Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012–2018*

Abstract

Objective: To evaluate the impact of sepsis, age, and comorbidities on death following an acute inpatient admission and to model and forecast inpatient and skilled nursing facility costs for Medicare beneficiaries during and subsequent to an acute inpatient sepsis admission. Design: Analysis of paid Medicare claims via the Centers for Medicare & Medicaid Services DataLink Project (CMS) and leveraging the CMS-Hierarchical Condition Category risk adjustment model. Setting: All U.S. acute care hospitals, excepting federal hospitals (Veterans Administration and Defense Health Agency). Patients: All Part A/B (fee-for-service) Medicare beneficiaries with an acute inpatient admission in 2017 and who had no inpatient sepsis admission in the prior year. Interventions: None. Measurements and Main Results: Logistic regression models to determine covariate risk contribution to death following an acute inpatient admission; conventional regression to predict Medicare beneficiary sepsis costs. Using the Hierarchical Condition Category risk adjustment model to illuminate influence of illness on outcome of inpatient admissions, representative odds ratios (with 95% CIs) for death within 6 months of an admission (referenced to beneficiaries admitted but without the characteristic) are as follows: septic shock, 7.27 (7.19–7.35); metastatic cancer and acute leukemia (Hierarchical Condition Category 8), 6.76 (6.71–6.82); all sepsis, 2.63 (2.62–2.65); respiratory arrest (Hierarchical Condition Category 83), 2.55 (2.35–2.77); end-stage liver disease (Hierarchical Condition Category 27), 2.53 (2.49–2.56); and severe sepsis without shock, 2.48 (2.45–2.51). Models of the cost of sepsis care for Medicare beneficiaries forecast arise approximately 13% over 2 years owing the rising enrollments in Medicare offset by the cost of care per admission. Conclusions: A sepsis inpatient admission is associated with marked increase in risk of death that is comparable to the risks associated with inpatient admissions for other common and serious chronic illnesses. The aggregate costs of sepsis care for Medicare beneficiaries will continue to increase.

Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012–2018*

“…In this report, we observe that stays with different severity tiers have differently improving survival over the study interval. Separating the study population into monthly cohorts (each monthly cohort contains 70,000 to >100,000 sepsis inpatient admissions) and further stratifying by severity, we observed that the survival data of the septic shock cohorts and of the nonsevere sepsis (either organism specified or organism unspecified) cohorts show modest improvements over the interval, a finding consistent with reports by others (1,14). In contrast, the data show a marked improvement in survival of the severe sepsis patients.…”

“…In the first article of this set, we discussed potential explanations for the rise in inpatient admissions assigned a sepsis code (1). In this report, we observe that stays with different severity tiers have differently improving survival over the study interval.…”

“…Once sepsis is diagnosed, contemporary management is only partially successful (10)(11)(12)(13). Although many beneficiaries survive the initial hospitalization, the first article in this series reported that the 3-year mortality following a sepsis diagnosis ranged from 50% to 75% depending on the severity inferred from the specific diagnostic code (1,14). The postdischarge trajectories reported herein suggest that only a minority of Medicare beneficiaries with an initial sepsis admission are promptly discharged to their personal home-fewer than 1/3.…”

World Sepsis Day: a global agenda to target a leading cause of morbidity and mortality

“…Post-sepsis syndrome has been increasingly recognized as a major contributor to poor longterm health after critical illness (19,25) which includes sequelae affecting physical, mental, and psychological health in all age groups, affecting long-term development of neonates and children with an impact lasting decades (4,37). In the United States, the inpatient admission and subsequent skilled nursing facility costs for sepsis in Medicare beneficiaries have risen up to 62 billion USD in 2018 (5). The full societal impact of sepsis due to reduced productivity of survivors, dependency on support in everyday life, and the multiplying effect on carers, siblings, and children has not been reliably assessed but is likely to exceed the direct sepsis costs several fold (27,28).…”

Dichloroacetate reverses sepsis-induced hepatic metabolic dysfunction

“…This reaction leads to aberrant immune responses and if not diagnosed and treated early after its onset, may limit survival by inducing coagulopathy, altered microvasculature, and dysregulation of the host's metabolism and organ function [1][2][3][4][5][6][7] . Sepsis accounts for one in three hospital deaths in the U.S. and millions of deaths each year globally, highlighting its hazard to public health 8,9 . The high mortality rate associated with sepsis reflects the lack of a clinically viable molecular-based therapeutic target.…”