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Present on Admission Indicators

Today and Tomorrow

Patrick W. Kennedy, Administrator, Office of Data Collection & Quality Assurance, Agency for Healthcare Administration, Thursday, March 20, 2008

AHCA logo

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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 Healthcare Administration, Thursday, March 20, 2008