As patient safety becomes tied to hospital payments, healthcare providers are devoting closer attention than ever to the medical problems that patients have before they arrive at the hospital. But a new study has found flaws in how providers record such “present-on-admission” conditions.

In a review of about 700 Medicare patients' bills from October 2008, contractors for HHS' inspector general's office found that about 18% of the beneficiaries had at least one incorrectly reported condition as present-on-admission, or POA. Those errors represented about 3% of the 5,491 conditions reported for the patients.

“The 3% national POA indicator error rate is relatively low,” the report says (PDF). “However, POA indicators provide an opportunity for monitoring hospital quality of care and are critical to CMS' efforts to link payment to quality; they must be accurate to serve these purposes.”

The Deficit Reduction Act of 2006 stipulated for the first time that providers cannot be paid for certain conditions that develop while Medicare patients are in the hospital, putting the burden on nurses, doctors and healthcare coders to accurately record existing medical problems. The Patient Protection and Affordable Care Act in 2010 increased that burden by tying federal payments to quality of care and placing more emphasis on quality reporting.

But providers may struggle to accurately record conditions that were still developing when the patient was admitted, like septic shock, blood infections, urinary tract infections, pneumonia, pressure ulcers, constipation and malnutrition, the report says. The office also found problems with the recording of conditions exempt from the reporting requirements, like prior diagnosis of cancer.

Finally, the reviewers found that medical records for nearly half of the misreported present-on-admission conditions were simply contradicted by the patient files, suggesting errors by the coders.