Unrecognized cardiogenic shock: a costly gap in hospital care

Cardiogenic shock (CS) continues to pose a major challenge for hospitals nationwide, largely because delayed recognition contributes to poor patient outcomes. Even with significant progress in interventional cardiology, mortality remains high, with one-year rates often approaching or surpassing 50%. Timely clinical recognition of CS is consistently linked with improved patient outcomes. Recognition of CS also has implications for hospital operations and financial performance. Importantly, CS is classified by CMS as a major complication or comorbidity (MCC), which shifts many cardiac cases into a higher-weighted Diagnosis Related Group (DRG), significantly increasing potential reimbursement. 

The extent of the DRG financial impact depends on the payer, region, and underlying diagnosis.  However, what is clear is that unrecognized or undocumented cases will often result in significant lost revenue for hospitals.

Why condition severity matters – the evolution to MS-DRGs

Previously, DRGs didn’t adequately differentiate between sicker, higher-cost patients and less complex ones, leading to reimbursement inequities. To address this, CMS introduced Medicare Severity-DRGs (MS-DRGs), which divide base DRGs into subclasses:

• Without CC/MCC (no complication or comorbidity)
• With CC (complication or comorbidity)
• With MCC (major complication or comorbidity)

Cardiogenic Shock is listed as an MCC when the patient is discharged alive. This means that when cardiogenic shock is correctly coded as a secondary diagnosis, the patient’s case shifts into a higher-weighted DRG.

Hospitals that recognize and document CS therefore receive payments that better reflect the true cost of care. Conversely, missed or undocumented shock results in assignment to a lower-weight DRG and lost revenue.

How hospitals can realize additional revenues through more timely and accurate DRG coding.

To identify CS in a timely and accurate manner, hospitals need real-time surveillance platforms.  Etiometry’s clinical intelligence software platform is already providing real-time surveillance and decision support for over 50 hospitals across the world. Etiometry’s AI-powered platform integrates with existing EHR systems and bedside monitors, ensuring minimal disruption to current workflows while maximizing data utility. By giving teams earlier visibility of shock and shock progression, the platform helps hospitals reduce the risk of missed or undocumented CS cases, thus supporting more accurate DRG assignment and protecting revenue.

Key Etiometry platform capabilities, leveraging the hospital’s CS identification and staging criteria, include:

• Real-time SCAI and other shock staging protocols: Enables teams to monitor patient progression and regression through stages of CS.
• Hospital-wide surveillance: Assists early identification of patient deterioration across the hospital, not just in the ICU.
• Informational Flags: Identifies patients who meet criteria for risk review based on hospital protocols.
• Team-wide coordination: Ensures that interdisciplinary teams are aligned, from cardiologists and intensivists to emergency physicians and nurses.
• Informational notifications (where enabled): Can be configured to support awareness when hospital-defined criteria are met. Notifications are informational and not clinical alarms; clinicians must review underlying data.

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Contact us if you’re seeking to automate the efficient escalation and safe de-escalation of care workflows, or equip your team with AI-based clinical intelligence to enhance outcomes, reduce length of stay and realize additional patient revenues.

Note: Etiometry’s platform is a clinician-configured decision-support tool and does not independently identify or treat cardiogenic shock. The platform is not an active patient monitoring or alarm system.

1. Sinha, S, Morrow, D, Kapur, N. et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Evaluation and Management of Cardiogenic Shock: A Report of the American College of Cardiology Solution Set Oversight Committee. JACC. 2025 Apr, 85 (16) 1618–1641.
2. https://hcup-us.ahrq.gov/db/nation/nis/APS-DRGsDefManualV27Public.pdf