Transcript Understanding the Impact of HACs/POAs and Never Events

Understanding the Impact
of HACs/POAs and Never
Events/Adverse Events
Nadyne Hagmeier, RN
Hospital Project Manager
NQF Serious Reportable Events
• In 2002, The National Quality Forum (NQF) created and
endorsed a list of serious reportable events (SREs) to
increase public accountability and consumer access to
critical information about healthcare performance.
• The list includes both injuries caused by care
management (rather than the underlying disease) and
errors that occur from failure to follow standard care or
institutional practices and policies.
• The events are largely preventable, but also very serious.
• The errors are of concern to the public and healthcare
providers and warrant careful investigation that should be
targeted for mandatory public reporting.
CMS Initiatives Addressing Never
Events
CMS Initiatives Addressing Never
Events
CMS Initiatives Addressing Never Events
CMS Initiatives Addressing Never Events
Additional Hospital Acquired Conditions
• Catheter-associated UTI
• Vascular catheter-associated infection
• Surgical site infection –
– Mediastinitis following CABG
– Certain orthopedic procedures of the spine, neck, shoulder and
elbow
– Bariatric surgery for obesity – Laparascopic gastric bypass,
Gastroenterostomy, Laparascopic gastric restrictive surgery
• DVT and Pulmonary embolism following total knee replacement and
hip replacement
• Manifestations of poor glycemic control –
– Diabetic ketoacidosis, nonketotic hyperosmolar coma,
hypoglycemic coma, secondary diabetes with ketoacidosis or
hyperosmolarity
National Coverage Determination
CMS is accepting public comments on its
proposed policies through January 1.
Read the proposed decisions at:
www.cms.hhs.gov/mcd/index_list.asp?list_type=nca
Present on Admission (POA)
• October 1, 2007:
– IPPS hospitals are required to begin
submitting POA information on all primary and
secondary diagnoses on Medicare claims
• January 1, 2008:
– CMS begins processing POA data
• April 1, 2008:
– Claims that do not contain proper POA data
will be returned for correct submission of POA
information
POA General Requirements
• POA indicator required for all claims involving
Medicare inpatient admissions to general
acute care hospitals
• POA is defined as present at the time the
order for inpatient admission occurs -conditions that develop during an outpatient
encounter, including emergency department,
observation, or outpatient surgery, are
considered POA
• Assigned to principal and secondary
diagnoses
POA General Requirements (cont)
• 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 the POA
indicator would not be reported
• POA indicator is not required for the external
cause of injury code unless it is being
reported as an “other diagnosis”
POA Coding
• Use the UB-04 Data Specifications Manual
and the ICD-9-CM Official Guidelines for
Coding and Reporting to facilitate the
assignment of the POA indicator for each
“principal” and “other” diagnosis codes
reported on the UB-04 and ASC X12N 837
Institutional
POA Documentation
• Medical record documentation from any
provider involved in the care and treatment
of the patient may be used to support the
determination of whether a condition was
present on admission
For more information on POA
• The HAC POA web page at
http://www.cms.hhs.gov/HospitalAcqCond/
provides further information including the
links to the law, regulations, change
requests(CRs), and educational resources
including presentations, MLN articles, and
fact sheets
Additional Resources
• NQF:
http://www.qualityforum.org/
• Fact sheets:
– Hospital Acquired Conditions http://www.cms.hhs.gov/HospitalAcqCond/Do
wnloads/hac_fact_sheet.pdf
– Present on Admissionhttp://www.cms.hhs.gov/HospitalAcqCond/Do
wnloads/poa_fact_sheet.pdf
• KHIMA:
http://www.khima.com/news-information/newsinformation.html
Contact Information
Nadyne Hagmeier, RN
Quality Data Reporting
Kansas Foundation for Medical Care, Inc.
2947 SW Wanamaker Drive
Topeka, KS 66614
1-800-432-0770
This material was prepared by the Kansas Foundation for Medical Care, Inc. (KFMC), the Medicare Quality Improvement Organization
for Kansas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health
and Human Services. The contents presented do not necessarily reflect CMS policy. 9SOW-KS-BP_BEN-08-01