Sepsis treatment must focus on patients
Sepsis treatments have seen some controversy in recent years, but the decisions need to come down to the most cost-effective, patient-focused methods.
Sepsis is one of the most common — and costly — causes of death in U.S. hospitals. That’s why the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission launched the Sepsis Core Measure for all 4,000 Joint Commission-accredited hospitals in the U.S. back in 2015.
Since then, however, those measures have met with some pushback. Steven Simpson, MD, professor of medicine in the University of Kansas Division of Pulmonary, Critical Care, and Sleep Medicine, said the focus should stay on what is best for the patient.
“For years they have paid more for sepsis care than for infection care,” Dr. Simpson said. “They believe they are saving money for patients who meet more stringent criteria — the ones who do not respond to fluids and antibiotics. The refractory cases.”
According to Dr. Simpson, these decisions are just costing everyone more money in the long run by focusing on the wrong areas. And in so doing it is moving the discussion away from the methods that provide the best outcome for patients.
“Where [insurance companies] go awry is the costs of those individuals really are substantially higher,” Dr. Simpson said. “The best treatment for really severe sepsis or septic shock is prevention.”
The need for that preventative care is just one aspect of Monday’s session, “Shock to the System: Sepsis Update for Hospitalists.” Dr. Simpson said insurance companies cover other types of preventative care, such as vaccines for serious illnesses like pneumococcal pneumonia, meningococcemia, and influenza so that they can prevent the downstream cost of a severe infection.
“While there is no vaccine for sepsis, it is interesting that [insurance companies] do not want to incentivize hospitals to find sepsis before it is expensive,” he said. “And you do that by finding it when it is less severe and can be treated easily.”
During the session, Dr. Simpson will explore how to recognize and care for patients with sepsis, including the arguments for and against early antibiotics, standardized fluid management, and even the Sepsis Core Measure itself, which has been updated numerous times since its inception.
Dr. Simpson said he also will discuss why aggressive initiation of antibiotics and aggressive antibiotics are in fact synergistic, rather than being opposite, and look at newer laboratory approaches to diagnosing sepsis.
“The goal,” he said, “is for all of us to take a well-reasoned approach to diagnosing and treating seriously ill patients with infection.”
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