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