Not Your Mother's Administrative Data Anymore: Present on Admission (POA) Collection and Use In States

Slide presentation from the AHRQ 2010 conference.

On September 28, 2010, Denise Love made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (284 KB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

Not Your Mother's Administrative Data Anymore: Present on Admission (POA) Collection and Use In States

Not Your Mother's Administrative Data Anymore:
Present on Admission (POA) Collection and Use In States


Denise Love
National Association of Health Data Organizations (NANDO)
September 2010
 

Image: The NANDO logo appears on the left-hand side of this slide and all subsequent slides.

Slide 2

Overview

Overview

  • POA survey results (NAHDO)
  • Highlights of states' experience collecting and using POA
  • Best Practices and Technical Assistance Needs
  • Other data set enhancements

Slide 3

In 1999 . . .

In 1999...

  • NAHDO conducted an inventory of state data collection practices for the HCUP.
  • Two out of 44 states collecting inpatient discharge data reported they collect POA.
  • Identified by states as a priority for national standards.

Slide 4

1999 NAHDO Recommendations

1999 NAHDO recommendations:

  • POA inclusion in the next X12N Implementation Guide.
  • Education of discharge data agencies about the value of the field to outcomes studies.
  • Provision of technical support to enable its collection where needed.

Slide 5

NAHDO Member Survey, 2010-POA Collection/Use

NAHDO Member Survey, 2010—POA Collection/Use

  • Survey and Webinar conducted in response to member inquiries about POA practices
  • Surveymonkey
  • 27 / 48 respondents

Slide 6

Does your agency collect POA with inpatient data?

Does your agency collect POA with inpatient data?

A table shows the following information:

Survey Responses27 State and Private Health Data Organizations
Yes, collecting POA21
No, not collecting POA6

Slide 7

Does your agency release POA in its public use files?

Does your agency release POA in its public use files?

A table shows the following information:

Survey Responses27 State and Private Health Data Organizations
Yes13
No12
Non response2

Of those releasing in public use files:

  • 8 validate POA
  • 5 do not validate POA

Slide 8

Reasons for not releasing POA in public use files

Reasons for not releasing POA in public use files:

  • Data quality concerns:
    • "2009 data was not reliable."
    • "We will consider release of the 2010 data after reliability analysis."
  • Data are incomplete:
    • "Some hospitals are only recording POA on Medicare patients, and critical access hospitals are not required to code POA."
  • In the process of deciding

Slide 9

Have there been any issues related to the use of POA in the Public Use File?

Have there been any issues related to the use of POA in the Public Use File?
 

  • Most respondents reported no problems.
  • Issues identified:
    • POA is not coded in Critical Access, LTAC & Rehab Hospitals.
    • Reporting for non Medicare patients is not part of normal billing requirements.
    • Worry about liability from the hospital perspective.
    • Some facilities do not have the capabilities to report it at this time.

Slide 10

Does your agency use POA in public reports?

Does your agency use POA in public reports?

A table shows the following information:

Survey Responses27 State and Private Health Data Organizations
Yes6
No17
Non response4

If yes, how is POA used?

  • "We only use POA to the extent is is used in AHRQ quality indicators."
  • Risk adjustment modeling only
  • PSI statistics in hospital performance reports
  • Feedback to hospitals

Slide 11

Why is POA not used in your agency reports?

Why is POA not used in your agency reports?

  • POA reporting is not complete and/or reliable
  • Cannot verify accuracy of coding across providers
  • When data quality is better understood, we will use POA in reports
  • Will disclose POA only upon request

Slide 12

Does your agency validate the POA code?

Does your agency validate the POA code?

A table shows the following information:

Survey Responses27 State and Private Health Data Organizations
Yes14
No9
Non response4

Slide 13

Briefly describe your validation/editing process

Briefly describe your validation/editing process:

  • Provider feedback:
    • Aggregate reports of CMS HAC's given to hospitals quarterly
    • Provider statistics against benchmarks
  • Limited system edits:
    • Vendor does the screens
    • Flag invalid, missing code
    • Check for exempt POA assigned to non-exempt dx codes and vice versa
    • Check for percent of "N" POAs and blanks in monthly submissions

Slide 14

Briefly describe your validation/editing process

State Presentation: Quality of POA Coding

  • Accurate distinction between hospital-acquired complications and comorbidities that were present on admission is essential to ensure validity of estimates of predicted mortality rates.
  • Quality of POA coding was measured using 15 screens applied to high risk medical, elective surgical, and obstetrical cases.
  • Predictive models were derived using only data from hospitals with acceptable POA coding.

Slide 15

POA Reporting-Select AHRQ Patient Safety Indicators

POA Reporting—Select AHRQ Patient Safety Indicators

Image: A bar chart shows the following rates per 1,000 discharges:

PSIVirginia
Pre-POA
National
Inpatient Sample
(2006)
Virginia
Post-POA
Decubitus Ulcer

33.1

24.57

8.7

Post-operative
pulmonary embolism

15.4

11.18

8.7

Post-operative sepsis

18.1

15.06

15.9

Slide 16

Quick "HAC" Query-California

Quick "HAC" Query—California

Image: A sad "smiley" face.

A table shows the following information:

First half
of 2009
POA
Values
ICD-9-CM CodeExcluding Principal Diagnosis
Number of dischargesICD-9-CM Description for Pressure Ulcer
  13,429Y707.23 707.24Pressure Ulcer, Stage III  Pressure Ulcer, Stage IV
      398N707.23 707.24Pressure Ulcer, Stage III  Pressure Ulcer, Stage IV
         9U707.23 707.24Pressure Ulcer, Stage III  Pressure Ulcer, Stage IV
         2W707.23 707.24Pressure Ulcer, Stage III  Pressure Ulcer, Stage IV
 13,837Total707.23 707.24Pressure Ulcer, Stage III  Pressure Ulcer, Stage IV

Slide 17

Examples of POA Data Requests

Examples of POA Data Requests

  • Outcomes studies before and after surgery
  • Trends of conditions associated with alcoholic liver disease
  • Factors associated with admissions and readmissions
  • Design a rural health system to meet the broadest level of health conditions

Image: A cartoon figure with a lightbulb going on over its head.

Slide 18

Best Practices will Evolve

Best Practices will Evolve

  • Current Best Practices:
    • Provider feedback reports
    • Release of POA in public use files
    • Use of POA in agency reports
  • State resources and funding constraints will limit:
    • Provider POA training activities in states
    • Analytic workforce capacity to fully use this field

Slide 19

State Technical Assistance Requests Related to POA

State Technical Assistance Requests Related to POA

  • Analysis of potential or real legal issues related to public reports revealing provider comparisons
  • Sharing of open-source POA edits/screens
  • How other states are using POA
  • Implications for previously-released quality reports

Slide 20

Conclusions

Conclusions

  • POA collection in states for all payer data bases is growing.
  • Divergence in POA Philosophy:
    • Some states are not releasing due to validity concerns.
    • Other states don't validate and are releasing.
  • States are seeking guidance on minimum edit protocols:
    • This will support enforcement of data quality thresholds.

Slide 21

 

Thank You.

Thank You.

Thank You

Current as of December 2010
Internet Citation: Not Your Mother's Administrative Data Anymore: Present on Admission (POA) Collection and Use In States. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/love/index.html