Data Source 
 
 
 
 The estimates in this Statistical Brief are based upon data from the Healthcare Cost and Utilization Project (HCUP) 2011 Nationwide Inpatient Sample (NIS). The statistics were generated from HCUPnet, a free, online query system that provides users with immediate access to the largest set of publicly available, all-payer national, regional, and State-level hospital care databases from HCUP. 
 
 
 
 Definitions 
 
 
 
 Diagnoses, ICD-9-CM, and Clinical Classifications Software (CCS) 
 
 The principal diagnosis is that condition established after study to be chiefly responsible for the patient's admission to the hospital. Secondary diagnoses are concomitant conditions that coexist at the time of admission or develop during the stay. 
 
 
 
 ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are approximately 14,000 ICD-9-CM diagnosis codes. 
 
 
 
 CCS categorizes ICD-9-CM diagnoses into a manageable number of clinically meaningful categories.3 This "clinical grouper" makes it easier to quickly understand patterns of diagnoses. CCS categories identified as "Other" typically are not reported; these categories include miscellaneous, otherwise unclassifiable diagnoses that may be difficult to interpret as a group. 
 
 
 
 Types of hospitals included in HCUP 
 
 HCUP is based on data from community hospitals, which are defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include obstetrics and gynecology, otolaryngology, orthopedic, cancer, pediatric, public, and academic medical hospitals. Excluded are long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals. However, if a patient received long-term care, rehabilitation, or treatment for psychiatric or chemical dependency conditions in a community hospital, the discharge record for that stay will be included in the NIS. 
 
 
 
 Unit of analysis 
 
 The unit of analysis is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate "discharge" from the hospital. 
 
 
 
 Costs and charges 
 
 Total hospital charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS).4 Costs will reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case. For each hospital, a hospital-wide cost-to-charge ratio is used. Hospital charges reflect the amount the hospital billed for the entire hospital stay and do not include professional (physician) fees. For the purposes of this Statistical Brief, costs are reported to the nearest hundred. 
 
 
 
 Payer 
 
 Payer is the expected primary payer for the hospital stay. To make coding uniform across all HCUP data sources, payer combines detailed categories into general groups: Medicare: includes patients covered by fee-for-service and managed care Medicare 
 
 Medicaid: includes patients covered by fee-for-service and managed care Medicaid 
 
 Private Insurance: includes Blue Cross, commercial carriers, and private health maintenance organizations (HMOs) and preferred provider organizations (PPOs) 
 
 Other: includes Worker's Compensation, TRICARE/CHAMPUS, CHAMPVA, Title V, and other government programs 
 
 Uninsured: includes an insurance status of "self-pay" and "no charge." 
 
 Encounters billed to the State Children's Health Insurance Program (SCHIP) may be classified as Medicaid, Private Insurance, or Other, depending on the structure of the State program. Because most State data do not identify SCHIP patients specifically, it is not possible to present this information separately. 
 
 
 
 When more than one payer is listed for a hospital discharge, the first-listed payer is used. 
 
 
 
 About HCUP 
 
 
 
 HCUP is a family of powerful health care databases, software tools, and products for advancing research. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP includes the largest all-payer encounter-level collection of longitudinal health care data (inpatient, ambulatory surgery, and emergency department) in the United States, beginning in 1988. HCUP is a Federal-State—Industry Partnership that brings together the data collection efforts of many organizations—such as State data organizations, hospital associations, private data organizations, and the Federal governmentâ€”to create a national information resource. 
 
 
 
 HCUP would not be possible without the contributions of the following data collection Partners from across the United States: 
 
 
 
 Alaska State Hospital and Nursing Home Association 
 
 Arizona Department of Health Services 
 
 Arkansas Department of Health 
 
 California Office of Statewide Health Planning and Development 
 
 Colorado Hospital Association 
 
 Connecticut Hospital Association 
 
 Florida Agency for Health Care Administration 
 
 Georgia Hospital Association 
 
 Hawaii Health Information Corporation 
 
 Illinois Department of Public Health 
 
 Indiana Hospital Association 
 
 Iowa Hospital Association 
 
 Kansas Hospital Association 
 
 Kentucky Cabinet for Health and Family Services 
 
 Louisiana Department of Health and Hospitals 
 
 Maine Health Data Organization 
 
 Maryland Health Services Cost Review Commission 
 
 Massachusetts Center for Health Information and Analysis 
 
 Michigan Health & Hospital Association 
 
 Minnesota Hospital Association 
 
 Mississippi Department of Health 
 
 Missouri Hospital Industry Data Institute 
 
 Montana MHA - An Association of Montana Health Care Providers 
 
 Nebraska Hospital Association 
 
 Nevada Department of Health and Human Services 
 
 New Hampshire Department of Health & Human Services 
 
 New Jersey Department of Health 
 
 New Mexico Department of Health 
 
 New York State Department of Health 
 
 North Carolina Department of Health and Human Services 
 
 North Dakota (data provided by the Minnesota Hospital Association) 
 
 Ohio Hospital Association 
 
 Oklahoma State Department of Health 
 
 Oregon Association of Hospitals and Health Systems 
 
 Oregon Health Policy and Research 
 
 Pennsylvania Health Care Cost Containment Council 
 
 Rhode Island Department of Health 
 
 South Carolina Budget & Control Board 
 
 South Dakota Association of Healthcare Organizations 
 
 Tennessee Hospital Association 
 
 Texas Department of State Health Services 
 
 Utah Department of Health 
 
 Vermont Association of Hospitals and Health Systems 
 
 Virginia Health Information 
 
 Washington State Department of Health 
 
 West Virginia Health Care Authority 
 
 Wisconsin Department of Health Services 
 
 Wyoming Hospital Association 
 
 
 
 About the NIS 
 
 
 
 The HCUP Nationwide Inpatient Sample (NIS) is a nationwide database of hospital inpatient stays. The NIS is nationally representative of all community hospitals (i.e., short-term, non-Federal, nonrehabilitation hospitals). The NIS is a sample of hospitals and includes all patients from each hospital, regardless of payer. It is drawn from a sampling frame that contains hospitals comprising more than 95 percent of all discharges in the United States. The vast size of the NIS allows the study of topics at both the national and regional levels for specific subgroups of patients. In addition, NIS data are standardized across years to facilitate ease of use. 
 
 
 
 About HCUPnet 
 
 
 
 HCUPnet is an online query system that offers instant access to the largest set of all-payer health care databases publicly available. HCUPnet has an easy step-by-step query system, allowing for tables and graphs to be generated on national and regional statistics as well as trends for community hospitals in the United States. HCUPnet generates statistics using data from HCUP's Nationwide Inpatient Sample (NIS), the Kids' Inpatient Database (KID), the Nationwide Emergency Department Sample (NEDS), the State Inpatient Databases (SID), and the State Emergency Department Databases (SEDD). 
 
 
 
 For More Information 
 
 
 
 For more information about HCUP, visit 
 
 
 
 For additional HCUP statistics, visit HCUPnet, our interactive query system, at 
 
 
 
 For information on other hospitalizations in the United States, download HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States in 2009, located at 
 
 
 
 For a detailed description of HCUP, more information on the design of the Nationwide Inpatient Sample (NIS), and methods to calculate estimates, please refer to the following publications: 
 
 
 
 Introduction to the HCUP Nationwide Inpatient Sample, 2009. Online. May 2011. U.S. Agency for Healthcare Research and Quality. 
 
 
 
 Houchens R, Elixhauser A. Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June 6, 2005). U.S. Agency for Healthcare Research and Quality. 
 
 
 
 Suggested Citation 
 
 
 
 Torio CM (AHRQ), Andrews RM (AHRQ). National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. HCUP Statistical Brief #160. August 2013. Agency for Healthcare Research and Quality, Rockville, MD. 
 
 
 
 The estimates in this Statistical Brief are based upon data from the Healthcare Cost and Utilization Project (HCUP) 2011 Nationwide Inpatient Sample (NIS). The statistics were generated from HCUPnet, a free, online query system that provides users with immediate access to the largest set of publicly available, all-payer national, regional, and State-level hospital care databases from HCUP.Diagnoses, ICD-9-CM, and Clinical Classifications Software (CCS)The principal diagnosis is that condition established after study to be chiefly responsible for the patient's admission to the hospital. Secondary diagnoses are concomitant conditions that coexist at the time of admission or develop during the stay.ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are approximately 14,000 ICD-9-CM diagnosis codes.CCS categorizes ICD-9-CM diagnoses into a manageable number of clinically meaningful categories.This "clinical grouper" makes it easier to quickly understand patterns of diagnoses. CCS categories identified as "Other" typically are not reported; these categories include miscellaneous, otherwise unclassifiable diagnoses that may be difficult to interpret as a group.Types of hospitals included in HCUPHCUP is based on data from community hospitals, which are defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include obstetrics and gynecology, otolaryngology, orthopedic, cancer, pediatric, public, and academic medical hospitals. Excluded are long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals. However, if a patient received long-term care, rehabilitation, or treatment for psychiatric or chemical dependency conditions in a community hospital, the discharge record for that stay will be included in the NIS.Unit of analysisThe unit of analysis is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate "discharge" from the hospital.Costs and chargesTotal hospital charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS).Costs will reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case. For each hospital, a hospital-wide cost-to-charge ratio is used. Hospital charges reflect the amount the hospital billed for the entire hospital stay and do not include professional (physician) fees. For the purposes of this Statistical Brief, costs are reported to the nearest hundred.PayerPayer is the expected primary payer for the hospital stay. To make coding uniform across all HCUP data sources, payer combines detailed categories into general groups:Encounters billed to the State Children's Health Insurance Program (SCHIP) may be classified as Medicaid, Private Insurance, or Other, depending on the structure of the State program. Because most State data do not identify SCHIP patients specifically, it is not possible to present this information separately.When more than one payer is listed for a hospital discharge, the first-listed payer is used.HCUP is a family of powerful health care databases, software tools, and products for advancing research. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP includes the largest all-payer encounter-level collection of longitudinal health care data (inpatient, ambulatory surgery, and emergency department) in the United States, beginning in 1988. HCUP is a Federal-State—Industry Partnership that brings together the data collection efforts of many organizations—such as State data organizations, hospital associations, private data organizations, and the Federal governmentâ€”to create a national information resource.HCUP would not be possible without the contributions of the following data collection Partners from across the United States:State Hospital and Nursing Home AssociationDepartment of Health ServicesDepartment of HealthOffice of Statewide Health Planning and DevelopmentHospital AssociationHospital AssociationAgency for Health Care AdministrationHospital AssociationHealth Information CorporationDepartment of Public HealthHospital AssociationHospital AssociationHospital AssociationCabinet for Health and Family ServicesDepartment of Health and HospitalsHealth Data OrganizationHealth Services Cost Review CommissionCenter for Health Information and AnalysisHealth & Hospital AssociationHospital AssociationDepartment of HealthHospital Industry Data InstituteMHA - An Association of Montana Health Care ProvidersHospital AssociationDepartment of Health and Human ServicesDepartment of Health & Human ServicesDepartment of HealthDepartment of HealthState Department of HealthDepartment of Health and Human Services(data provided by the Minnesota Hospital Association)Hospital AssociationState Department of HealthAssociation of Hospitals and Health SystemsHealth Policy and ResearchHealth Care Cost Containment CouncilDepartment of HealthBudget & Control BoardAssociation of Healthcare OrganizationsHospital AssociationDepartment of State Health ServicesDepartment of HealthAssociation of Hospitals and Health SystemsHealth InformationState Department of HealthHealth Care AuthorityDepartment of Health ServicesHospital AssociationThe HCUP Nationwide Inpatient Sample (NIS) is a nationwide database of hospital inpatient stays. The NIS is nationally representative of all community hospitals (i.e., short-term, non-Federal, nonrehabilitation hospitals). The NIS is a sample of hospitals and includes all patients from each hospital, regardless of payer. It is drawn from a sampling frame that contains hospitals comprising more than 95 percent of all discharges in the United States. The vast size of the NIS allows the study of topics at both the national and regional levels for specific subgroups of patients. In addition, NIS data are standardized across years to facilitate ease of use.HCUPnet is an online query system that offers instant access to the largest set of all-payer health care databases publicly available. HCUPnet has an easy step-by-step query system, allowing for tables and graphs to be generated on national and regional statistics as well as trends for community hospitals in the United States. HCUPnet generates statistics using data from HCUP's Nationwide Inpatient Sample (NIS), the Kids' Inpatient Database (KID), the Nationwide Emergency Department Sample (NEDS), the State Inpatient Databases (SID), and the State Emergency Department Databases (SEDD).For more information about HCUP, visit http://www.hcup-us.ahrq.gov/ For additional HCUP statistics, visit HCUPnet, our interactive query system, at http://hcupnet.ahrq.gov/ For information on other hospitalizations in the United States, download HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States in 2009, located at http://www.hcup-us.ahrq.gov/reports.jsp For a detailed description of HCUP, more information on the design of the Nationwide Inpatient Sample (NIS), and methods to calculate estimates, please refer to the following publications:Introduction to the HCUP Nationwide Inpatient Sample, 2009. Online. May 2011. U.S. Agency for Healthcare Research and Quality. http://hcup-us.ahrq.gov/db/nation/nis/NIS_2009_INTRODUCTION.pdf . Accessed July 22, 2013.Houchens R, Elixhauser A. Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June 6, 2005). U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/methods/CalculatingNISVariances_RevisedFinal121814.pdf . Accessed July 22, 2013.Torio CM (AHRQ), Andrews RM (AHRQ). National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. HCUP Statistical Brief #160. August 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.pdf *** AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. We also invite you to tell us how you are using this Statistical Brief and other HCUP data and tools, and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please e-mail us at 
 
 
 
 Irene Fraser, Ph.D., Director 
 
 Center for Delivery, Organization, and Markets 
 
 Agency for Healthcare Research and Quality 
 
 540 Gaither Road 
 
 Rockville, MD 20850 
 
 
 
 
 
 
 
 1 Centers for Medicare & Medicaid Services. National Health Expenditure Accounts. 
 
 2 Martin AB, Lassman D, Washington B, Catlin A. National Health Expenditure Accounts Team. Growth in US health spending remained slow in 2010; health share of gross domestic product was unchanged from 2009. Health Aff (Millwood). 2012 Jan;31(1):208-19. 
 
 3 HCUP Clinical Classifications Software (CCS). Healthcare Cost and Utilization Project (HCUP). U.S. Agency for Healthcare Research and Quality, Rockville, MD. Available at 
 
 4 HCUP Cost-to-Charge Ratio Files (CCR). Healthcare Cost and Utilization Project (HCUP). 2001-2009. U.S. Agency for Healthcare Research and Quality, Rockville, MD. Available at AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. We also invite you to tell us how you are using this Statistical Brief and other HCUP data and tools, and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please e-mail us at hcup@ahrq.gov or send a letter to the address below:Irene Fraser, Ph.D., DirectorCenter for Delivery, Organization, and MarketsAgency for Healthcare Research and Quality540 Gaither RoadRockville, MD 20850Centers for Medicare & Medicaid Services. National Health Expenditure Accounts. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html . Accessed July 17, 2013.Martin AB, Lassman D, Washington B, Catlin A. National Health Expenditure Accounts Team. Growth in US health spending remained slow in 2010; health share of gross domestic product was unchanged from 2009. Health Aff (Millwood). 2012 Jan;31(1):208-19.HCUP Clinical Classifications Software (CCS). Healthcare Cost and Utilization Project (HCUP). U.S. Agency for Healthcare Research and Quality, Rockville, MD. Available at http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp . Updated March 2013. Accessed July 17, 2013.HCUP Cost-to-Charge Ratio Files (CCR). Healthcare Cost and Utilization Project (HCUP). 2001-2009. U.S. Agency for Healthcare Research and Quality, Rockville, MD. Available at http://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp . Updated July 2013. Accessed July 17, 2013. 

 An updated version of this piece is at: What are septic shock and sepsis? The facts behind these deadly conditions. 
 
 Most Americans have never heard of it, but according to new federal data, sepsis is the most expensive cause of hospitalization in the US. 
 
 Sepsis is a complication of infection that leads to organ failure. One million patients are hospitalized for sepsis each year (across all types of health insurance). This is more than the number of hospitalizations for heart attack and stroke combined. Sepsis can be a particular risk for older people. In 2013 alone, 400,000 Medicare beneficiaries were hospitalized because of sepsis at a cost of US$5.5 billion. 
 
 And it is deadly. Between one in eight and one in four patients with sepsis will die during hospitalization. In fact sepsis contributes to one-third to one-half of all in-hospital deaths. 
 
 Despite these grave consequences, fewer than half of Americans know what the word sepsis means. 
 
 What is sepsis and why is it so dangerous? 
 
 Sepsis a severe health problem sparked by your body’s reaction to infection. When you get an infection, your body fights back, releasing chemicals into the bloodstream to kill the harmful bacteria or viruses. When this process works the way it is supposed to, your body takes care of the infection and you get better. With sepsis, the chemicals from your body’s own defenses trigger inflammatory responses, which can impair blood flow to organs, like the brain, heart or kidneys. This in turn can lead to organ failure and tissue damage. 
 
 Sepsis can result from any type of infection. Most commonly, it starts as a pneumonia, urinary tract or intra-abdominal infection such as appendicitis. It is sometimes referred to as “blood poisoning,” but this is not an accurate term. Blood poisoning is an infection present in the blood, while sepsis refers to the body’s response to any infection, wherever it is. 
 
 Once a person is diagnosed with sepsis, she will be treated with antibiotics, IV fluids and support for failing organs, such as dialysis or mechanical ventilation. This usually means a person needs to be hospitalized, often in an ICU. Sometimes the source of the infection must be removed, as with appendicitis or an infected medical device. 
 
 Part of the problem we face with sepsis is agreeing on just what it is, from a medical standpoint. Experts last defined sepsis in 2001. 
 
 However, recent studies suggest the current definition does a poor job distinguishing sepsis from other diseases that can make one very sick. Many conditions can mimic sepsis, including severe allergic reactions, bleeding, heart attacks, blood clots and medication overdoses. Sepsis requires particular prompt treatments, so getting the diagnosis right matters. 
 
 The revolving door of sepsis care 
 
 As recently as a decade ago, doctors believed that sepsis patients were out of the woods if they could just survive to hospital discharge. But that isn’t the case – 40% of sepsis patients go back into the hospital within just three months of heading home, creating a “revolving door” that gets costlier and riskier each time, as patients get weaker and weaker with each hospital stay. 
 
 If sepsis wasnt’t bad enough, it can lead to another health problem: Post-Intensive Care Syndrome (PICS), a chronic health condition that arises from critical illness. Common symptoms include weakness, forgetfulness, anxiety and depression. 
 
 Post-Intensive Care Syndrome and frequent hospital re-admissions mean that we have dramatically underestimated how much sepsis care costs. On top of the $5.5 billion we now spend on initial hospitalization for sepsis, we must add untold billions in re-hospitalizations, nursing home and professional in-home care, and unpaid care provided by devoted spouses and families at home. 
 
 Unfortunately, progress in improving sepsis care has lagged behind improvements in cancer and heart care, as attention has shifted to the treatment of chronic diseases. 
 
 Rethinking treatment and care 
 
 Raising public awareness increases the likelihood that patients will get to the hospital quickly when they are developing sepsis. This in turn allows prompt treatment, which lowers the risk of long-term problems. 
 
 Beyond increasing public awareness, doctors and policymakers are also working to improve the care of sepsis once patients get to the hospital. 
 
 Several physician groups are collaborating to develop a new prediction tool called qSOFA. This instrument identifies patients with infection who are at high risk of death or prolonged intensive care. In contrast to existing methods for identifying sepsis, the new tool is data-driven. It was developed through examining millions of electronic patient records. 
 
 Researchers are also refining a mainstay of sepsis treatment – antibiotic therapy. These medications must be given within hours of diagnosis, but how long they are needed is unclear. 
 
 Newer studies indicate that shorter treatment courses may be as effective as longer courses, while potentially limiting disruption to healthy bacteria living on and within us. 
 
 Preliminary research by us and our colleagues suggests that the risk for sepsis is temporarily increased when healthy bacteria are disturbed. This raises the intriguing possibility that diet or supplements aimed at restoring healthy bacteria may reduce the risk of future sepsis. 
 
 Life after sepsis 
 
 Even with great inpatient care, some survivors will still have problems after sepsis, such as memory loss and weakness. 
 
 Doctors are wrestling with how to best care for the growing number of sepsis survivors in the short and long term. This is no easy task, but there are several exciting developments in this area. 
 
 The Society of Critical Care Medicine’s THRIVE initiative is now building a network of support groups for patients and families after critical illness. THRIVE will forge new ways for survivors to work with each other, like how cancer patients provide each other advice and support. 
 
 As medical care is increasingly complex, many doctors contribute to a patient’s care for just a week or two. Electronic health records let doctors see how the sepsis hospitalization fits into the broader picture – which in turn helps doctors counsel patients and family members on what to expect going forward. 
 
 The high number of repeat hospitalizations after sepsis suggests another opportunity for improving care. We could analyze data about patients with sepsis to target the right interventions to each individual patient. 
 
 Better care through better policy 
 
 In 2012, New York State passed regulations to require every hospital to have a formal plan for identifying sepsis and providing prompt treatment. It is too early to tell if this is a strong enough intervention to make things better. However, it serves as a clarion call for hospitals to end the neglect of sepsis. 
 
 The Centers for Medicare & Medicaid Services (CMS) are also working to improve sepsis care. Starting in 2017, CMS will adjust hospital payments by quality of sepsis treatment. Hospitals with good report cards will be paid more, while hospitals with poor marks will be paid less. 
 
 To judge the quality of sepsis care, CMS will require hospitals to publicly report compliance with National Quality Forum’s “Sepsis Management Bundle.” This includes a handful of proven practices such as heavy-duty antibiotics and intravenous fluids. 
 
 While policy fixes are notorious for producing unintended consequences, the reporting mandate is certainly a step in the right direction. 
 
 Right now, sepsis care varies greatly from hospital to hospital, and patient to patient. But as data, dollars and awareness converge, we may be at a tipping point that will help patients get the best care, while making the best use of our health care dollars.
– Most Americans have never heard of sepsis, but the condition hospitalizes a million patients every year—more than heart attack and stroke hospitalizations combined—and is the nation's costliest reason for hospitalization, the Conversation reports. Yet it's hard to diagnose and many doctors don't look for, let alone spot, the deadly condition. So what is it? Often confused with blood poisoning, sepsis occurs when the body responds in a toxic way to an infection (anything from pneumonia to a UTI). As the Sepsis Alliance puts it, "Your body’s immune system, which is supposed to fight off the infection, goes into overdrive and begins to attack your body." Sepsis can cause tissue damage or multiple organ failure, landed 400,000 Medicare beneficiaries in ICUs across the country in 2013 alone, and plays a role in 33% to 50% of all US hospital deaths. It cost $5.5 billion for those initial Medicare hospitalizations in 2013, yet triggers return visits 40% of the time. And as far as percentages go, here's another big one: A report based on 2011 data found sepsis "resulted in an aggregate cost of $20.3 billion or 5.2%" of what America spent on all hospitalizations that year. Treatment may improve as hospitals create sepsis teams and new prediction tools, as well as investigate treatments; antibiotics and fluids alone can save lives, notes the Sepsis Alliance, which in 2013 reported only 44% of Americans had ever heard of sepsis. Meanwhile, experts are advising people with symptoms like depression, anxiety, forgetfulness, and weakness to seek faster hospitalization. Root causes include smoking, alcoholism, pollution, and pulmonary problems, a professor told Frontline magazine years ago. But problems persist: In Canada, hundreds of malpractice cases in recent years involved sepsis, usually over poor diagnosis, the National Post reports. (See how quickly sepsis killed this high school student.)