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Objectives: Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database., Design: Observational cohort study., Setting: First 27 months of mandated sepsis reporting (April 1, 2014, to June 30, 2016)., Patients: Hospitalizations with sepsis at New York State Article 28 acute care hospitals., Intervention: Sepsis regulations with mandated reporting., Measurements and Main Results: We compared cases reported to the New York State Department of Health Sepsis Clinical Database with discharge records in the Statewide Planning and Research Cooperative System database. We classified discharges as 1) "coded sepsis discharges"-a diagnosis code for severe sepsis or septic shock and 2) "possible sepsis discharges," using Dombrovskiy and Angus criteria. Of 111,816 sepsis cases reported to the New York State Department of Health Sepsis Clinical Database, 105,722 (94.5%) were matched to discharge records in Statewide Planning and Research Cooperative System. The percentage of coded sepsis discharges reported increased from 67.5% in the first quarter to 81.3% in the final quarter of the study period (mean, 77.7%). Accounting for unmatched cases, as many as 82.7% of coded sepsis discharges were potentially reported, whereas at least 17.3% were unreported. Compared with unreported discharges, reported discharges had higher rates of acute organ dysfunction (e.g., cardiovascular dysfunction 63.0% vs 51.8%; p < 0.001) and higher in-hospital mortality (30.2% vs 26.1%; p < 0.001). Hospital characteristics (e.g., number of beds, teaching status, volume of sepsis cases) were similar between hospitals with a higher versus lower percent of discharges reported, p values greater than 0.05 for all. Hospitals' percent of discharges reported was not correlated with risk-adjusted mortality of their submitted cases (Pearson correlation coefficient 0.11; p = 0.17)., Conclusions: Approximately four of five discharges with a diagnosis code of severe sepsis or septic shock in the Statewide Planning and Research Cooperative System data were reported in the New York State Department of Health Sepsis Clinical Database. Incomplete reporting appears to be driven more by underrecognition than attempts to game the system, with minimal bias to risk-adjusted hospital performance measurement.

While following the same approach to care as hospice, palliative care reaches patients who do not necessarily have a terminal diagnosis or a life-threatening illness, and/or are seeking curative treatment. Reimbursement methodologies and requirements for palliative care differ from hospice, and are not explicitly covered by federal and state regulations. In the first article of a two-part series, the author reviews licensing issues, reimbursement requirements, fraud and abuse pitfalls, and cost report requirements for home health agency palliative care programs.

As more that 40 states face present and projected deficits in their health care budgets, some legislatures are considering market-based reforms to control rising health care costs. This continues a trend begun in the 1990s that emphasized market competition over state regulation and mandates. However, little is known about the impact of many market-based reforms on quality of care. This Issue Brief evaluates the effect of one reform--the deregulation of hospital reimbursement rates in New Jersey--on one important outcome of care-mortality from acute myocardial infarction (heart attack). The findings serve as a reminder that cost-constraining reforms may reduce the quality of care, particularly for uninsured and other vulnerable populations.