Readmissions in Sepsis

9/15/18 8:00 AM

In 2012, the Centers for Medicare & Medicaid Services (CMS) instituted the Readmission Reduction Program (HRRP) in all hospitals that follow the Inpatient Prospective Payment System (IPPS). HRRP aims to reduce readmission rates by disincentivizing hospitals that have an excess number of readmissions for six indications: acute myocardial infarction (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG) surgeries, and elective primary total hip and/or total knee arthroplasty (THA/TKA). CMS only tracks 30-Day readmission rates for these six indications as these are generally accepted to account for the highest proportion of readmissions in hospitals.

However, in one study that investigated readmission rates for sepsis-related cases, it was found that “sepsis is a leading cause of readmissions and associated costs.” The researchers analyzed data from the 2013 Nationwide Readmission Database and calculated the percentage of patients with sepsis readmissions as well as the above indications. They concluded that sepsis readmissions were the largest proportion of readmissions (14.5 %), and length of stay (LOS) for sepsis patients was much longer than the others (7 days). All results were deemed significant after statistical analysis. The mean cost of readmission of sepsis was also noticeably larger than that of the other indications ($10,119). According to the authors “adding sepsis to the Hospital Readmission Reduction Program may lead to development of new interventions to reduce unplanned readmissions and associated costs.”

Similar results were also found in another study that was published in 2015 in the Journal of the American Medical Association (JAMA). This study found that 90-day readmission rates for sepsis cases were common and that many readmissions could be prevented if treated early. This study analyzed data from the representative US Health and Retirement Study and tracked severe sepsis indications and 15 common acute medical conditions.

The study found that 42.6% of patients from the database were readmitted within 90 days and that there were common readmission diagnoses: heart failure, pneumonia, and chronic obstructive pulmonary disease exacerbation. These readmission diagnoses were much more prevalent after initial sepsis hospitalization than the other 15 common acute medical conditions. A caveat of the study is that it only looked at readmissions for ambulatory care sensitive conditions (ACSC). Further, the authors of the study state uncertainty about whether ACSC readmissions are preventable after initial sepsis hospitalization.

However, the implications of this study are important as they indicate potential areas where readmission rates can be reduced and patient care can be improved.

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