University of Pittsburgh Medical Center and VA
Pittsburgh Healthcare System researchers found that sepsis is the reason more
Medicare beneficiaries are readmitted to hospitals than for the conditions the
Centers for Medicare & Medicaid Services (CMS) measures under the Hospital Readmissions Reduction Program.
Sepsis is a life-threatening condition caused by a
body’s reaction to an infection.
Researchers said the sepsis 30-day readmission rate of
12.2 percent topped those for acute myocardial infarction (AMI) at 1.2 percent,
heart failure at 6.7 percent, chronic obstructive pulmonary disease (COPD) at
4.6 percent, and pneumonia at 5.2 percent. These four conditions, and not
sepsis, are the CMS benchmarks for its pay-for-performance program.
“We hypothesized that sepsis hospitalizations account
for a higher proportion of unplanned 30-day readmissions than hospitalizations
for AMI, heart failure, COPD, and pneumonia in the United States,” according to
the report, which recently appeared in the Journal
of the American Medical Association.
Florian Mayr, MD, lead author of the report and a
faculty member at the University of Pittsburgh’s Department of Critical Care
Medicine, says the investigation stemmed from an interest among clinicians in
what other conditions, like sepsis, caused readmissions versus the currently
tracked illnesses. He said it is important for the provider community and CMS
to realize that readmissions associated with sepsis were on average lengthier
and costlier than the other conditions.
The average cost per patient with sepsis was found to
be $10,070, versus between $8,417 and $9,533 for the other conditions. The
length of stay average topped seven days for those suffering from sepsis, while
the four measured illnesses ranged from 5.7 to 6.7 days on average. “So, the two
big points are that sepsis has the highest proportion of readmissions and is
longer and costlier,” Mayr says.
From a clinician standpoint, he says, there was not a
lot of surprise from the findings “based on how frequently we see sepsis in the
hospital, particularly in the ICU…it is a heavy hitter.” But a wrinkle found in
the research should be a warning to acute-care and post-acute care hospitals
and the long term care community in general.
“When you develop sepsis, go to the ICU, get better, and
go home, with a third of patients going to skilled nursing facilities, everyone
thinks it’s done, But the truth is, it is not done. Patients who survive sepsis
have a high risk of getting it again. There is a high risk of death one to
three years from the initial sepsis incident,” Mayr says.