The Cost of Sepsis

Guest Author: Jim O’Brien
Vice President of Quality and Patient Safety
Ohio Health Riverside Methodist Hospital

I am biased about sepsis, but I will try to put that aside and present an argument for why people who have day jobs like me – hospital administrators – should focus on improving sepsis care today.

I am not going to spend time writing about the altruistic nature of medicine and the desire to eliminate human suffering. I believe this is self-evident and covered by others on this blog. Instead, I want to talk dollars and cents, operational efficiencies and reimbursement penalties.

Sepsis is the most expensive reason for hospitalization. In 2011¹ (the most recent published data), the US spent $20.3 billion dollars on hospital care for patients with sepsis. This means we are spending $55,616,438 on sepsis care in US hospitals every day. An average hospital stay for sepsis costs approximately double a stay for another diagnosis, and the annual rate of growth of sepsis costs in hospitals is three-times the rate for hospital costs overall. Sepsis patients stay in the hospital 75% longer than other patients – impacting the ability for hospitals to move patients out of the emergency department and into hospital beds. Survivors of sepsis are more likely to be discharged to a place other than home after the hospital² and suffer readmissions at a high rate, costing approximately $2B per year³.

Leading organizations understand the cost of caring for these patients and have realized significant savings as a result. However, this realization is far from universal. One reason is that traditional financial incentives are not aligned with best sepsis care. Traditional healthcare economics measures a return on investment based on new revenue – not avoided costs. Investing in better sepsis care does not increase the volume of services – what most hospitals and doctors income is based on. Multiple improvement projects have shown that immediate identification of the suspicion of sepsis and treatment as a medical emergency reduces the likelihood of continued deterioration – from sepsis to severe sepsis to septic shock. However, hospitals (and, to a lesser degree, doctors) get paid more for providing care to sicker patients. For example, in 2013 in Ohio, Medicare paid, on average $11,794 per case of severe sepsis that did not require patient to be on a mechanical ventilator for at least 96 hours⁴. If the patient required this level of care, presumably because they were sicker, Medicare paid $40,878 per case. The problem is that we do not have a good way to determine if patients are sicker in spite of the care they receive or because of it. Despite this, I am dubious that changing reimbursement for sepsis care will be sufficient to improve outcomes. Instead, an empowered team of clinicians using proven performance improvement methods appears to be the necessary ingredient. However, eliminating misaligned financial incentives may bring sepsis to the attention of less forward-thinking administrators and provide greater support and resources to the clinical teams.

Another influential factor are that sepsis is not something known by the public. Less than half of Americans have heard the word “sepsis.” As a result, there is not the informal, but influential, discussions at cocktail parties and back yard barbecues of which hospital treats sepsis care best. Instead, I hear my neighbors and friends discuss the great heart care they received at hospital X and the terrific knee replacement done by Dr. Y. Hospital board members and CEOs attend these functions too. And most of them are not physicians – they are administrators like me. When we aren’t being asked what we are doing about sepsis, we don’t know we should be doing anything about sepsis.

1. Pfuntner et al. Costs for Hospital Stays in the United States. HCUP Statistical Brief #168.
2. Hall et al. Inpatient care for septicemia or sepsis: A challenge for patients and hospitals. NCHS Data Brief, No. 62; June 2011.
3. Hines et al. HCUP Statistical Brief #172. April 2014.
4. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html, Accessed June 4, 2015.

Jim O’Brien is the Vice President of Quality and Patient Safety at OhioHealth Riverside Methodist Hospital. A medical intensivist by training, Jim began his career at OhioHealth in July 2012 after an academic career as a successful clinical researcher and epidemiologist, publishing more than fifty articles and chapters in peer review journals. Common themes include the effect of excess body weight on outcomes for critically ill patients, epidemiology and risk factors for sepsis and medical decision making. He currently oversees multiple quality improvement projects and is responsible for Riverside’s efforts toward patient safety, regulatory compliance and utilization management. Jim is the past chair of the Quality Improvement Committee of the American College of Chest Physicians and currently serves on a Society of Critical Care Medicine committee developing a support infrastructure for survivors of critical illness and on a Critical Care Societies Collaborative task force defining core competencies for providers of critical care services.

Jim serves as the Chair of the Board of Directors and medical advisor to Sepsis Alliance – a not-for-profit organization dedicated to raising awareness of sepsis by educating patients, families and healthcare professionals to treat sepsis as a medical emergency. Jim is also co-founder of Spike Out Sepsis, an annual sand volleyball tournament to benefit Sepsis Alliance, which will hold its eighth event on June 25, 2016.