Where are the benchmarking data?

This particular post is based on my observations and opinions.

The current theories associated with improving health care seem to have little or no data to establish a current state or target state of health care in the U.S. How will we know things are better if we do not know where we started? How will we know where to focus or how to prioritize our efforts?

Certainly there is more to measure than dollars, deaths, CPT codes and ICD-9 codes. Until the day we demand patient centric health care data that is meaningful, actionable, well defined, standardized, and required we will not achieve evidence based, outcomes based, or patient centric care. Too many patients die because providers think they know better than research and data, their patients are different, sicker, less-compliant, etc… These heretics cannot be concerned with scientific findings that support improved outcomes through treatment plans and protocols!

So at the end of my little rant I guess I am requesting that someone actually care about really changing healthcare by providing meaningful information to those that purchase and consume health care. The fact that health care is organized around its self rather than those whose lives depend on it for more than a pay check seems more than a little counter-productive.

What is POA?

POA stands for "Present on Admission". Without getting in to a lot of regulatory jargon; this basically means that if you get a “reasonably preventable” problem while you are in the hospital CMS (Medicare) is not going to pay for it.

I know what you are going to say “Hey Suzy, who gets to decide what is reasonably preventable?” That would be the payer of course which in this case in CMS.

The dollar figures are significant.

Example:

If a patient is admitted to the hospital with a stroke and a stage III pressure sore is present on admission the DRG payment is $8030.28

If a patient is admitted with a stroke and develops a stage III pressure sore during their hospital stay the payment is $5347.98

What does this mean for the Emergency Department? I have spent significant time questioning CMS officials about this regulation as it states:

· 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.

http://www.cms.hhs.gov/HospitalAcqCond/04_Reporting.asp#TopOfPage

But I have been reassured that it does NOT have to be identified before you put in the order for the bed. Time will tell of course.

The main POA diagnoses that will impact the ED are:

· Pressure sores
· Catheter associated urinary tract infections

Most of the others pretty much would have to include a non-ED procedure or would be difficult to demonstrate that it didn’t occur in the hospital. So unless Dr. Garvey decides he’s going to perform your appendectomy on his kitchen table, it is unlikely that you would have a retained surgical foreign body from any place but the hospital.

Let me know if this helps!

Smiles!

-Suzy

The entire list can be found at:

http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp#TopOfPage