Critics complain proposed sepsis reporting rules could lead to overtreatment

Sepsis is one of the top drivers of costs, readmissions and mortality for hospitals, accounting for up to half of all hospital deaths, but until recently it has not received the same scrutiny as other top causes from the Centers for Medicare & Medicaid Services. But proposed CMS reporting requirements for doctors who treat the condition are drawing mixed reviews.

Under the requirements, set to take effect in October, providers must take several steps to treat the condition, including measuring the patient's lactate level, obtaining blood cultures and administrating broad-spectrum antibiotics. Providers must take these steps within the first three hours of care.

Some providers, however, take issue with the federal government's definition of severe sepsis, which is significantly different from the consensus definition among providers, Scott Weingart, M.D., an emergency physician at the State University of New York at Stony Brook, wrote in a blog post. 

It's "pretty unacceptable to hold every hospital in the U.S. accountable to an arbitrary definition that has not been tested in large-scale trials," he said. 

In addition, he said the new measures will lead doctors to treat patients for sepsis when they may not actually have it. 

But Christopher Seymour, M.D., of the University of Pittsburgh School of Medicine, told MedPageToday that sepsis is difficult to define by nature, because there is no single concrete identifier for the condition. And research shows that for every one-hour delay in administrating antibiotics, there is a three percent to seven percent increase in the odds that the patient will die from sepsis.

"Sepsis is under recognized and underdiagnosed," he said, "and anything we can do to promote doctors and hospitals to take better care of patients with sepsis is serving the greater good."

Seymour recently co-published in JAMA a set of best practices for the condition, which lays out key features of any effective approach such as IV antibiotics, assessment and reassessment of severity and other complications.

To learn more:
- read the requirements (.pdf)
- here's Weingart's blog post
- check out the MedPageToday article
- read the JAMA article

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