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For POA, put focus on patient care not billing
Quality professionals must take the lead
When it comes to requirements for "present on admission" (POA), the focus too often is on reimbursement instead of patient care, according to some quality improvement experts.
"It is time for hospitals to quit focusing on the billing and technical aspects of the POA indicators," argues Nancy McLean, RN, BSN, MHSA, senior consultant at Courtemanche and Associates in Charlotte, NC. "POA is not a billing issue — it is a clinical quality initiative," she says. "It is time for quality professionals to take the lead and change the focus to prevention."
Since July 2007, most organizations have focused on improving licensed independent practitioner (LIP) documentation to capture as many diagnoses as possible on admission. "But when we are reporting a condition as either POA or a health care-acquired complication, it is too late to impact potential reimbursement or try to figure out how to recover uncompensated dollars spent in the treatment of health care-acquired complications," says McLean.
The loss of revenue will come from two sources, says McLean: the no pay POA complications and the resulting change in case mix index from inability to bill for secondary diagnoses that are hospital-acquired.
"We need to redirect our energy to elimination of hospital-acquired complications," she says. "It is also time for the quality professional to take the lead and change paternalism to partnership, and change the POA focus from billing to prevention."
The quality professional must lead the way in establishing the organization's POA priorities. "Quality professionals should think of a way they can add in the information that they learn from this effort to their ongoing quality improvement activities," says Beth Feldpush, senior associate director for quality at the American Hospital Association.
Answer these questions, advises McLean:
Request that the finance department provide you with the history of incidences of billing for the identified DRGs that will no longer be reimbursed. "Look at national data on discharge incidence of the identified POA," says McLean.
In 2000, the incidence per 100,000 discharges of decubitus ulcers was 21.96. "This was the highest of all the POA indicators selected for no payment this year," says McLean. "Review the data with leaders, and develop actions that focus on prevention."
The elimination of decubitus ulcers should be on your performance improvement plan for this year, and you should answer these questions, says McLean:
Health care-acquired complications have been accepted as inevitable over the years, says McLean. "Sadly, we have to be forced into improving the quality of care we provide by CMS taking away reimbursement dollars," she says.
Reshape your performance improvement plan to focus on the list of POAs for 2008 and to begin addressing the POAs coming in 2009. "We know what complications are not being reimbursed — CMS provided us with a list," says McLean. "Stop the complication from occurring. The organization's reimbursement won't increase, but expenses will decrease. We may even improve the bottom line."
[For more information, contact:
Nancy McLean, RN, BSN, MHSA, Senior Consultant, Courtemanche and Associates, PO Box 17127, Charlotte, NC 28227. Phone: (941) 809-2092. E-mail: firstname.lastname@example.org.]