An article in the December 2007 issue of hfm magazine provides a thorough overview of IPPS changes. Of particular interest is the article’s detailed description of changes to CMS's hospital quality reporting initiative.

The article, "Surviving Medicare’s IPPS changes: what you need to know," is written by S-DRG Report contributor Dean Farley, vice president of the Lewin Group (an Ingenix company), and Renee Leary, director of Vineyard Point Associates, and the former COO of HSS, an Ingenix company.
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Hospitals transitioning to MS-DRGs and POA reporting are citing an increased incidence of physician queries by the HIM staff to clarify the clinical documentation used in code determination. This presents a potentially sticky situation, since CMS has traditionally not allowed — until recently — the inclusion of query forms in the medical record to support coding determination during an audit or a review by a Quality Improvement Organization (QIO).

In this latest policy clarification, CMS stated a query form would be considered acceptable "to the extent it provides clarification and is consistent with other medical record documentation." The agency's position is that a query form should not be leading, and it should not introduce new information not otherwise contained in the medical record.
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An article in the Dec. 26 issue of For the Record suggests that while reporting the POA indicator will initially create some challenges for the industry, it may also create opportunities to improve care quality by:

• Adding precision to ICD-9-CM coding, enabling organizations to distinguish between pre-existing conditions and complications.
• Increasing the efficiency and effectiveness of hospital quality assurance activities.
• Improving the accuracy of mortality risk assessment and outcomes research.

The initial challenges, according to the article, include dealing with decreases in coder productivity. States that have had POA-like policies in place (New York, California, Florida, Massachusetts and Maryland), all reported coder productivity decreases in the months following POA implementation.
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