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Present on Admission Indicators
Today and Tomorrow
Patrick W. Kennedy, Administrator, Office of Data Collection & Quality Assurance, Agency for Health Care Administration, Thursday, March 20, 2008
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The History of POA in Florida
- POA reporting adopted on a voluntary basis via administrative rule in 2006
- POA reporting then mandated by rule to begin in 1stQ of 2007 (numeric format) and 2ndQ of 2007 (alpha format)
- 2ndQ 2007 change aligns FL reporting with national standards
- Mandatory reporting began 1stQ 2007
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Easy Stuff First...
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POA Defined...
- Stands for: "Present on Admission"
- Defined in rule as: "Present at the time an order for inpatient admission occurs."
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What Does That Mean?
- Conditions that develop during an outpatient encounter, including ED, observation or outpatient surgery are considered as present on admission.
- For each diagnosis and external cause of injury code a present on admission indicator should be assigned.
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POA Actual Indicators
- Y = Yes - Present at the time that the order for inpatient admission occurs.
- N = No - Not present at the at the time that the order for inpatient admission occurs.
- U = Unknown - Documentation is insufficient to determine if condition is present on admission
- W = Clinically undetermined - Provider is unable to clinically determine whether condition was present on admission.
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Exempt from Reporting
- Leave the present on admission field blank if the condition is on the list of ICD-9 CM codes for which this field is not applicable.
- These conditions are considered exempt because they do not represent a current disease or injury or are always present on admission:
- This is the only circumstance in which the POA field may be left blank.
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Examples of Exempt Codes
- V11 - Personal history of mental disorder
- V22 - Normal pregnancy
- V52 - Fitting and adjustment of prosthetic device and implant
- V67 - Follow-up examination
- E810-E819 - Motor vehicle traffic accidents
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POA Examples
- Pt. admitted for diagnostic work-up for cachexia. Final dx malignant neoplasm with metastasis. Assign "Y" as condition was clearly not present at admit even though dx occurred in hospital.
- Pt. undergoes outpt surgery. During recovery develops a-fib and admitted. Assign "Y" as condition developed prior to admit.
- Pt. undergoes inpt surgery. Afterward devlops fever & is treated aggressively. Physician's final dx "possible postop infection". Code "N" since final dx contains term "possible".
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Nursing Homes and POA
- Many nursing home admissions are made through ED
- Standard practice for many nursing homes
- In such cases, proper use of POA is key in characterizing conditions that are hospital-acquired
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Why POA?
- CMS began collecting POA indicators
- Consistency of data (comparability)
- Policy and Research
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Policy and Research?
- Florida Center collects data from all hospitals, ASCs and EDs
- Data used by facilities, academia and government
- Understanding Florida's healthcare system
- Supports reasonable and informed regulatory and systems change decision-making
- Transparency assists informed consumer decisions (www.FloridaHealthFinder.gov)
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POA & VBP
- VBP - Value-based purchasing
- POA - (certain)HACs - SOS... er... VBP
- CMS limiting reimbursements for some conditions that were not POA
- Better than across-the-board cuts?
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AHCA & POA: The Present
Potential Uses for POA:
- Transparency
- Track in-hospital morbidity (r/o)
- Track avoidable re-admissions (r/o)
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AHCA & POA: The Present
Potential problems with POA:
- First Q = Garbage
- Second Q = ??
- Source of Admission (Point of Origin)
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AHCA & POA: The Future
- Medicaid and VBP? - No!...
- As in No!...plans right now
- CMS has not authorized
- Legislature ultimate control
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Patrick W. Kennedy
Administrator, Office of Data Collection & Quality Assurance, Agency for Health Care Administration, Thursday, March 20, 2008
