Admission+ +Dr+Pratt

8/2/2019 Admission+ +Dr+Pratt

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Present on Admission &Hospital Acquired Conditions

Department Chair Meeting

September 17, 2008Alan Pratt, M.D.


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What is it?

For discharges occurring on or after October 1,2008, hospitals will not receive additionalpayment from Medicare for cases in whichone of the selected conditions was notpresent on admission, i.e., the case will bepaid as though the secondary diagnosis were

not present.


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Current Conditions Designated by CMS asHospital Acquired Conditions (HAC)


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Current HAC continued..


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Present on Admission (PoA)

Present at the time the order for inpatient admission is written conditions that develop during an outpatient encounter thatprecedes admission (emergency department, observation, oroutpatient surgery) are considered as present on admission.CMS intends to use the PoA indicator to assess the quality ofhealthcare, perform risk adjustments and other quality measurementactivities.This indicator is assigned to each diagnosis code. It will allow CMSto identify hospital acquired conditions that CMS has determinedshould be reasonably preventable.(http://www.cms.hhs.gov/HospitalAcqCond/ )Whether a diagnosis was present on admission can be documentedby the physician at any time during the inpatient hospital stay.
http://www.cms.hhs.gov/HospitalAcqCond/http://www.cms.hhs.gov/HospitalAcqCond/


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PoA indicator is assigned by the Hospital CodingSpecialist using Physician documentation. Y Yes Present on Admission

. If thisdiagnosis puts the patient intoa higher paying DRG. CMS willallow it.

N No Not Present on Admission . If thisdiagnosis is designated as ahospital acquired condition andconsidered to be reasonablypreventable, CMS will not allow ahigher paying DRG.Reimbursement will be as if uncomplicated.

W Undetermined. Physician documents unable toclinically determine whether the condition waspresent at the time of admission. CMS will allowhigher paying DRG and track frequency.

U Insufficient Documentation to determine if thecondition was present at the time of admisison. CMSwill not allow a higher paying DRG.


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Examples

Conditions that are clinical findings only atadmission and then diagnosed later in thevisit are considered present on admission.

A patient is admitted with elevated WBC, temp of39.6C, confusion. The next day sepsis is diagnosed.Sepsis would be present on admissionA patient is admitted with high fever and pneumonia.The patient rapidly deteriorates and becomes septic.The discharge diagnosis lists sepsis and pneumonia.The documentation is unclear as to whether the sepsiswas present on admission or developed shortly afteradmission. The Coder will send a query to the

physician to clarify if sepsis was present on admission.


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Examples

Patient is status post BKA 2 weeks ago. Patientadmitted with purulent drainage from the amputationsite and fever. Cultures taken from amputation site.Several days later the lab results show MRSA.

Patient was treated with IV antibiotics anddischarged to the nursing home. The dischargediagnosis lists only wound infection. In this case,Coder will send a query to the physician to add the

MRSA to the discharge summary. Both the woundinfection and the MRSA would be consideredpresent on admission.


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Examples

A patient undergoes outpatient surgery. Inrecovery, the patient develops atrialfibrillation and an order is written to place thepatient in the hospital as an inpatient. Theatrial fibrillation is present on admission sinceit developed prior to a written order for

inpatient admission.


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Why is it important to you?

Physician assessment and physician directedtreatment can prevent many of these conditions.Only physician documentation and diagnosticstatements can be used in making the determinationof present on admission.CMS has launched demonstration projects in 3states to test also reducing physician reimbursementwhen HACs occur.Accuracy is important because hospital claims datais the only source for national quality benchmarking,e.g., HospitalCompare, HealthGrades.


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What will success look like?

KS1 We will have nopreventable deaths, infection,pain, suffering, waiting, orwaste.


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What do we need from you?Share this information with medical staff, associatestaff and support staff in your departments.Reduce variation in care through consistentimplementation of clinical practice guidelines andevidence based best practicesPerform thorough patient assessment at admissionand regular reassessment throughout the patientshospitalization; include a comprehensive differentialdiagnoses list

Be receptive to reports of positive clinical findingsfrom nursing assessments; skin breakdown, woundconditions, blood glucose, central lines andcatheters. Assess and document your assessment.


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Thank-you for your assistance.

Questions?

Documents

Admission+ +Dr+Pratt