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L+M scores lowest in the state in Medicare rankings on sepsis care

August 10, 2018

New London — Lawrence + Memorial Hospital scored lower than all other Connecticut hospitals, and well below the state average, on a Medicare scorecard for timely treatment of sepsis, a serious complication that can be fatal.

L+M staff followed sepsis care protocol set by the Centers for Medicare & Medicaid Services only 13 percent of the time in a sample of 215 patients — 30 percentage points below the average score for Connecticut hospitals and 71 percentage points below the hospital with the highest score, Day Kimball Hospital in Putnam.

Medicare released the numbers on its Hospital Compare website for the first time in July after it started requiring hospitals to report their adherence to guidelines for treating severe sepsis and septic shock last year.

The average score for all Connecticut hospitals, excluding the two run by the Veterans Health Administration, was 43 percent.

Hospitals submitted records for a random sample of patients who were diagnosed in the first nine months of 2017 with sepsis, a life-threatening condition that occurs when the body responds to infection by releasing chemicals into the bloodstream, causing inflammation that can damage organ systems.

The Centers for Disease Control and Prevention says more than 1.5 million people get sepsis in the United States each year, and more than 250,000 die from it. Sepsis accounts for about a third of deaths in hospitals.

Hospital officials responded to the published numbers with an emailed statement Wednesday.

“We are absolutely dedicated to recognizing and treating sepsis in all of our patients,” hospital spokesman Mike O’Farrell said in a statement. “Traditionally, our numbers have been significantly higher, and we know that these results represent a single snapshot in time. Our affiliation with Yale New Haven Health is allowing us to optimize our sepsis care through the development of cutting edge recognition and treatment algorithms through our shared electronic medical record.”

The Centers for Medicare & Medicaid Services penalized L+M in fiscal years 2016 and 2017 for reporting high rates of hospital-acquired infections and injuries, including rates of post-operative sepsis, a separate measure from the ones published last month.

The government releases the data on a two-year lag, so when L+M managed to avoid the penalty in fiscal year 2018, hospital staff said it reflected the 2015 results of concerted efforts to improve communication among staff and reduce infections and injuries.

Medicare started requiring hospitals to report data about the timeliness of their sepsis treatment for the first time last year, after developing new treatment protocols and measurements for treatment quality.

Some physicians are skeptical about whether the government-mandated treatment steps and reporting rules accurately measure hospitals’ ability to treat cases of sepsis, said Dr. Jeremy Kahn, a professor of Critical Care Medicine and Health Policy & Management at the University of Pittsburgh School of Medicine and the co-author of a study of hospitals’ perceptions of the new requirements.

The scoring metrics are relatively new, Kahn said, and were rolled out more quickly than other Medicare-mandated quality measurements added in the past. Plus, he said, sepsis is complex and often difficult to diagnose, so there isn’t a universally agreed-upon set of rules for how to treat it.

“It is important to take these numbers with a grain of salt,” he said. “I think it would be important, before judging hospitals too harshly, that we let this measure mature ... and gain more understanding of how it works.”

But Kahn said sepsis can be deadly and often is not treated quickly enough, and hospital administrators still should pay close attention to their scores and work to improve them.

“Sepsis is a massive public health problem (and) we know that many, many patients report to the hospital and don’t get evidence-based care,” he said. “It’s not fair to ... dismiss the measure itself, or to pretend that all hospitals can’t do more to provide timely care. It’s worthy to focus on them and ... to say, ‘show us what these numbers are.’ In those numbers are very sick people who didn’t get evidence-based treatment.”

Mary Cooper, the senior vice president for clinical services at the Connecticut Hospital Association, said in a emailed statement Wednesday that all of the state’s hospitals are working to improve their responses to sepsis.

“We’re making progress but there is still work to do, and one of those areas is sepsis,” Cooper said. She said the hospitals are taking measures within their walls and also as participants in statewide Connecticut Hospital Association efforts and in the Centers for Medicare & Medicaid Services’ Hospital Improvement Innovation Network.

“Connecticut hospitals believe it is important for patients to be able to make informed choices about their health care, and they are transparent with quality data,” Cooper said. “Hospital Compare, like all publicly available systems, is a tool for patients to use with the understanding that individual care yields individual results. We encourage patients to work with their doctor to determine the facility that best meets their needs.”

m.shanahan@theday.com

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