Hospitalizations for Severe Sepsis in California

Hospitalizations for sepsis are among the most expensive. In 2021, hospital charges for sepsis totaled $86 billion in California, based on total charges for all sepsis.

Why Hospitalizations for Severe Sepsis#

Sepsis is a preventable, life-threatening medical condition, which if not treated timely and properly, can result in a severe condition with multiple organ failure (severe sepsis) and death. Sepsis impacts approximately 1.7 million people annually in the United States. Hospitalizations for sepsis are among the most expensive (CDC: What is Sepsis?).

In 2021, COVID-19 may have had an impact on the number of severe sepsis cases; 23.3 percent of severe sepsis patients also had a diagnosis of COVID-19, and 39.9 percent of severe sepsis patients who died in the hospital had a COVID-19 diagnosis (Effects of COVID-19 on Hospital Utilization Trends; HCAI Patient Discharge Data).

The visualizations below present patient information on in-hospital and 30-day mortality, length of stay, charges, and payers for severe sepsis hospitalizations, along with hospital characteristics including hospital size, location, ownership, and designation as a teaching facility.

Key Findings – Severe Sepsis Patient Information#

• From 2014 to 2021, the number of severe sepsis cases nearly doubled, while the number of in-hospital deaths for severe sepsis remained constant until 2019. However, the number of in-hospital severe sepsis deaths increased from 2019 to 2021, with a 15.2 percent increase from 2020 to 2021.
• The number of hospital-acquired severe sepsis cases remained steady over the last several years, before increasing in 2020 and 2021. There was a 24.2 percent rise for in hospital-acquired cases and 6.0 percent increase for non-hospital acquired cases from 2020 to 2021. From 2014 to 2021, non-hospital acquired severe sepsis cases outnumbered hospital-acquired cases.
• The average length of stay for severe sepsis hospitalizations increased from 2020 to 2021. However, from 2014 to 2021, the average length of stay for severe sepsis decreased by approximately one day. The median charge per day increased by 25.2 percent from 2014 to 2021. Charges may not reflect the actual cost paid by the patient or insurer.
• Medicare was the expected payer for more hospitalized severe sepsis cases than any other payer in 2021, accounting for 175,994 hospitalizations (56.5 percent), followed by Medi-Cal for 74,161 hospitalizations (23.8 percent), Private Coverage for 51,196 hospitalizations (16.4 percent), Other Payer for 6,840 hospitalizations (2.2 percent), and Self Pay for 3,435 hospitalizations (1.1 percent). 
• With the introduction of Hospice Care as a discharge category in 2015, there was a reduction in the number of deaths in each of the six other categories, with the greatest decrease in deaths in the skilled nursing category. In 2020, most severe sepsis patients who died within 30 days following discharge died at hospice care facilities (48.9 percent), followed by skilled nursing facilities (22.0 percent), and home health service organizations (11.6 percent).
• The percentage of hospital-acquired severe sepsis patients among those who died within 30 days of discharge decreased from 2014 to 2020, while the share who acquired severe sepsis outside the hospital increased.

Note: Between 2020 and 2021, HCAI updated its definition of severe sepsis to include more diagnosis codes. Users should be cautious when interpreting the increase in severe sepsis cases in 2021, which is partly because of this definition change.

Medicare includes: Medicare Advantage, traditional Medicare. Medi-Cal includes: Medi-Cal managed care, fee-for-service Medi-Cal. Private Coverage includes: employer group coverage, individual coverage (including coverage purchased through Covered California), organized charity payers (e.g., March of Dimes, Shriners). Self-Pay includes: uninsured patients, as well as instances when insurance does not cover the treatment, or the patient would like to keep the medical procedure private.

ᵜOther Payer includes: Workers’ Compensation, County Indigent Programs, any third-party payment not included in any other category, stays for which no payment will be required by the facility (e.g. courtesy patients), and stays for which no valid expected payer was reported to HCAI.

* Hospitalization charges reported with $0 are not included. Charges are not adjusted for inflation.
ᵟ Hospice Care was introduced as a discharge category in 2015.

Key Findings – Severe Sepsis Hospital Characteristics#

• The smallest hospitals (1-99 beds) had the highest rates of hospital-acquired severe sepsis compared to other facility sizes. Hospital facilities of all sizes experienced a large increase in rates of hospital-acquired severe sepsis from 2019 to 2021.
• Urban hospitals had higher rates of hospital-acquired severe sepsis compared to rural hospitals. From 2020 to 2021, rates of hospital-acquired severe sepsis increased by 46.9 percent for rural hospitals and 19.2 percent for urban hospitals.
• Nonprofit hospitals had the lowest rates of hospital-acquired severe sepsis followed by government hospitals, and investor-owned hospitals. From 2019 to 2021, there was a rise in rates of hospital-acquired severe sepsis in all three categories.
• Teaching hospitals had higher rates of hospital-acquired severe sepsis compared to non-teaching hospitals. The rates in teaching and non-teaching hospitals increased steadily, with the largest increase between 2019 and 2021.

* Investor-owned hospitals are for-profit. Nonprofit hospitals are operated by nonprofit organizations such as churches. Governmental include district, city/county and state facilities that receive government funding.

General Information about Sepsis#

• Sepsis: the body’s extreme response to an infection. Almost any type of infection can lead to sepsis.
• Sepsis symptoms: high heart rate or low blood pressure, chills, fever, extreme pain or discomfort, confusion, shortness of breath or clammy/sweaty skin.
• Hospital-acquired sepsis: acquired while a patient is hospitalized for another illness or procedure.
• Severe sepsis: without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
• People in high-risk of developing sepsis: the very young, the very old, those with chronic illnesses, and those with a weakened or impaired immune system.
• For more information on sepsis visit the Centers for Disease Control and Prevention website.

How HCAI Created This Product#

Severe sepsis cases were identified by a diagnosis of sepsis and organ dysfunction from the Patient Discharge Data (PDD).

Additional Information#

Topic: Healthcare Utilization
Source Link: Healthcare Utilization – Inpatient Discharges
Citation: HCAI Patient Discharge Data – Hospitalizations for Severe Sepsis in California, 2014-2021
Temporal Coverage: 2014-2021
Spatial/Geographic Coverage: Statewide
Frequency: Annually