Query for palliative care POA. Please help!

renmeyer@sbcglobal.net

Hi everyone

Our quality department wants CDI to query whether or not hospice/palliative care/comfort care was POA.  Apparently it has a big influence on O/E ratio if it was POA rather than documented on day 3. Can you tell me how you do this and  what a query for this would look like?  Any help greatly appreciated!

morris-jeff@CooperHealth.edu

For us, it was a huge risk adjuster in the Vizient mortality methodology with DNR status. They now require it be POA “Y”. I’ve queried, using yes/no, on some trauma patients that were clearly only being kept alive until their family could arrive and then they were removed from life support. Mixed reviews from the MD’s...many said not POA as the patient was not a DNR at the time of admission. 

Jeff 

afrady@blr.com

Mortality is a weak point of mine but if memory serves, the DNR only works in the Vizient methodology but for CMS they had to be full hospice on admit or you get dinged via the "all cause mortality" metric (which is completely silly as it seems to imply that NO DISEASE process EVER = an expected death but I won't launch my tirade about that here at this time). 

izusman

I believe that the impact of the comfort care POA status on mortality data is a different issue from whether or not it is appropriate to query for this every time. The POA status for this code is usually related to when the comfort care order was issued, and most of the times it is available in the record. .

lprescott1

Remember POA designation is assigned based on presence AT THE TIME the INPATIENT ORDER WAS WRITTEN. Make sure your providers understand that concept.

renmeyer@sbcglobal.net

This is what I now have been tasked to do.  "If on chart review you are seeing that the patients have an end stage disease process or high severity of illness, you'll have to query the MD's to see if they would benefit from a palliative care and/or hospice consult."  If you have any input of how this is being done or query examples, I would really appreciate it!  I have to make a spreadsheet and report back. 

My first thought was that this would be discussions the case managers and discharge planners should have with the patients and physicians.

Thank you to everyone who replied so far!

jmccorkl@stanfordhealthcare.org

I agree, suggesting a consult would be outside the scope of a CDI who has not evaluated the patient, only the documentation.
Jeanne McCorkle, RN, CCDS

evanspx@sutterhealth.org

Not sure you need a query as the status should be as per the MD orders...palliative care status must be ordered. 

stephaniehaase

Not on topic ( a little close) but I was reading an interesting comment copied below.  Would anyone be able to confirm  CMS "only accepting the first 9 diagnoses" for mortality reporting.  I agree with Paul... POA status of comfort care  is objective based on the time of ordering.  

"Z51.5 excludes cases from some mortality index calculation models, but only if it is coded with the POA indicator 'Yes', so you have to educate your coding staff. The most common mistake in assigning the correct POA indicator happens when the order for palliative care is issued in the ER before the patient was admitted. Many people assign POA indicator 'No' because the order was issued after the patient had already arrived to the hospital. The correct POA assignment is 'Yes'.

"Also keep in mind that this diagnosis should be reported within first 8 diagnoses (9 if you count admitting diagnosis) because CMS still accepts only 9 diagnoses for mortality reporting."

Interesting info from 2012:http://www.hcpro.com/content.cfm?dp=HIM&content_id=276597

renmeyer@sbcglobal.net

Thanks for all the input!