The Joint Commission on Accreditation of Healthcare Organizations is still dealing with a controversy of its own creation that began this past spring over a data-mining deal between its subsidiary, Joint Commission Resources, and the Blue Cross and Blue Shield Association.
The controversy boiled to the surface again last week as 18 Blues plans officially and publicly announced the pilot quality-monitoring programs driven by the data analyzed by Joint Commission Resources. But it was a continuation of the same pilot program that surfaced five months ago.
The dust-up began in May when many hospital leaders were surprised after some Blues plans uncorked without warning the first batch of a series of quarterly performance reports on their facilities. The leaders' surprise turned to anger when they learned the reports were based in part on aggregated data the hospitals were required to supply to the JCAHO for accreditation under its Oryx quality improvement program. Adding to their ire is a new JCAHO proposal that also would require hospitals to provide the Joint Commission with the patient-specific clinical data from which the aggregated Oryx data is derived.
Not all hospital leaders are mollified. The JCAHO effort is an unnecessary redundancy and exposure of patient data, said Pat Merryweather, senior vice president of the Illinois Hospital Association. "Where do patients' privacy rights come in?" she asked. "Hospitals feel very strongly they need to let patients know they are the protectors of that information. Consumers do want information, but they (also) want their information protected."
The Blues, under their national Network Hospital Measurement program, will release quarterly performance reports on hospitals comparing 18 evidence-based metrics. Employers will be provided the reports. To create the reports, Joint Commission Resources combined the Oryx data with data obtained from other sources.
Blues companies in about 30 states participating in the performance-monitoring scheme represent more than 80% of the 93 million Blues subscribers nationwide, according to the Chicago-based Blue Cross and Blue Shield Association.
"Our mission is to improve the consistency of these proven, evidence-based treatments at hospitals across the nation," said Blues association President and Chief Executive Officer Scott Serota, in a news release. "This program is designed to collaboratively elevate the quality of care delivered by hospitals in the Blue Cross and Blue Shield plans' networks."
The program is scheduled to last one year, but it could be extended, according to an association spokesman.
In July, JCAHO President Dennis O'Leary issued letters of apology to hospitals that were not aware of the agreement with the Blues before they were confronted with the first batch of reports. The JCAHO and hospitals are still deciding how the effort will proceed.
"It's still up for quite a bit of discussion," the IHA's Merryweather said. "All hospitals are going through a re-evaluation of their contracts for next year, and a good majority of them have been amending them for HIPAA protections and the use of data. I think the idea is to try to get a focus on what the information is being collected for, and what information the Joint Commission is going to require going forward."
Merryweather's association acts as a data collector and processor for about 100 Illinois member hospitals, forwarding edited data to Oryx, the government and the American Hospital Association-supported Hospital Quality Alliance, which partners in the provision of public access to hospital-specific information via a government Web site.
Merryweather said she has yet to see a full proposal from the JCAHO. "There has been a lot of talk about it, but nothing put in writing we can put our hands on," she said. The AHA has taken the lead in negotiations with the JCAHO on the issue, she said.
AHA spokesman Richard Wade said privacy and the focus of the JCAHO are the two main sticking points in the talks, the tenor of which he characterized as "bleak."
"There are serious HIPAA problems that have not been resolved by the contract amendments the Joint Commission would accept," Wade said. "We cannot roll over for a business venture of the Joint Commission that would put our patients' privacy in jeopardy."
Also, Wade asked, "Since when was the Joint Commission created to be a broker of information they collect and blow it out the door and sell it to insurance companies? We think there is a fundamental problem here. Is this one more broker of information in the marketplace or the serious accreditor of hospitals that the government looks to? That issue has not been resolved."
Charles Mowll, JCAHO executive vice president for business development, government and external relations, said the Joint Commission seeks to minimize duplication of reporting by hospitals by gathering the new, patient-specific data from the 40 to 50 vendors, like the IHA, that format and report the data for most hospitals under Oryx.
Mowll also said the JCAHO has been receiving, without complaint, samples of patient-specific data to check the accuracy of the data sets transmitted by the vendors since the Oryx program began in 2002. "We would never release patient-level data to anyone," Mowll said. "Patient-level data will help us ensure the information we're making publicly available is accurate, complete, valid and credible. It is very much a confidence issue here."