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

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:

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 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: Fact sheets : –Hospital Acquired Conditions - wnloads/hac_fact_sheet.pdf wnloads/hac_fact_sheet.pdf –Present on Admission- wnloads/poa_fact_sheet.pdf wnloads/poa_fact_sheet.pdf KHIMA: information.html

Contact Information Nadyne Hagmeier, RN Quality Data Reporting Kansas Foundation for Medical Care, Inc SW Wanamaker Drive Topeka, KS 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