New sepsis rule is too rigid, infectious disease experts say

Hospitals and infectious disease physicians contend that CMS' final rule on sepsis care is too rigid and does not allow clinicians flexibility to determine how recommendations should apply to their specific patients.

The Biden administration finalized a rule in August that ties specific sepsis treatment metrics to hospitals' Medicare reimbursements, starting in 2024. The guidelines, first rolled out in 2015, require hospitals to conduct timely blood tests and start antibiotics within three hours of identifying a possible case, among other targets.

Smaller hospitals that miss these targets could lose "hundreds of thousands" of dollars, while larger hospitals may see a shortfall in the "millions-of-dollars range," Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association, told KFF Health News.

Some infectious disease experts and medical associations — including AHA — are pushing back on the rule's broad scope, arguing it does not give clinicians enough flexibility for tailored sepsis care.  

Sepsis prevention efforts are necessary, but "where it gets controversial becomes 'Is this the best way to do it?'" Chanu Rhee, MD, an infectious disease physician and associate professor of population medicine at Boston-based Harvard Medical School, told the publication.

The Infectious Diseases Society of America is one such group pushing back on the rule's broad application and has argued that metrics should only apply to patients with sepsis shock, as opposed to all sepsis patients. AHA has also warned that the rule could lead to excessive antibiotic use and fuel resistance. 

"We believe there is enough flexibility to incorporate clinician judgment in the measure," CMS said in a May proposed rule, adding that the guidelines have led to significant reductions in sepsis mortality, readmission rates and length of stay. 

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