A report finds both the number of patients and the total amount spent on inpatient care fell from two years earlier.

June 15—Septicemia was the costliest condition treated by hospitals, according to the latest accounting by the Agency for Health Research and Quality (AHRQ). And the cost is growing quickly.

Septicemia was the most expensive condition in 2013—the most recent year for which data is available—according to a new AHRQ report. Septicemia treatments cost $23.7 billion, or 6.2 percent of the aggregate cost for all hospitalizations. The total was an increase from $20.3 billion spent on the condition in 2011, which represented 5.2 percent of national costs, according to a previous report.

The 17 percent increase in both total septicemia costs and hospital spending on the condition in just two years was likely driven by an aging population, according to Thomas Heymann, president and executive director of the Sepsis Alliance.

“That’s a pretty dramatic increase, and it’s going the wrong way,” Heymann said in an interview.

Septicemia was the most costly hospital condition among Medicare patients and the uninsured, and it ranked among the four costliest hospital conditions in each of the four payer groups tracked by AHRQ: Medicare, Medicaid, private insurance, and the uninsured.

Septicemia was the second-most common reason for hospitalization, accounting for 3.6 percent of inpatient stays.

The latest increase in septicemia rates followed a previous AHRQ report that found that from 2000 to 2009, the number of hospitalizations with a principal diagnosis of septicemia increased by 148 percent and hospitalizations with a secondary diagnosis of septicemia increased by 66 percent.

Further adding to the burden: Septicemia was the second-leading cause of hospital readmissions, according to a previous AHRQ report. It drove 5 percent of all Medicare readmissions and carried $3 billion in costs, Heymann said.

The implications of the higher prevalence of septicemia were underscored in an AHRQ toolkit, which noted that up to 27 percent of patients admitted to intensive care units have severe sepsis, and mortality rates range from 20 percent to more than 50 percent.

The findings came amid increasing hospital efforts to reduce the incidence of the blood infection that can progress into sepsis. For instance, Kennedy Health, a three-hospital, not-for-profit health system in southern New Jersey, recently was recognized by the Sepsis Alliance for its efforts to reduce the condition’s toll. Kennedy reduced its mortality rate through a program initially developed to recognize sepsis in emergency department patients and subsequently used to detect and then treat sepsis patients throughout the hospital, according to an alliance post. Those efforts lowered the sepsis mortality rate from 21.5 percent to 9.7 percent, a Kennedy Health spokeswoman said.

The smaller system was recognized, in part, to provide an example for other smaller hospitals, both urban and rural, that have struggled to address sepsis among their patients, Heymann said

“They’re showing that this can be done,” Heymann said.

Additionally, as part of an effort to assess the quality of sepsis care nationwide, the Centers for Medicare & Medicaid Services (CMS) mandated that hospitals begin reporting adherence to a sepsis management bundle starting Oct. 1, 2015.

However, that approach was criticized in a recent Annals of Internal Medicine commentary as “overly prescriptive, rigid, and onerous.”

Michael Klompas, MD, associate professor of population medicine, and Chanu Rhee, MD, a population health professor at Harvard Medical School, criticized the “clinical uncertainties” with the treatment approach prescribed by the bundle, as well as the “considerable administrative burden it imposes on hospitals.”

“We believe that the answer is to report objective sepsis rates and risk-adjusted outcomes rather than subjective processes of care,” the two researchers wrote.

Heymann countered that although the approach was not perfect, it was helpful to have a first-time CMS measure tracking sepsis.

“The fact that attention is being paid to a disease that is the No. 3 cause of death is a good thing because it certainly has been under-addressed, under-researched and underfunded,” Heymann said.

Other Costs

Other high-cost hospitalizations were for osteoarthritis ($16.5 billion, or 4.3 percent of national costs); live births ($13.3 billion, or 3.5 percent); complication of device, implant, or graft ($12.4 billion, or 3.3 percent); and acute myocardial infarction ($12.1 billion, or 3.2 percent). The only change among the top five costly conditions from 2011 was that the cost of live births overtook device complications. All of the top five accounted for larger shares of national costs from the previous report.

Six conditions, in addition to septicemia, were among the 20 most expensive conditions for all four payer groups: Complication of device, implant or graft; acute myocardial infarction; congestive heart failure; pneumonia; acute cerebrovascular disease; and respiratory failure.

The 20 most expensive conditions accounted for 43.7 percent of all hospital stays, led by live births, (10.6 percent of all stays), osteoarthritis (2.9 percent), pneumonia (2.7 percent), congestive heart failure (2.5 percent), and mood disorders (2.3 percent).

Payers Differ

Demographics and regional coverage variations drove differences in most-costly conditions among payer groups. For instance, osteoarthritis and back problems were among the most expensive hospital conditions for Medicare and private insurance.

Meanwhile, hospitalizations associated with pregnancy and childbirth accounted for five of the 20 most expensive conditions for hospital stays covered by Medicaid and three of top 20 for stays covered by private insurance. Skin infections were among the most expensive hospital conditions covered by Medicaid and among the uninsured.

The report also found that 46 percent of the $381 billion in aggregate hospital costs was attributed to Medicare, 17 percent to Medicaid, 28 percent to private insurance, 5 percent to the uninsured, and 4 percent to “other/missing.”

Of the 35.6 million hospital stays in 2013, 39 percent were by Medicare patients, 21 percent by Medicaid patients, 30 percent by the privately insured, 6 percent by the uninsured, and 4 percent by “other/missing.”

Both totals were reduced from two years earlier, when hospitals had nearly 39 million stays that totaled $387 billion.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C. office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, June 15, 2016