Hospital Infections, Joint Replacements Leading Medical Expenses: CMS Report

Joint replacement surgery and hospital infections top the list of the most expensive health care costs for the U.S. medical system, according to a new government report. 

The U.S. Centers for Medicare and Medicaid Services (CMS) issued a report on June 1, involving data on hospitalization and payments for fiscal year 2013, which outlines the top ten most costly healthcare concerns.

CMS found that major joint replacement and severe sepsis infections topped the list, with no other healthcare costs coming even close.

Major joint replacement or reattachment of lower extremities cost the most and were the most frequent hospital utilization. Total discharges for fiscal year 2013 were 446,148 procedures, costing Medicare a total of $6.6 billion.

Septicemia or severe sepsis came in second, with 398,004 total discharges at a cost of $5.56 billion that year. That represents a 15% increase from 2012.

The CMS study looked at the top diagnostic related groups based on discharges, costs, and service utilization. It looked at hospital data on the 100 most common Medicare inpatient stays and 30 outpatient procedures conducted by 3,000 hospitals in all 50 states and the District of Columbia.

“Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers,” Niall Brennan, CMS chief data officer, said in a press release. “CMS will continue to release the hospital and physician data on an annual basis so we can enable smarter decision making about care that is delivered in the health care system.”

Sepsis Health Risks

The sepsis infection numbers are of particular concern because in many cases they are hospital-acquired infections, which, unlike most joint replacement operations, are largely preventable.

According to the U.S. Centers for Disease Control and Prevention, about 750,000 people are hospitalized each year in the U.S. due to sepsis. From 2000 to 2010, the rate of deaths due to sepsis infections increased 17%, and hospital deaths related to sepsis increased from 45,000 to 135,000.

Sepsis occurs when the body overreacts to an infection, causing the immune system to begin damaging the body’s own tissues as well as combating foreign bacteria. Every hour that treatment is delayed lowers the rate of survival by about 8%, yet many hospitals fail to immediately diagnose sepsis and do not begin providing appropriate treatment for four to six hours.

Symptoms of septic shock are often vague, including:

• Confusion
• Shortness of breath
• Increase heart rate
• Declining blood pressure
• Weakness

A 2010 study found that, despite its widespread prevalence, 60% of Americans had never heard of sepsis and do not know the signs of septic shock.