Sepsis Tops Conditions Tracked for Readmission Rates, but Triggers No Penalties

Sepsis has a higher rate of readmission than heart failure, but the federal government does not penalize hospitals for excessive readmissions due to sepsis.

Despite being the number one killer of hospital patients, a factor in late deaths, and leading cause of hospital readmissions, sepsis is not used by the federal government as a measure for care quality and reimbursement penalties, according to a study by the University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System.

Adapting to the CMS Sepsis Bundle

"One thing we know is that patients who do get sepsis get rehospitalized very frequently," said lead author Florian B. Mayr, MD, faculty member in Pitt's Department of Critical Care Medicine and the Center for Health Equity Research and Promotion at the VA Pittsburgh.

The Centers for Medicare & Medicaid Services tracks and penalizes hospitals for excessive readmissions for heart attack, heart failure, chronic obstructive pulmonary disease, and pneumonia.

"Sepsis has always been under-appreciated. It's well known among intensivists," he says. "We know how commonly we see sepsis in the hospital, and particularly in the intensive care unit. But people have not taken as much notice as when you talk about heart failure or pneumonia."

For their study, Mayr and his colleagues analyzed data from the 2013 Nationwide Readmissions Database, which comprises 49% of U.S. inpatients, for the four conditions and sepsis. They found that sepsis accounts for 12.2% of readmissions, followed by 6.7% for heart failure, 5% for pneumonia, 4.6% for COPD and 1.3% for heart attack.

The estimated average cost per readmission for sepsis was $10,070, compared to $9,533 for pneumonia, $9,424 for heart attack, $9,051 for heart failure and $8,417 for COPD.

"The awareness is definitely increasing, and our study and other recently published studies make the repeated point that this is a big problem," Mayr says.

"Maybe adding it to the Hospital Readmissions Reduction Program may fuel incentives and innovation to reduce unplanned or avoidable readmissions and the associated costs."

The study was published this month in the JAMA, and Mayr says the findings highlight the need for coordinated efforts to develop new medical interventions aimed at improving sepsis outcomes and reducing readmissions.

Sepsis Plays a Role in Late Deaths, Data Suggests

"If we, as a nation, place such high emphasis on reducing readmissions for the other four conditions, then we really need to look for opportunities to improve outcomes for sepsis, which has a higher rate of readmission than heart failure," Mayr says.

"People who survive an initial episode of sepsis often don't do well. They return to the hospital frequently, accrue new health conditions, and have significantly elevated death rates."

The National Institutes of Health estimates that sepsis may occur in more than 1 million U.S. patients every year, and that between 28% to 50% of these patients do not survive. Patients who survive the condition often continue to suffer related health problems.

"Many people think infections and sepsis are short-term illnesses and that once patients are discharged from the hospital, they are better," said study senior author Sachin Yende, MD, associate professor in the Pitt School of Medicine and vice president of Critical Care at the VA Pittsburgh.

"But all research to date shows that sepsis has serious, lingering consequences, and patients continue to have problems well after they are discharged."

Mayr says the study provides "another building block" in the case for using sepsis as a quality measure. "Maybe it's time that we take it to the same level as pneumonia, heart attacks and heart failure and work on incentives that improve outcomes."