Implications Of Cm Ss Present On Admission (Poa) Provisions Making Dollars And Sense

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Policy regulations and hospital reimbursement are at risk with new CMS rules based on Present on Admission criteria

Text of Implications Of Cm Ss Present On Admission (Poa) Provisions Making Dollars And Sense

  • 1. Implications of CMSs Present on Admission Provisions in the ICU: Making Dollars and Sense Todd M. Grivetti, MSN, RN, CCRN, CNML Clinical Nurse Manager Regional Neurosciences Center Poudre Valley Hospital Ft. Collins, CO 2008 Award Recipient
  • 2. Disclosure Statement
    • Todd M. Grivetti, MSN, RN, CCRN, CNML
    • Disclosure
      • Speakers Bureau AACN
      • Financial Interest - None
  • 3. House Keeping tips
    • Class Code 169
    • Session Times 2:15 3:30 pm
    • Please turn cell phones and pagers off or to Vibrate.
    • Please utilize the microphones in the room for questions.
  • 4. Learning Objectives
    • Review, Discuss, and Understand the Present on Admission Provisions
    • Discuss practical implications of hospital acquired conditions
    • Incorporate evidence-based research with confidence to establish unit specific guidelines to eliminate hospital-acquired conditions
    • Develop and implement a customized POA risk assessment.
  • 5. Definitions
    • CMS Centers for Medicare and Medicaid Services
    • IPPS Inpatient Prospective Payment System
    • DRG Diagnosis Related Group
    • HAC Hospital Acquired Conditions
    • NI Nosocomial Infection
    • POA Present on Admission
  • 6. Evolution to Quality Based Payment
    • Public Awareness
      • 1999 IOMs To Err is Human is published.
      • 2001 IOMs Crossing the Quality Chiasm.
    • Quality Reporting
      • 2003 CMS Begins quality reporting in-patient initiatives.
        • Ten Metrics
      • 2008 CMS Begins Quality reporting out-patient initiatives.
        • Seven Metrics
  • 7. Evolution to Quality Based Payment
      • 2007 Physician Quality reporting
      • 2008 Outcome measures introduced
    • Other entities monitoring hospital quality and safety initiatives:
      • Joint Commission
      • Association of Healthcare Research & Quality (AHRQ)
      • Leap Frog
      • Health Grades
      • State Governments
      • Private Insurance companies
      • Patient Safety Organizations
  • 8. Evolution to Quality Based Payments
    • Individual contracts between hospitals and insurers
    • 2004 - CMS/Premier begins demonstration project.
      • Pay for Performance
      • Hospital Quality Indicator Demonstration (HQID)
        • Uses national measures to test payment methods.
    • Deficit Reduction Act (2005)
      • IPPS 2008
        • Severity adjusted payments
        • POA Provisions
  • 9. Deficit Reduction Act - 2005
    • CMS selected a variety of hospital-acquired conditions deemed to be reasonably preventable that will receive lower payment if not coded at present on admission.
    • If a claim includes one of the conditions falling under this policy as a secondary diagnosis without a present on admission indicator, it will be reimbursed as if the secondary diagnosis was not present, leading to reduced payment.
  • 10. Hospital Acquired Conditions selected for Present on Admission Provisions
    • FY 2008
      • Pressure Ulcers (decubitus ulcers)
      • Catheter-associated urinary tract infections
      • Object left in surgery
      • Mediastinitis after CABG surgery
      • Air embolism
      • Blood incompatibility
      • Vascular catheter associated infections
      • Falls
  • 11. Hospital Acquired Conditions selected for Present on Admission Provisions
    • FY-2009 Conditions not selected but being considered.
      • Clostridium difficile associated disease
      • Deep vein thrombosis (DVT)
      • Pulmonary embolism
      • Staphylococcus aureus septicemia
      • Ventilator associated pneumonia (VAP)
      • Methicillin Resistant Staphylococcus aureus (MRSA)
      • Delerium
  • 12. Hospital Acquired Conditions selected for Present on Admission Provisions
    • Conditions NOT SELECTED for FY-2009 and will not be subjected to provisions
      • Legionnaires disease Not typically a HAC
      • Wrong site or Wrong surgery
        • Medicare WILL NOT pay at all
  • 13. Phased Implementation of POA
    • August 2007
      • FY 08 IPPS Final rule announced: POA provision finalized
    • October 2007
      • Short term, acute care hospitals required to begin reporting POA codes, information not used in claims.
    • January 2008
      • CMS begins processing POA data and provide feedback on POA reporting errors
      • Hospitals submitting invalid POA code receive remark code on remittance advice; claims with errors still processed.
  • 14. Phased Implementation of POA
    • April 1, 2008:
      • Claims that are submitted for payment that do not contain proper POA data will be returned to the provider for correct submission of POA information.
    • April 15 2008:
      • FY09 IPPS Proposed Rule announced; CMS outlines plan to expand POA provision to additional conditions
    • August 2008:
      • FY09 IPPS Final Rule expected; expansion of condition list in POA provision likely.
    • October 2008:
      • POA provision set to officially launch; reimbursement at stake.
  • 15. Practical Implications of POA Financial Clarifying Implications Limitations
  • 16. Practical Implications of POA Indicators
    • General Reporting Requirements:
      • POA indicators required for all claims involving Medicare inpatient admissions to acute care hospitals.
      • POA is defined as present at the time the order for inpatient admission occurs conditions that occur during an outpatient encounter, including emergency department, observation, or outpatient surgery are considered POA.
      • POA indicators is assigned to both primary and secondary diagnoses.
      • Issues related to inconsistent, missing, conflicting or unclear documentation must be resolved by the provider.
      • If a condition would not be coded and reported based on Uniform Hospital Discharge Data Set definitions and current official coding guidelines, then POA indicator would not be reported.
      • CMS does not require POA indicators for external cause of injury