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The Center for Healthcare Research & Transformation at the University of Michigan today releases a new report that shows a dramatic increase in hospitalizations for septicemia from 2007 to 2011. The hospitalization rate for orthopedic procedures that improve mobility and alleviate chronic pain also increased. The issue brief, The Cost Burden of Disease: United States and Michigan, is an analysis of hospitalization rates and charges from 2007–2011.

Hospital discharge rates for septicemia rose sharply among the total population in both the U.S. and Michigan, by 56.8 percent and 62.1 percent, respectively. In 2011, this resulted in total charges for septicemia diagnoses of $74.2 billion in the U.S. and $1.9 billion in Michigan.

The sharp increase in septicemia⁽¹⁾The category of septicemia comprises a variety of diagnosis codes, including severe sepsis and septic shock. is likely indicative of an important shift upward in the disease burden of severe sepsis, as well as changes in coding and recognition. Septicemia is one cause of severe sepsis, which occurs when the body’s response to an infection causes problems in other body systems. Such infections can result in death, but can be effectively treated with antibiotics and fluids, often in an ICU environment.

“The rise in severe sepsis can be attributed in part to the fact that more people are surviving life-threatening diseases such as cancer, but those patients also become more vulnerable to diseases such as severe sepsis,” says Theodore J. Iwashyna, M.D., Ph.D., associate professor of Pulmonary and Critical Care Medicine at the University of Michigan and co-author of a recently published study on hospitalized patients with sepsis.⁽²⁾V. Liu, G. Escobar, J. Greene, J. Soule, A. Whippy, D. Angus, T. Iwashyna, “Hospital Deaths in Patients with Sepsis from Two Independent Cohorts,” The Journal of the American Medical Association. Published online May 18, 2014. doi:10.1001/jama.2014.5804. “Healthy people are also at risk for severe sepsis if they have an infection which triggers the condition.”

“It is important for physicians and patients alike to understand this increase, so we can do a better job of identifying these potentially life threatening illnesses,” says Marianne Udow-Phillips, director of the Center for Healthcare Research and Transformation. “Treatment for sepsis is much more effective when it is found early.”

Another key finding from CHRT’s report is that three of the highest-charge procedures in both Michigan and in the United States were surgeries related to chronic pain relief and mobility: spinal fusion, arthroplasty in the knee and hip replacement. In Michigan, each of these procedures increased as a proportion of total discharges by at least 8 percent from 2007 to 2011.

“Another trend is the increase in the rate and cost of procedures for orthopedic conditions and chronic pain,” says Udow-Phillips. “Treating chronic pain is a significant issue that will rise with the aging of the population. There is an urgent case for finding better ways for treating pain.”

Udow-Phillips is a member of the Service Delivery and Reimbursement Workgroup of the National Institutes of Health’s National Pain Strategy Task Force, developed as part of the Affordable Care Act to create a comprehensive strategy for pain prevention, treatment, management and research.

Other findings include: The discharge rate for most heart conditions fell both nationally and in Michigan from 2007 to 2011; in Michigan, discharge rates for seven heart-related conditions fell by at least 10 percent. This may indicate that heart conditions are being adequately treated on an outpatient basis. Average charges per discharge were consistently lower in Michigan than nationwide for both total charges and charges per discharge.

The Cost Burden of Disease: United States and Michigan is issued periodically by CHRT. For more information, and to review the issue brief in detail, visit: https://chrt.org/publications/price-of-care/cost-burden-of-disease-2014/.

CHRT is an external member of the U-M Institute for Healthcare Policy and Innovation (IHPI). Iwashyna is an IHPI member.