Sepsis hospitalizations cost Medicare $41.8B in 2018—and that number's likely to grow

Hospital bed
A new Department of Health and Human Services study examines Medicare spending and outcomes related to sepsis. (Getty/gorodenkoff)

Sepsis hospitalizations cost Medicare $41.8 billion in 2018 alone, a new study from the Department of Health and Human Services (HHS) shows. 

The rate of Medicare beneficiaries hospitalized with sepsis has increased by 40% over the past seven years, the HHS study found. The researchers analyzed more than 9.5 million inpatient admissions between 2012 and 2018, making for one of the largest studies into the impact of sepsis. 

The growing sepsis infection rate isn’t related to ballooning Medicare enrollment, the study says, as enrollment grew by 22% even as infection rates grew by 40%. 

“Sepsis is a lethal and costly health threat affecting Americans’ lives and our economy, yet many Americans may never have heard of it,” Robert Kadlec, M.D., HHS assistant secretary for preparedness and response, said in a statement. 

“Any infection can lead to sepsis, including infections caused by influenza or emerging diseases like coronaviruses, which makes sepsis a significant concern in public health emergencies,” Kadlec said. 

RELATED: About half of all hospital deaths could be sepsis-related. We don’t have the means to prevent them 

A study released last month by the University of Pittsburgh estimates that sepsis is responsible for one in every five deaths worldwide, double previous projections. And while high-income countries have plenty of work to do to address sepsis rates, middle- and low-income countries disproportionately bear the burden of the disease, the Pitt study found.

HHS’ analysis dug into sepsis’ impact on outcomes for Medicare beneficiaries and found that 10% of those with non-severe sepsis died while hospitalized or within a week of discharge, and 60% died within three years of contracting the infection. 

Of those diagnosed with severe sepsis, or septic shock, 40% died in the hospital or within a week of discharge, and 75% died within three years, according to the study. 

Mortality risks were highest among beneficiaries with comorbid chronic conditions, HHS said. 

Medicare patients were more likely to arrive at the hospital with the infection rather than contracting it while hospitalized, the study found. However, two-thirds had a medical encounter in the week before their hospitalization, emphasizing the need for earlier detection. 

RELATED: Why providers shouldn’t overlook bundles for sepsis care 

The study suggests the cost burden of sepsis isn’t likely to decrease anytime soon. HHS projects that in 2019 the cost for inpatient and skilled nursing care related to sepsis could exceed $69 billion. 

Costs increased by 12% to 14% every two years, the study found. 

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said in a statement that the study highlights the “urgent need” for continued action to mitigate sepsis and said the agency is moving full speed ahead with efforts to eliminate regulatory hurdles that can inhibit access to lifesaving drugs. 

“This groundbreaking study sheds light on the sepsis-related challenges faced by patients, providers, and taxpayers alike,” Verma said. 

“CMS continues to clear away regulatory obstacles and financial disincentives that have long inhibited the development of life-saving antibiotics capable of treating sepsis patients,” she added. “Patients suffering from sepsis deserve to see America’s full innovative potential mobilized to address this devastating condition.” 

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