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2022 Joint Commission ORYX Requirements

The Joint Commission quietly released their 2022 ORYX® requirements this week. Or rather, I should say they were a bit buried beneath the announcement that The Joint Commission’s DDS platform is shut down and being rebuilt, therefore, the deadline to submit your 2021 abstracted and eCQM performance is delayed.

“On Sept. 30, 2021, the Apervita platform for direct data submission of chart-abstracted measures and/or eCQMs shut down permanently, resulting in the inability for hospitals to submit ORYX performance measurement data to The Joint Commission. Due to this, chart-abstracted and eCQM accreditation data submission timelines will be delayed in 2021 and 2022.

A new Joint Commission Direct Data Submission Platform (DDSP) is being built to collect both chart-abstracted and eCQM data. … We anticipate that hospitals will submit their 2021 and 2022 data to the new DDSP in the second half of 2022. A more specific timeline will be communicated when the platform launch date has been determined.”


Beyond that big announcement, there weren’t many changes to the ORYX
® program requirements in 2022. To be honest, the biggest challenge we foresee is keeping the requirements straight between the ORYX® program and the CMS Inpatient Quality Reporting (IQR) program. They used to be mostly identical and now they are similar but with enough changes to confuse us all.

Let’s review some of the major changes to the ORYX® program and then go over the actual requirements for 2022.

ORYX® Program Notable Changes

  1. You must submit three quarters of eCQM data instead of two (same as IQR).
  2. There is one new eCQM available - ePC-07 Severe Obstetric Complications (not available in the IQR program).
  3. As of now, TJC still will not publicly report eCQM results (IQR eCQM results will be published by CMS).
  4. If your hospital is required to submit eCQMs, but unable to, then you must submit an extenuating circumstance request (ECR) form prior to the chart-abstracted deadline and must submit 3 chart-abstracted measures for all four quarters of 2022 instead. Hospitals must submit a new ECR form each year.

That covers the major changes you should be aware of. Now let’s move onto the requirements for the ORYX® program in 2022.

2022 TJC ORYX® program requirements

For reference, here is The Joint Commission’s PDF of 2022 requirements.

Chart-abstracted measure ORYX® requirements

The Joint Commission abstracted measure requirements essentially remain the same. Remember that Critical Access Hospitals are now required to submit data (abstracted and/or eCQMs).

Note: For any or all of the required chart-abstracted Perinatal Care Measures (PC-01, PC-02, PC-05 and PC-06), hospitals may submit a minimum of three quarters of the associated PC eCQM instead of four quarters of the corresponding chart-abstracted measure.

Requirement:

Chart-Abstracted Measures

Hospitals with ≥26 beds

OR ≥50,000 Outpatient visits

AND:

300+ live births

Hospitals with ≥26 beds

OR ≥50,000 Outpatient visits

AND:

1-299 live births

Hospitals with ≥26 beds

OR ≥50,000 Outpatient visits

AND:

No OB services
Freestanding Psychiatric Hospitals Critical Access Hospitals Hospitals with <26 beds AND <50,000 Outpatient visits
PC-01
PC-02
PC-05
PC-06
PC-01 None HBIPS-1
HBIPS-2
HBIPS-3
HBIPS-5
Submit any combination of 3 eCQMs (3 quarters) and/or chart-abstracted measures (4 quarters) Submit any combination of 3 eCQMs (3 quarters) and/or chart-abstracted measures (4 quarters)

 

eCQM ORYX® requirements

In 2022, hospitals must submit three quarters of data instead of two quarters. The eCQMs must be the same for all three quarters but they don’t have to be consecutive quarters. Remember that this data must still be submitted via the DDS platform, but unlike the abstracted measures, eCQMs must still contain patient-level data in the form of a QRDA I file format. Also, as of now, TJC will not publicly report eCQM results unlike CMS who will publish the IQR eCQM results.

Note: For any or all of the required chart-abstracted Perinatal Care Measures (PC-01, PC-02, PC-05 and PC-06), hospitals may submit a minimum of three quarters of the associated PC eCQM instead of four quarters of the corresponding chart-abstracted measure.

Requirement:

eCQMs

Hospitals with ≥26 beds

OR ≥50,000 Outpatient visits

AND:

300+ live births

Hospitals with ≥26 beds

OR ≥50,000 Outpatient visits

AND:

1-299 live births

Hospitals with ≥26 beds

OR ≥50,000 Outpatient visits

AND:

No OB services
Freestanding Psychiatric Hospitals Critical Access Hospitals Hospitals with <26 beds AND <50,000 Outpatient visits
Submit any 4 eCQMs, reporting the same eCQMs for 3 self-selected quarters Submit any 4 eCQMs, reporting the same eCQMs for 3 self-selected quarters Submit any 4 eCQMs, reporting the same eCQMs for 3 self-selected quarters HBIPS-1
HBIPS-2
HBIPS-3
HBIPS-5
Submit any combination of 3 eCQMs (3 quarters) and/or chart-abstracted measures (4 quarters) Submit any combination of 3 eCQMs (3 quarters) and/or chart-abstracted measures (4 quarters)

 

Facilities with suspended requirements

As in the past, the following facilities are exempt from The Joint Commission ORYX® requirements in 2022:

  • Freestanding Children’s Hospitals
  • Long Term Acute Care Hospitals
  • Inpatient Rehabilitation Facilities
  • Hospitals participating in the CMS PPS-Exempt-Cancer Hospital Quality Reporting program

 

 

Stay Ahead of the Quality Curve

This is a big year for Quality. Medisolv can help you along the way. Along with award-winning software you receive a Quality Advisor that helps you with all of your technical and clinical needs.

We consistently hear from our clients that the biggest differentiator between Medisolv and other vendors is the level of one-of-one support. Especially if you use an EHR vendor right now, you’ll notice a huge difference.

  • We help troubleshoot technical and clinical issues to improve your measures.
  • We keep you on track for your submission deadlines and ensure you don’t miss critical dates
  • We help you select and set up measures that make sense based on your hospital’s situation.
  • You receive one Quality Advisor that you can call anytime with questions or concerns. 

Contact us today.

Here are some resources to help you get started:

Download: "[eBook] 2022 IQR Program Requirements"

 

 

Erin Heilman

Erin Heilman is the Vice President of Marketing for Medisolv, Inc.

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