Healthcare associations push back on CMS' sepsis rule, advocate tweaks

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The Infectious Diseases Society of America and a coalition of medical professional societies have released recommendations for modifying the Centers for Medicare and Medicaid Services sepsis metrics to improve sepsis care and outcomes saying hospitals could potentially lose federal funding if they fail to meet the new benchmarks.

The associations' primary recommendation is to retire CMS' Severe Sepsis/Septic Shock Management Bundle (SEP-1) rather than incorporating it into the Hospital Value-Based Purchasing Program.

In addition to the Infectious Diseases Society of America, the American College of Emergency Physicians, the Pediatric Infectious Diseases Society, the Society for Healthcare Epidemiology of America, the Society of Hospital Medicine and the Society of Infectious Diseases Pharmacists have signed onto the recommendation.

WHAT'S THE IMPACT?

The SEP-1 measure requires clinicians to provide a bundle of care to all patients with possible sepsis within three hours of recognition. The bundle includes drawing blood cultures, administering broad-spectrum antibiotics, and other measures.

But the SEP-1 measure doesn't take into account that many serious conditions present in a similar fashion to sepsis, the organizations said. Pushing clinicians to treat all these patients as if they have sepsis, they contend, leads to overuse of broad-spectrum antibiotics, which can be harmful to patients who are not infected, those who are infected with viruses rather than bacteria, and those who could safely be treated with narrower-spectrum antibiotics.

The associations pointed to a series of studies published since the SEP-1 measure went into effect which show that, in practice, SEP-1 has not lowered mortality rates. Independent analyses including hundreds of hospitals show that the release of SEP-1 was associated with increases in broad-spectrum antibiotic use, laboratory testing and fluid administration, but no change in patient outcomes.

The professional societies did commend CMS' intention to create a new sepsis measure that will focus on sepsis mortality rates. The modified measure, they said, will help hospitals focus on what matters most to patients and their families, namely improving outcomes.

The societies' consensus document suggests ways to fine-tune the measure and priority areas for hospitals. These include enhancing diagnostic strategies, optimizing the care of sepsis patients throughout hospitalization and improving rehabilitation services for sepsis survivors.

"We are encouraged by the increased attention to sepsis and support CMS' creation of a sepsis mortality measure that will encourage hospitals to pay more attention to the full breadth of sepsis care," said Dr. Chanu Rhee, lead author of the recommendations. "Retiring past measures and refining future ones will help stimulate new innovations in diagnosis and treatment and ultimately improve outcomes for the many patients affected by sepsis."

THE LARGER TREND

Each year, more than 1.7 million U.S. adults receive hospital care for sepsis, and more than 250,000 American adults die of sepsis, spurring clinicians, hospitals, policymakers and patient advocates to action, the organizations said.

Last year, Bryan Bliven, CIO, University of Missouri Health Care, told attendees at the HIMSS22 annual conference that the health system saved lives by putting in place an early-warning system tied to the EHR to alert rapid-response teams of a patient's risk for developing sepsis. One of every three patients who dies in the hospital has sepsis, he said.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com