“Sepsis 2.5”: Bridging the Gaps Between Definitions and Outcomes on Patient Care and Denials
Recorded On: 09/29/2022
Description:
The need to choose between Sepsis-2 and Sepsis-3 criteria presents great challenges for healthcare professionals and organizations. Sepsis-2 emphasizes early identification, but results in a high denial volume for reimbursement. Most insurance companies have adopted Sepsis-3 for reimbursement, but healthcare professionals who choose Sepsis-3 run the risk of delaying patient care and performing poorly on CMS’s SEP-1 Core Measure. In this session, presenters will discuss the concept of “Sepsis-2.5,” including what it is, why it was developed, and the approach to adoption and rollout taken within the John Peter Smith (JPS) Health Network system. The presenters will also review how, with “Sepsis-2.5,” JPS Health Network maintained SEP-1 bundle compliance greater than the national average and a mortality rate lower than the global average, while simultaneously mitigating denial risk and maintaining accurate reimbursement.
Learning Objectives:
At the end of the activity, the learner should be able to:
- Understand the difference between Sepsis-2 and Sepsis-3 definitions and the need for a Sepsis-2.5;
- Analyze key data metrics on sepsis performance at their organization to determine if Sepsis-2.5 is appropriate;
- Apply strategies for implementing Sepsis-2.5.
Target Audience:
Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.
Alexis Wells, MSN, RN, CCDS, LSSYB
Associate Director of Education and Quality
Emory Healthcare
Alexis Wells, MSN, RN, CCDS, LSSYB, has been a registered nurse since 2008, working in various states (Michigan, Texas, California, Florida, and Washington) and areas including CVICU, neuro ICU, med/surg ICU, telemetry, bone marrow transplant unit, and home hospice. This provided a well-rounded foundation to become a Clinical Documentation Specialist in 2015. Within six months, Alexis was promoted as the CDI Clinician Coordinator, facilitating education to providers and cultivating relationships with essential ancillary departments such as Nutrition, Wound Care, and IT. In 2021, Alexis took on the opportunity to become a Quality Educator, combining the two worlds of CDI and Quality. Now, she serves as the Associate Director of CDI over Quality and Education at an 11-hospital health system, continuing to break down silos and advocating to make it easy to do the right thing, especially for the very vulnerable and critical septic population.
Alexis Wells had no relevant financial relationships to disclose.
Stacia Gandee, RHIA, CCS, CDIP, LSSYB
Manager of Clinical Documentation Integrity
JPS Health Network
Stacia Gandee, RHIA, CCS, CDIP, LSSYB, has been a dedicated Clinical Documentation Specialist (CDS) since 2017. She advanced quickly in her career, stepping into the specialized role of Clinical Validation CDS in 2019 and then into management in 2020. Her journey in clinical documentation is rooted in over a decade of experience as an inpatient coder, which provided her with deep expertise in both coding and documentation.
Stacia is an active member of her organization’s sepsis committee and has attended national conferences to ensure her CDI Program is optimizing impact in patient care, documentation, and coding practices. Stacia brings ambition, knowledge, and coding expertise that is instrumental to organization-wide change in practice as it relates to the integrity of clinical documentation and coding.
Stacia Gandee had no relevant financial relationships to disclose.
Provider approved by the California Board of Registered Nursing, Provider Number CEP17068 for 1.2 contact hours.
Other healthcare professionals will receive a certificate of attendance for 1.0 contact hours.
Medical Disclaimer
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