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Sepsis Among Medicare Beneficiaries: 4. Precoronavirus Disease 2019 Update January 2012-February 2020
Charles E Frank1,2, Timothy G Buchman1,2, Steven Q Simpson1,3
1United States Department of Health and Human Services, Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, Washington, DC.
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.
Insights
Sepsis admissions in Medicare beneficiaries significantly increased from 2012 to 2019, with high mortality rates and substantial healthcare costs. Changes in coding and quality metrics around 2015 may have influenced trends.
Area of Science:
- Public Health
- Healthcare Economics
- Infectious Diseases
Background:
- Sepsis represents a significant and growing public health concern.
- Understanding the economic and clinical burden of sepsis is crucial for healthcare policy.
- Medicare beneficiaries are a key population for studying national healthcare trends.
Purpose of the Study:
- To provide updated data on the incidence, mortality, and costs associated with sepsis hospitalizations among Medicare beneficiaries.
- To analyze trends in sepsis admissions before the COVID-19 pandemic.
- To identify potential impacts of healthcare policy changes on sepsis care.
Main Methods:
- Analysis of paid Medicare claims (fee-for-service and Medicare Advantage) from January 2012 to February 2020.
- Inclusion of all U.S. acute-care hospitals, excluding federal facilities.
- Examination of sepsis diagnostic codes, mortality rates, and associated inpatient costs.
Main Results:
- Sepsis admissions rose from 981,027 in 2012 to 1,700,433 in 2019.
- Medicare Advantage sepsis admissions increased proportionally, reaching 35.39% of total MA admissions by 2019.
- In 2019, 6-month mortality rates for fee-for-service beneficiaries ranged from 26.5% (unspecified sepsis) to 59.9% (septic shock).
- Total inpatient costs for sepsis in fee-for-service Medicare rose from $17.79 billion (2012) to $22.98 billion (2019).
- Estimated aggregate cost of sepsis hospital care for the entire U.S. population was at least $57.47 billion in 2019.
- Trends in cost, admissions, and "present on admission" labeling shifted around November 2015, coinciding with ICD-10 implementation and the SEP-1 metric.
Conclusions:
- Sepsis imposed substantial burdens on Medicare beneficiaries, healthcare systems, and taxpayers prior to 2020.
- The study highlights the persistent challenge of sepsis management and its economic impact.
- Further research is needed to understand the long-term effects of coding changes and quality metrics on sepsis outcomes.
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