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. 2021 Dec 1;49(12):2058-2069.
doi: 10.1097/CCM.0000000000005332.

Sepsis Among Medicare Beneficiaries: 4. Precoronavirus Disease 2019 Update January 2012-February 2020

Charles E Frank  1   2 , Timothy G Buchman  1   2 , Steven Q Simpson  1   3 , Kimberly L Sciarretta  1 , George E Plopper  1   4 , Kristen P Finne  5 , Nicole Sowers  6 , Michael Collier  6 , Saurabh Chavan  6 , Cheng Lin  6 , Ibijoke Oke  6 , Kiersten E Rhodes  6 , Aathira Santhosh  6 , Steve Chu  7 , Thomas E MaCurdy  6 , Sandeep A Patel  1 , Gary L Disbrow  1 , Jeffrey A Kelman  7
Affiliations

Sepsis Among Medicare Beneficiaries: 4. Precoronavirus Disease 2019 Update January 2012-February 2020

Charles E Frank et al. Crit Care Med. .

Abstract

Objectives: To provide updated information on the burdens of sepsis during acute inpatient admissions for Medicare beneficiaries.

Design: Analysis of paid Medicare claims via the Centers for Medicare and Medicaid Services DataLink Project.

Setting: All U.S. acute-care hospitals, excluding federally operated hospitals (Veterans Administration and Defense Health Agency).

Patients: All Medicare beneficiaries, January 2012-February 2020, with an explicit sepsis diagnostic code assigned during an inpatient admission.

Interventions: None.

Measurements and main results: The count of Medicare Part A/B (fee-for-service) plus Medicare Advantage inpatient sepsis admissions rose from 981,027 (CY2012) to 1,700,433 (CY 2019). The proportion of total admissions with sepsis in the Medicare Advantage population rose from 21.43% to 35.39%, reflecting the increasing beneficiary proportion enrolled in Medicare Advantage. In CY2019, 6-month mortality rates in Medicare fee-for-service beneficiaries for sepsis continued to decline, but remained high: 59.9% for septic shock, 35.5% for severe sepsis, 30.8% for sepsis attributed to a specific organism, and 26.5% for unspecified sepsis. Total fee-for-service-only inpatient hospital costs rose from $17.79B (CY2012) to $22.98B (CY2019). We estimated that the aggregate cost of sepsis hospital care for the entire U.S. population was at least $57.47B in 2019. Inclusion of 14 months' (January 2019-February 2020) newer data exposed new trends: the cost per patient, number of admissions, and fraction of patients with sepsis labeled as present on admission inflected around November 2015, coincident with the change to International Classification of Diseases, 10th Edition, and introduction of the Severe Sepsis and Septic Shock Management Bundle (SEP-1) metric.

Conclusions: Sepsis among Medicare beneficiaries precoronavirus disease 2019 imposed immense burdens upon patients, their families, and the taxpayers.

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Conflict of interest statement

Drs. Frank, Buchman, Sciarretta, Sowers, Collier, Chavan, Lin, Oke, Rhodes, Santhosh, Chu, Patel, Disbrow, and Kelman disclosed government work. Dr. Buchman’s institution received funding from United States government Biomedical Advanced Research and Development Authority (BARDA)/Division of Research, Innovation, and Ventures and the Society of Critical Care Medicine (Editor in Chief of Critical Care Medicine). Dr. Simpson disclosed he is the President of the American College of Chest Physicians. Dr. Sowers’s institution received funding from BARDA, Office of the Assistant Secretary for Preparedness and Response. Drs. Collier, Chavan, Lin, Oke, Rhodes, and Santhosh disclosed that this work was performed by Acumen, LLC under contract with the Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services (Contract No. HHSM-500-2014-00027I; Task Order No. HHSM-500-T0004), with funding from U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Dr. MaCurdy’s institution received funding from Centers for Medicare & Medicaid Services, he received support for article research from Centers for Medicare & Medicaid Services; and he disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Total admissions with a sepsis diagnosis in Medicare beneficiaries, both fee-for-service (FFS) and Medicare Advantage (MA).
Figure 2.
Figure 2.
Trends in inpatient (IP) sepsis admissions to acute care hospitals of Medicare fee-for-service beneficiaries. A, Sepsis IP admissions per million enrolled beneficiaries per month. B, Rate of sepsis IP admissions out of all IP admissions in the Medicare fee-for-service beneficiary population. C, Rates of sepsis stay out of all Medicare fee-for-service IP admissions stratified by sepsis severity.
Figure 3.
Figure 3.
One-wk and 6-mo mortality in Medicare fee-for-service patients with sepsis. IP = inpatient.
Figure 4.
Figure 4.
Mortality among the Medicare fee-for-service population stratified by sepsis severity within 1 wk (A) and 6 mo (B).
Figure 5.
Figure 5.
Monthly inpatient (IP) costs for sepsis among Medicare fee-for-service (FFS) beneficiaries Healthcare Consumer Price Index adjusted to December 2019 U.S. dollar values (6). A, Total costs. B, Average cost per patient.
Figure 6.
Figure 6.
Analysis of the seven most common diagnosis-related groups (DRGs) for admissions with a sepsis diagnostic code labeled as present on admission (POA). A, Percentage of all admissions assigned to the seven most common DRGs. B, Average cost-per-case for the top seven most common DRGs (costs are adjusted using the Healthcare Consumer Price Index, normalized to the index year 2019) (6). Costs inflected in 2015. The DRGs represented (in order of frequency): septicemia or severe sepsis without mechanical ventilation (MV) > 96 hr with major complication or comorbidity (MCC), septicemia or severe sepsis without MV > 96 hr without MCC, infectious and parasitic diseases with operating room (OR) procedure with MCC, septicemia or severe sepsis with MV greater than 96 hr or peripheral extracorporeal membrane oxygenation, other kidney and urinary tract diagnoses with MCC, infectious and parasitic diseases with OR procedure with complication or comorbidity, other circulatory system diagnoses with MCC.
Figure 7.
Figure 7.
Interrupted time series regression analysis of change in frequency of diagnosis of sepsis as present on admission (POA) (A) and not POA (nPOA) (B). Interruption occurs in November 2015.
Figure 8.
Figure 8.
Interrupted time series analysis of the 12-month moving average sepsis admissions among Medicare fee-for-service and Medicare Advantage beneficiaries. The point of maximal difference occurs in April 2016, reflecting that the inflection occurred in October 2015, 6 mo prior.
Figure 9.
Figure 9.
Predicted and actual sepsis costs among Medicare fee-for-service beneficiaries. All values adjusted using the Healthcare Consumer Price Index, normalized to the index value in December 2019 (6).
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References

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