31, 1998, these facilities will be required to report on four clinical measures that relate to at least 40 percent of the patient or resident population; by Dec. 31, 1999, those figures increase to six and 60 percent. At the end of the year 2000, ORYX will require hospitals and long-term care organizations to amass data on eight clinical measures, encompassing at least 80 percent of an institution’s patient or resident population.

To accommodate hospitals already engaged in performance measurement activities that go far beyond the basic ORYX requirements, the Joint Commission is offering a voluntary accelerated option known as ORYX Plus. Initially, participation in ORYX Plus, which is being offered only to accredited acute care hospitals, will involve choosing at least 10 of 32 measures that the Joint Commission has identified as being common to acute care organizations.

Lest you think other types of accredited health care institutions have been forgotten, rest assured—they, too, will be phased into the ORYX initiative. By Dec. 31, 1997, Joint Commission-accredited health plans, integrated delivery networks and provider-sponsored organizations (PSOs) are required to have chosen a minimum of 10 separate measures that have the greatest relevance to their enrolled populations from one or more of five specified consensus-based measure sets. Then, in 1998, data analyses based on the selected measures will be reviewed during the accreditation survey. In 1999, the health plan will need to demonstrate improvement in outcomes and other measures, such as functional status or enrollee satisfaction.

In addition, it is anticipated that clinical laboratories and home health, behavioral health and ambulatory care organizations will have to meet initial ORYX requirements in the near future.

The Systems
To comply with ORYX, facilities must choose a performance measurement system that has been deemed acceptable by the Joint Commission’s Council on Performance Measurement (COPM) and Board of Commissioners. One system on the market, the Indicator Measurement System (IMSystem), was developed in-house by the Joint Commission. Computer Sciences Corp., based in San Diego, will be maintaining IMSystem’s database and processing the data it gathers.

“The measures in the IMSystem were developed in consultation with a variety of experts—physicians, nurse practitioners, pharmacists and other health care practitioners,” Zibrat explained. “The Joint Commission decided upon these measures from a much larger pool of measures after two years’ worth of beta testing.”

In the interest of fairness, however, there are scores of other systems available on the market—99 to date—that have met the COPM’s initial criteria for inclusion in ORYX. “The IMSystem is just one of the many performance measurement systems that a health care facility could choose to meet the requirements of the ORYX initiative,” said Zibrat.

(For a list of accepted vendors, call Joint Commission’s special ORYX information line at (630) 792-5085 or visit their web site at http://www .JointCommission.org).

The ORYX initiative not only provides health care organizations with a good framework for strategic planning, it offers a bonus to HIM professionals as well: the unique opportunity to showcase their talents throughout the entire facility.

“HIM professionals should seize the day, so to speak,” Sprenger stated. “It’s a good chance to make other health care professionals aware of exactly what you do. HIM professionals can demonstrate how data are collected and how codes are assessed and assigned, point out the implications and limitations of certain pieces of data, and stress the importance of putting data into a relevant context.”

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