Like a horse that's been spooked, the hospital industry has reared up in alarm again at something cast in its path by the Joint Commission on Accreditation of Healthcare Organizations.
This time it's Oryx, the performance measurement mandate unveiled by the Joint Commission almost two years ago. Late last year, the JCAHO introduced a new element into the Oryx mix. Now the industry is saying "thanks, but no thanks."
In fact, the hospitals claim that the JCAHO made the change without adequate input from the field or the JCAHO's board.
In a three-page open letter to Dennis O'Leary, M.D., the JCAHO's president and chief executive officer, 17 state hospital associations complain that the accreditation agency has exceeded the industry's ability to meet its demands.
Specifically, hospitals are upset about the commission's announcement on Nov. 20 that it had selected 12 "acute-care focus areas" for core performance measures as the next stage of Oryx. Hospitals fear they are losing their freedom to select the clinical measures they submit to the JCAHO.
Eventually, hospitals will have to show improved clinical results to earn accreditation.
The state associations' letter, dated Jan. 4, is introduced by a letter from Don Nielsen, M.D., the American Hospital Association's senior vice president for quality leadership. The AHA endorses the states' concerns.
"There is a significant investment on the part of hospitals . . . in complying with current policy," Nielsen said in an interview. "The core measurement policy will require significant additional investment and rework by many organizations."
Take Caesarean sections, for example. That performance measurement can be calculated a lot of ways under Oryx, depending on the denominator-such as whether it includes all mothers or just those at risk-and the system vendor. But after a specific core measurement is decided on, Nielsen said, hospitals "might have to go back and redo and recalculate the C-section rate, or revamp data collection procedures," to be able to show clinical improvement.
In a letter to Nielsen, O'Leary said the state hospital groups' letter raised "some legitimate issues, but it also contains significant misperceptions and erroneous information."
Contrary to the allegations in the letter, O'Leary said, the JCAHO has tried from the beginning to involve all interested parties in the creation of the new measurement system. The Joint Commission won't impose the measures by fiat or before the industry is ready, he said.
O'Leary said he wants to invite all the state hospital associations to a face-to-face meeting in Chicago within the next six weeks to iron out the differences.
Nielson's letter says the AHA "supports the concerns" of the state associations despite the fact that the AHA appoints seven members to the JCAHO's board of commissioners.