Readmissions, costs higher for sepsis than for four CMS–measured conditions

Sepsis accounted for far more 30-day hospital readmissions than each of the four conditions the government uses to measure penalties for facilities that see a lot of readmissions, according to an analysis of data for nearly half of all inpatients in the United States.

Readmissions for sepsis also cost more money and led to longer stays in the hospital, according to Sachin Yende, MD, associate professor of critical care medicine and clinical and translational sciences at the University of Pittsburgh School of Medicine and vice president of critical care for the VA Pittsburgh Healthcare System, and colleagues.

Currently, the Affordable Care Act mandates that CMS reduce payments under Medicare’s inpatient prospective payment system to hospitals with excess readmissions. The Hospital Readmission Reduction Program (HRRP) is based on 30-day readmission rates of four conditions: myocardial infarction (MI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia.

Yende said recent studies have shown that readmissions for these four conditions have decreased since the HRRP was instituted on Oct. 1, 2012.

“Whether adding readmissions to the HRRP improves patient outcomes is still unclear, but one could speculate that avoiding hospitalizations would reduce risk of hospital-acquired conditions — for example, infections — and that most patients would prefer to avoid admission to the hospital,” he told Infectious Disease News.

Writing in JAMA, Yende and colleagues said they analyzed data from the 2013 Nationwide Readmission Database, a government index of acute-care hospitalizations from 21 states that represents 49% of all U.S. inpatients, to determine the readmission rates and costs of sepsis.

Credit: Nicole Davison/UPMC.
Researchers from the University of Pittsburgh and VA Pittsburgh Healthcare System compared sepsis readmission with the four conditions tracked by CMS.
Source: Nicole Davison/UPMC.

Among the approximately 1.2 million patients aged 18 years and older who met the criteria for inclusion in the study and had an unplanned readmission within 30 days, around 12.2% had a diagnosis of sepsis, compared with 6.7% who were diagnosed with heart failure, 5.0% with pneumonia, 4.6% with COPD and 1.3% for MI. The estimated mean length of stay following readmission was approximately 7.4 days for sepsis, compared with 6.7 days for pneumonia, 6.4 days for heart failure, 6.0 days for COPD, and 5.7 days for MI.

Further, the estimated mean cost of readmission for sepsis was $10,070 per patient compared with $9,533 for pneumonia, $9,424 for MI, $9,051 for heart failure, and $8,417 for COPD.

According to Yende and colleagues, adding sepsis to the HRRP “may lead to development of new interventions to reduce unplanned readmissions and associated costs.”

Yende said providers should consider developing programs or interventions to reduce the long-term sequelae associated with sepsis after discharge.

“Future research is needed to develop more personalized interventions to reduce readmission after sepsis,” he told Infectious Disease News. “For this to happen, we need to have a better understanding of a patient's likelihood to be readmitted and the reasons for readmission. Many of these patients are still recovering at home and in nursing homes and rehabilitation facilities, often too weak to return to the clinic to see their primary care physician. Therefore, future research should focus on developing new models to provide care for these patients.” – by Gerard Gallagher

Reference:

Mayr FB, et al. JAMA. 2017;doi:10.1001/jama.2016.20468.

Disclosure: Yende reports receiving grants from Bristol-Myers Squibb.

Sepsis accounted for far more 30-day hospital readmissions than each of the four conditions the government uses to measure penalties for facilities that see a lot of readmissions, according to an analysis of data for nearly half of all inpatients in the United States.

Readmissions for sepsis also cost more money and led to longer stays in the hospital, according to Sachin Yende, MD, associate professor of critical care medicine and clinical and translational sciences at the University of Pittsburgh School of Medicine and vice president of critical care for the VA Pittsburgh Healthcare System, and colleagues.

Currently, the Affordable Care Act mandates that CMS reduce payments under Medicare’s inpatient prospective payment system to hospitals with excess readmissions. The Hospital Readmission Reduction Program (HRRP) is based on 30-day readmission rates of four conditions: myocardial infarction (MI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia.

Yende said recent studies have shown that readmissions for these four conditions have decreased since the HRRP was instituted on Oct. 1, 2012.

“Whether adding readmissions to the HRRP improves patient outcomes is still unclear, but one could speculate that avoiding hospitalizations would reduce risk of hospital-acquired conditions — for example, infections — and that most patients would prefer to avoid admission to the hospital,” he told Infectious Disease News.

Writing in JAMA, Yende and colleagues said they analyzed data from the 2013 Nationwide Readmission Database, a government index of acute-care hospitalizations from 21 states that represents 49% of all U.S. inpatients, to determine the readmission rates and costs of sepsis.

Credit: Nicole Davison/UPMC.
Researchers from the University of Pittsburgh and VA Pittsburgh Healthcare System compared sepsis readmission with the four conditions tracked by CMS.
Source: Nicole Davison/UPMC.

Among the approximately 1.2 million patients aged 18 years and older who met the criteria for inclusion in the study and had an unplanned readmission within 30 days, around 12.2% had a diagnosis of sepsis, compared with 6.7% who were diagnosed with heart failure, 5.0% with pneumonia, 4.6% with COPD and 1.3% for MI. The estimated mean length of stay following readmission was approximately 7.4 days for sepsis, compared with 6.7 days for pneumonia, 6.4 days for heart failure, 6.0 days for COPD, and 5.7 days for MI.

Further, the estimated mean cost of readmission for sepsis was $10,070 per patient compared with $9,533 for pneumonia, $9,424 for MI, $9,051 for heart failure, and $8,417 for COPD.

According to Yende and colleagues, adding sepsis to the HRRP “may lead to development of new interventions to reduce unplanned readmissions and associated costs.”

Yende said providers should consider developing programs or interventions to reduce the long-term sequelae associated with sepsis after discharge.

“Future research is needed to develop more personalized interventions to reduce readmission after sepsis,” he told Infectious Disease News. “For this to happen, we need to have a better understanding of a patient's likelihood to be readmitted and the reasons for readmission. Many of these patients are still recovering at home and in nursing homes and rehabilitation facilities, often too weak to return to the clinic to see their primary care physician. Therefore, future research should focus on developing new models to provide care for these patients.” – by Gerard Gallagher

Reference:

Mayr FB, et al. JAMA. 2017;doi:10.1001/jama.2016.20468.

Disclosure: Yende reports receiving grants from Bristol-Myers Squibb.