Present On Admission (POA)

THCIC releases to the public yearly quality reports for each of the hospitals based on the Agency for Healthcare Quality (AHRQ) indicators.  Currently, those reports do not take into account the possibility of certain diagnosis, such as an infection, that might have been present on admission.  This could be intrepreted incorrectly and appear to be a hospital acquired infection (HAI).  As we in the healthcare community all know, a key factor in tracking quality in the hospital setting is the ability to separate the pre-existing conditions a patient has upon arrival from the conditions acquired during the hospital stay. While some hospital-acquired conditions may occur even with the most vigilant processes, recording of diagnoses already present on admission is a crucial step in tracking and assessing a hospital’s performance.

On October 25, 2010, Texas adopted new rules for collecting the Present on Admission (POA) flag for all diagnosis codes on all inpatient claims.  For many of our hospitals, the POA flag seems as though this might be old news since the Deficit Reduction Act, enacted into law in early 2006, required all general acute care hospitals to report the POA flag for Medicare beneficiaries starting on October 1, 2007.

Increasingly, the administrative billing data is being used for measuring hospital performance and for public reporting and the key reasons as to why it is important to comply and submit POA is as follows: