6 healthcare orgs push back on parts of new CMS sepsis rule

Six of the nation's leading healthcare associations have penned new recommendations on sepsis care to CMS on behalf of U.S. hospitals, which face the loss of federal funding if they fail to meet new benchmarks.

The revised recommendations that call for CMS to refine some of the rule's aspects were jointly written by experts from the Infectious Disease Society of America, American College of Emergency Physicians, Pediatric Infectious Diseases Society, the Society for Healthcare Epidemiology of America, Society of Hospital Medicine and the Society of Infectious Diseases Pharmacists. 

The position paper, published Oct. 13 in the Clinical Infectious Diseases journal, points out that CMS's effort to develop a 30-day mortality electronic clinical quality measure (also referred to as eCQM) for sepsis is outdated and not quite in line with the CDC's recent Adult Sepsis Event surveillance metric.

Aligning the two would "promote unity in federal measures, decrease reporting burden for hospitals, and facilitate shared prevention initiatives," the groups wrote in the paper. "These steps will result in a more robust measure that will encourage hospitals to pay more attention to the full breadth of sepsis care, stimulate new innovations in diagnosis and treatment, and ultimately bring us closer to our shared goal of improving outcomes for patients."

The new rule, which was finalized by the Biden administration and finalized in August, aims to reduce sepsis-caused deaths, which nationally sits at 270,000 per year. It requires hospitals to adopt a model known as the Severe Sepsis/Septic Shock Management Bundle — also referred to as SEP-1. Failing to adopt the new model or to meet the rule's outlined benchmarks would cost hospitals funding, but experts from these groups argue that the benchmarks are not the best metrics to measure progress in sepsis care. 

"Multiple studies indicate that SEP-1 implementation was associated with increased broad-spectrum antibiotic use, lactate measurements, and aggressive fluid resuscitation for patients with suspected sepsis but not with decreased mortality rates," the groups wrote. "Increased focus on SEP-1 risks further diverting attention and resources from more effective measures and comprehensive sepsis care. We recommend retiring SEP-1 rather than using it in a payment model and shifting instead to new sepsis metrics that focus on patient outcomes." 

The SEP-1 model is based on a practice that was introduced in 2015 that worked as a pay-for-reporting measure, and the new CMS rule turns the model into a "pay-for-performance measure by incorporating it into the Hospital Value-Based Purchasing Program," the position paper explains.

It's something the American Hospital Association also spoke out against in an Aug. 17 letter

For now, hospitals have until 2026 to fully adopt the SEP-1 model.

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