title: HAC-POA policy effects on hospitals, other payers, and patients.
abstract: BACKGROUND
  Prior to the implementation of the Hospital-Acquired Condition-Present on Admission (HAC-POA) payment policy, concerns regarding its potential impact were raised by a number of organizations and individuals. The purpose of this study was to explore direct and indirect effects of the HAC-POA payment policy on hospitals, patients, and other payers during the policy's first 3 years of implementation.
  
  
  METHODS
  The study included semi-structured telephone interviews with representatives of national organizations, hospitals, patient advocacy organizations, and other payers. Interview notes were coded using QSR NVivo qualitative analysis software using inductive and deductive qualitative analysis techniques. We conducted interviews with 106 individuals representing 56 organizations. Hospital staff included physicians, nurses, patient safety officers, coders, and finance, senior management, and information management staff. Individuals from other organizations represented leadership positions.
  
  
  RESULTS
  Key changes to hospitals included: cultural shifts involving attention, commitment, and support from hospital leadership for patient safety; hiring new staff to assure the accuracy of clinical documentation and POA oversight structures; increased time burden for physicians, nurses, and coders; need to upgrade or purchase new software; and need to collaborate with hospital departments or staff that did not interface directly in the past. The policy was adopted by a majority of other payers, although the list of conditions and payment penalties varies. The HAC-POA policy is invisible to patients; therefore, the presence or lack of unintended consequences to patients cannot be fully assessed at this time. Understanding of policy effects to all stakeholders is important for maximizing its successful implementation and desired impact.
authors.affiliation: RTI International.
authors.forename: Asta
authors.initials: A
authors.lastname: Sorensen
authors.affiliation: RTI International.
authors.forename: Nikki
authors.initials: N
authors.lastname: Jarrett
authors.affiliation: RTI International.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tant
authors.affiliation: RTI International.
authors.forename: Shulamit
authors.initials: S
authors.lastname: Bernard
authors.affiliation: RTI International.
authors.forename: Nancy
authors.initials: N
authors.lastname: McCall
mesh_terms: D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006291:Health Policy / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
keywords: Medicare; evaluation design and research; health policy; hospitals; law; politics; qualitative research; regulation