Health Information Management

News: Two new reports show little impact from POA reporting

CDI Strategies, December 6, 2012

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When CMS stopped paying for healthcare-associated infections such as catheter-associated blood stream infection and urinary tract infections, the agency expected rates for such infections to decline. In fact a recent study “found no evidence that the 2008 CMS policy had any measurable effect on infection rates in U.S. hospitals,” according to an article in the New England Journal of Medicine.

The Agency for Healthcare Research and Quality-funded study titled Effect of Nonpayment for Preventable Infections in U.S. Hospitals examined data from 398 hospitals showing significant decreases in rates of infections both prior to the implementation of present-on-admission (POA) and healthcare-associated infection reporting requirements in 2008 and afterwards.
“We had hypothesized that the policy might have larger effects on hospitals located in states without preexisting mandatory reporting of infections as well as on hospitals with a larger proportion of Medicare patients,” however, the study “did not find any beneficial effect,” the report states.
“As CMS continues to expand this policy to cover Medicaid through the Affordable Care Act, require public reporting of [National Healthcare Safety Network] data through the Hospital Compare website, and impose greater financial penalties on hospitals that perform poorly on those measures, careful evaluation is needed to determine when these programs work, when they have unintended consequences, and what might be done to improve patient outcomes,” the authors conclude.
In an unrelated report, the Office of the Inspector General (OIG) released information regarding the accuracy of POA indicator assignment. It examined whether hospital coding staff misreported indicators and found that only 3% of more than 5,000 POA indicators reviewed were inappropriate. The OIG made no recommendations, calling the error rate “relatively low” but reiterated the importance of POA reporting in “monitoring hospital quality of care” and the role such reporting plays in “CMS’ efforts to link payment to quality.”

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