In a move small hospitals welcomed, the Joint Commission on Accreditation of Healthcare Organizations relaxed its requirements for their participation in its new performance-measurement program Oryx.
The accrediting agency's board of commissioners eased up on smaller hospitals because it's trickier for them to find meaningful outcomes to measure, harder to attain reliable numbers, and relatively more costly.
The JCAHO board also moved to delay implementation of Oryx for freestanding psychiatric facilities because their operators say they lack sufficiently sophisticated measurement systems. The board decided it would be better to introduce Oryx for all elements of behavioral healthcare at the same time, probably late 1998.
Oryx is designed to encourage quality improvement in patient care by requiring hospitals to submit monthly data on outcomes as part of the accreditation process. By year-end, hospitals must choose an information system vendor and select at least two procedures on which to submit results.
Deborah Nadzam, vice president for performance measurement at the
JCAHO, said vendors have developed lots of systems that measure complicated procedures, such as open-heart surgery, but relatively few that monitor less complex conditions, such as pneumonia, that are the bread and butter of small community hospitals.
Small hospitals, defined by the JCAHO as having an average daily census of 10 to 30 patients, will submit data quarterly instead of monthly. The JCAHO decided a monthly data sample would be too small to show real improvements or declines in patient care. Those hospitals still must choose a computer system and procedures to measure.
Small hospitals that have more than 150 outpatient visits a month may focus their quality reporting on the ambulatory population instead of inpatients. For larger hospitals, at least one measure must be on inpatients.
Hospitals that have an average daily census of fewer than 10 patients and fewer than 150 outpatient visits a month are temporarily excused from Oryx. "We are looking at alternative strategies," Nadzam said. "The numbers are too small in both inpatient and outpatient settings."
The JCAHO is working on coming up with more meaningful requirements.
Fayette Memorial Hospital in La Grange, Texas, which runs 45 beds and has an average daily census of 20, was pleased with the JCAHO's decision, although paying for even the quarterly requirements will be a struggle.
The expense "is going to be a hardship for small hospitals," said Wanda Bartek, Fayette associate administrator of evaluation and support services. "We're a community-owned hospital. We're not part of a chain. We have to make it on our own."
The hospital will have to buy a new computer and lease software for about $11,000 a year. Up to this point Bartek has gotten by with a quality-control system she improvised using an off-the-shelf database. "It saved the hospital lots of money, but it's not adequate anymore," she said.
Bartek said she has found a software vendor she likes with programs that seem user-friendly for a small hospital. But she's waiting for the vendor to get final approval from the JCAHO.
Fayette is just starting budget planning for next year, and this is a major new expense, she said. "We're going to have to find the money somewhere. I'm really curious how many small hospitals may have to drop Joint Commission accreditation because of this."