1. Hospitalizations for Severe Sepsis Among Elderly Medicare Beneficiaries William Buczko, Ph.D. Research Analyst Centers for Medicare & Medicaid Services

2. Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: William Buczko No relationships to disclose

3. Introduction Severe sepsis (sepsis accompanied by organ dysfunction) is associated with increasing hospitalization and mortality rates among elderly persons. It has been associated with high resource use and costs typical of chronically critically ill patients. How do elderly patients with severe sepsis differ from other patients hospitalized for sepsis?

4. MEDPAR inpatient hospital discharge data for CY 2010 were examined for elderly Medicare fee-for-service beneficiaries hospitalized for sepsis (N=691,542). Patients with evidence of organ failure were classified as having severe sepsis (n= 476,593), representing 68.9% of all sepsis hospitalizations. Severe sepsis patients were identified using criteria presented in Lagu, et al. (2012) for defining sepsis and organ failure (the Angus method). Data

5. Comorbidities Patients with a diagnosis of ICD-9-CM codes 481.xx – 485.xx were classified as having pneumonia present. Patients with a diagnosis of ICD-9-CM codes 584.xx – 586.xx were classified as having renal failure present. Patients with a diagnosis of ICD-9-CM codes 250.xx were classified as having diabetes present. Patients with a diagnosis of ICD-9-CM codes 401.xx – 405.xx were classified as having hypertension present. Patients with a diagnosis of ICD-9-CM codes 430.xx – 438.xx were classified as having stroke present. Patients with a diagnosis of ICD-9-CM codes 490.xx – 496.xx were classified as having chronic obstructive pulmonary disease (COPD) present. Patients with a diagnosis of ICD-9-CM code 428 were classified as having congestive heart failure (CHF) present.

15. Effects of Severity and other Comorbidities on Length of Stay Standard Predictors Coefficient Error T. Age -0.1376 0.0016 -88.96 Female -0.1131 0.0267 - 4.24 Black 1.9769 0.0398 49.69 Hispanic 1.4235 0.0834 17.07 In Hospital Death -1.7898 0.0340 -52.66 Severe Sepsis 2.5405 0.0347 73.19 Pneumonia 5.5038 0.0510107.99 Renal Failure 0.9084 0.0309 29.40 Diabetes -2.6303 0.0380 -69.31 Hypertension -2.9033 0.0304 -95.66 Stroke 0.9144 0.0510 17.93 Chronic Obstructive -2.0175 0.0379 -53.28 Pulmonary Disease Congestive Heart -1.3629 0.0407 -33.50 Failure Intercept 20.07 N = 691,542 R 2 = 0.088, F= 5,101.30 with (13, 691,528) Degrees of Freedom

16. Effects of Severity and other Comorbidities on Log Total Medicare Covered Charges Standard Predictors Coefficient Error T. Age - 0.01750.0002 -99.97 Female - 0.03770.0030 -12.54 Black 0.10940.0045 24.36 Hispanic 0.3107 0.0094 33.00 In Hospital Death - 0.04430.0038 -11.53 Severe Sepsis 0.43950.0039 112.16 Pneumonia 0.49540.0058 86.11 Renal Failure 0.11870.0035 34.02 Diabetes - 0.3170 0.0043 - 73.98 Hypertension - 0.35050.0034- 102.31 Stroke 0.09620.0058 16.72 Chronic Obstructive - 0.17170.0043 - 40.16 Pulmonary Disease Congestive Heart - 0.14310.0046 - 31.14 Failure Intercept 9.51 N = 691,542, R 2 = 0.107, F= 6361.96 with (13, 691,528) Degrees of Freedom

17. Summary The average age of patients with and without severe sepsis was similar (79 years old). Length of stay and total covered charges were higher for severe sepsis patients than for patients with uncomplicated sepsis (11.2 days vs. 7.2 days; $9,609 vs. $4,165). The percent of patients dying in-hospital was far greater for severe sepsis (27.7%) compared to uncomplicated sepsis patients (7.6%). While most live discharges were to a SNF for both severe and uncomplicated sepsis hospitalizations, patients with severe sepsis were more likely to be discharged to a long-term acute care hospital (LTCH) and less likely to be discharged to home or home health care. The multivariate models for length of stay and for sepsis cost per case showed that the severe sepsis indicator had a major impact on both length of stay and Medicare covered charges per discharge. It may be necessary to consider the effects of comorbidities along with diagnosis codes to efficiently target patients who are chronically critically ill patients.