Changes in Sepsis Trends: Real or Artificial?
- Recent reports indicate a significant increase in the incidence of sepsis with a concomitant drop in mortality.
- Controversy exists over the true degree of change based on changing definitions and coding practices.
- Direct clinical indicators of infection and organ dysfunction are preferred over administrative codes.
- Sepsis remains a global issue with a recently reported 48.9 million cases worldwide.
- Sepsis remains one of the most expensive conditions in hospitals but accounts for less than 6% of all cases.
- Various reports tracking sepsis over the past decades have reported:
- Increasing actual numbers of sepsis cases annually
- Double digit rates of sepsis case increases
- Declining mortality rates at all severity levels of sepsis.
- Various explanations have been proposed for these changes and are listed below.
- Controversy exists over the degree of a true change in disease incidence and outcome versus artificial changes due to ever changing definitions and coding practices.
- Sepsis coding optimizes reimbursement
Coding Criteria Changes:
- October 2002: ICD-9 codes allowed for specific sepsis diagnosis within a single code.
- October 2003: CMS provides guidance on appropriate sepsis coding
- October 2007: CMD overhauls the previous Diagnosis Related Group reimbursement system to the “Medical Severity-Diagnosis Related Group” (MS-DRG) tying reimbursement to severity.
- A review of 635,780 severe sepsis cases from California from 2000-2010 saw annual hospitalization rates triple.
- Distinct sepsis hospitalization increases were seen following sepsis code changes.
- Overall California hospital admission rates had a non-significant change over the same time period.
- Comparing clinical criteria to discharge administrative codes in 57,273 patients with suspected infection and organ dysfunction from 2005 to 2013:
- If milder cases of disease are being documented and coded as sepsis, the increase number of cases and decreased mortality does not actually reflect improved outcomes.
- The lack of a “gold standard” diagnostic test coupled with highly subjective sepsis clinical criteria allows for discretion when coding for sepsis.
- Using objectively defined clinical criteria rather than administrative codes indicates that sepsis incidence and mortality rates have been essentially stable over the past decade.
- Measuring sepsis incidence, outcomes and trends should be based on data routinely found in the electronic health record.
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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.
To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (firstname.lastname@example.org), or video chat.