Joint Commission’s Ongoing Professional Practice Evaluation process called ‘costly, ineffective and potentially harmful’

The Joint Commission’s Ongoing Professional Practice Evaluation process, or OPPE, used to pinpoint trends that impact quality and safety, is “costly, ineffective and potentially harmful,” researchers claimed in a study published Wednesday.

Imaging providers who are accredited by the commission must undergo this process, which requires collecting data to assess core competencies such as patient care, medical knowledge, professionalism and communication skills. However, little to no research has been performed to support the effectiveness of the program, hospital leaders wrote in the Journal of the American College of Radiology [1].

“Based on the authors’ subjective experiences, our premise is that [Ongoing Professional Practice Evaluation] has added a significant administrative cost to healthcare organizations, identifies few to no outlier performers in which OPPE metrics alone result in lack of renewal, limitation, or revoking of hospital privileges, and has had a harmful effect on the culture of safety by mixing data gathered for the purpose of learning and improvement with that for the purpose identification of outlier performers,” radiologist Lane F. Donnelly, MD, a professor and director of quality at UNC Children’s Hospital, wrote Sept. 6.

To support their hypothesis, the University of North Carolina’s health system and five other such organizations partnered to evaluate labor expenses related to conducting The Joint Commission’s evaluation. Their estimates included average hours and wages paid for data analysts, medical staff office professionals, departmental physician leaders and administrative assistants, using estimates to extrapolate across the entire U.S. Donnelly and co-authors also identified the number of outlier performers who were pinpointed via the OPPE program’s metrics alone.

Across 12,854 providers evaluated by the program via the study, zero were labeled as outlier performers “solely through the OPPE process.” Hospitals spent recurring labor costs per provider of about $50.20, extrapolated for a total national cost of roughly $78.54 million. Spread across the past 15 years, researchers estimated that providers have spent some $1.178 billion during OPPE’s existence.

“These findings raise the possibility that, as currently practiced, OPPE could be viewed as predominantly administrative waste,” the authors concluded. “Further study and engagement between hospital systems, TJC, and professional societies to align regulatory goals, quality improvement, professional development, and national performance standards to produce a more effective and efficient mechanism of professional oversight is a worthy goal.”

The Joint Commission did not immediately respond to a Radiology Business request for comment on the analysis Wednesday. Other organizations involved in the study included Nemours Children’s Health, Cincinnati Children’s Hospital, Stanford Medicine Children’s Health, Texas Children’s Hospital and the Baylor College of Medicine.

Read more in JACR at the link below.

UPDATE: The Joint Commission provided the following statement on Sept. 8 in response to the JACR article, citing this standards document: 

Unfortunately, the authors have a serious misunderstanding about The Joint Commission’s OPPE requirements. All we require is “a clearly defined process in place that facilitates the evaluation of each physician’s or other licensed practitioner’s professional practice.” Organizations decide what to measure and how to measure. The claim that we require organizations to evaluate the six core competencies of ACGME is simply not true. It appears that the six-hospital system where this project was conducted has put in a large system for measuring performance. We applaud them for that. However, the system should be aware that they have the latitude to choose the measures that they think are most valuable for driving improvement, including identifying clinicians who need individual counseling and focused education or training to improve.