News: Sepsis-related readmissions, new criteria, and septic shock denials

The Surviving Sepsis Campaign released new care guidelines updating its 2012 recommendations to help clinicians caring for patients with sepsis and septic shock.

The guidelines—crafted through collaboration between the Society of Critical Care Medicine and the European Society of Intensive Care Medicine—aim to “tell a story about the approach to treating the sepsis patient through a management continuum beginning with diagnosis, initial resuscitation, antimicrobial therapy, source control, fluid/vasoactive therapy, and progressing through organ support and adjunctive therapy recommendations,” according to its users guide.

Surviving Sepsis Campaign recommendations come on the heels of the so-called “Sepsis-3” definitions of sepsis and septic shock released in February 2016 by the Journal of the American Medical Association (JAMA). (Click here to read a related ACDIS Advisory Board position paper on the matter.)

A JAMA report released this month (January 2017) shows sepsis-related conditions account for a large number of hospital readmissions and its authors urged CMS to add sepsis to its list of readmission reduction targets stating that such readmissions require lengthy, and costly, hospital stays, Florian Mayr, MD, of the University of Pittsburgh Medical Center, told the Society of Critical Care Medicine, MedPage Today reported.

CMS’ readmission reduction program currently tracks patients who return to the hospital within a 30-day period following inpatient treatment for acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia “because hospitalizations for these conditions are frequent and account for a large proportion of readmissions,” according to the study.

Sepsis readmissions accounted for as many, if not more, readmission cases than the conditions CMS currently tracks, study authors report.

Appropriate documentation for sepsis and its various manifestations continues to cause confusion for clinicians, CDI specialists, and coders alike, according to Allen R. Frady, RN, BSN, CCS, CCDS, CDI education specialist for ACDIS, in Middleton, Massachusetts, and Cesar M. Limjoco, MD, vice president of clinical services at DCBA, Inc., in Atlanta, Georgia, during a TalkTen Tuesday podcast on January 24.

The criteria CDI professionals use to discern whether a particular medical record reflects a patient with septic shock falls into an “80/20 rule,” Frady said, meaning its only accurate about 80% of the time, which is “unacceptable.”

“There’s nothing black and white in septic shock (as well as in medicine, in general) because certain circumstances may change the way diseases manifest,” Limjoco wrote in a companion piece.

So it’s easy for auditors to deny sepsis claims based on differing clinical criteria in the industry, Frady says.

“If you have an atypical patient, you have to go above and beyond in [investigating] the documentation,” Frady said. Since auditors have a definition and criteria for sepsis and septic shock, many see it as “low hanging fruit” for denials. “It’s easy enough to slap a denial on that,” Frady said.

“We need to get ourselves away from the trees to see the mountain,” Limjoco told TalkTen Tuesday listeners, meaning that while the new Surviving Sepsis care recommendations and Sepsis-3 definitions can be helpful, CDI specialists need to see the bigger patient picture to truly determine the severity of that individual’s condition.