“Sepsis 2.5”: Bridging the Gaps Between Definitions and Outcomes on Patient Care and Denials

“Sepsis 2.5”: Bridging the Gaps Between Definitions and Outcomes on Patient Care and Denials

5 (1 vote)

Recorded On: 09/29/2022


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, RN, MSN, LSSYB, CCDS

Quality Educator, Outcomes Management

JPS Health Network

Alexis Wells, RN, MSN, LSSYB, CCDS, has been a registered nurse since 2008. She has worked in various areas, including CVICU, neuro ICU, med/surg ICU, telemetry, bone marrow transplant unit, and home hospice, which provided her with a well-rounded foundation when she became a clinical documentation specialist (CDS) in 2015. Within six months, Ms. Wells was promoted to the clinical coordinator role, in which she facilitated healthcare professional education and cultivated relationships with essential ancillary departments such as dietary, wound care, and IT. In 2018, Ms. Wells was hired at John Peter Smith (JPS) hospital as the CDI Quality Assurance Auditor, where she continued working towards the same goals of breaking down barriers and improving workflow and engagement of everyone involved with clinical documentation. In December 2021, Ms. Wells transitioned to a new role at John Peter Smith, becoming the Quality Educator for the entire organization.

Ms. Wells has taken care of multiple patients with sepsis and understands that early identification and intervention are key to survival. This led her to act when the question was posed: how do you bridge patient care and reimbursement when it comes to the septic population?

Stacia Gandee, RHIA, CCS, CDIP, LSSYB

Manager of Clinical Documentation Integrity

JPS Health Network

Stacia Gandee, RHIA, CCS, CDIP, LSSYB, began serving as a clinical documentation specialist (CDS) in February 2017 at John Peter Smith (JPS) hospital. She was quickly promoted to the specialized role of Clinical Validation CDS in 2019, and then again to the manager role in 2020. Prior to this, Ms. Gandee worked as a coder at Baylor Scott & White as well as a contract coder for HIMagine. 

Ms. Gandee is a member of her organization’s sepsis committee and has attended national conferences to ensure her CDI Program is optimizing its impact on patient care, documentation, and coding of sepsis. Ms. Gandee 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.

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.

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