Kentucky Health Plans Group Argues Outdated Sepsis Rule Inflates Billing
In a commentary piece, Tom Stephens, executive director of the Kentucky Association of Health Plans, argues that hospital billing practices, including AI-assisted upcoding and Kentucky's outdated sepsis definition, are driving avoidable healthcare cost growth. He cites a KFF analysis showing hospital care drove 40% of national health spending growth from 2022-2024, and a Blue Health Intelligence review finding a sharp rise in complex-admission coding at some hospitals. He notes Kentucky is one of three states whose 2024 law locks Medicaid plans into using a 1991 sepsis definition rather than the updated 2016 Sepsis-3 criteria, which he says lets hospitals bill more infections as sepsis without changing patient care. Stephens calls on Kentucky to modernize the sepsis law and let health plans flag unsupported charges.