Meeting the Sepsis CMS Measures

Speaker:

Reena Duseja, MD, MSChief Medical Officer for Quality Measurement and Value-Based Incentives Group in the Centers for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services

Webinar SeriesSepsis: Across the Continuum of Care

Severe Sepsis and Septic Shock: Management Bundle (SEP-1)

inCMS’ Hospital Inpatient Quality Reporting Program

SEP-1 Measure Background

• Measure steward: Henry Ford Hospital• National Quality Forum (NQF) endorsed (#0500)

• First endorsed in 2008• Currently endorsed (last endorsement July 13, 2017)

• Hospital Inpatient Quality Reporting (IQR) Program adopted the measure in the 2015 Inpatient Prospective Payment System (IPPS) Final rule beginning with the Fiscal Year (FY 2017) Payment Determination• Hospitals began submitting measure data on October 1, 2015

3

SEP-1 Measure Background

• Public reporting of the SEP-1 measure began in July 2018§ Q1 through Q3 2017 discharges

• Full year of SEP-1 measure data (Q1 through Q4 2017) occurred with the October 2018 refresh of Hospital Compare

• Multiple non-substantive measure updates§ Improve understanding and reduce abstraction burden

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Numerator Statement v5.6

512/11/2018

Patients who received ALL of the following: Within three hours of presentation of severe sepsis:

• Initial lactate level measurement • Broad spectrum or other antibiotics administered • Blood cultures drawn prior to antibiotics

AND received within six hours of presentation of severe sepsis. ONLY if the initial lactate is elevated:

• Repeat lactate level measurement AND within three hours of initial hypotension:

• Resuscitation with 30 mL/kg crystalloid fluids OR within three hours of septic shock: • Resuscitation with 30 mL/kg crystalloid fluids

Numerator Statement v5.6 (continued)

612/11/2018

AND within six hours of septic shock presentation, ONLY if hypotension persists after fluid administration:

• Vasopressors are administered AND within six hours of septic shock presentation, if hypotension persists after fluid administration or initial lactate >= 4 mmol/L:

• Repeat volume status and tissue perfusion assessment is performed

Denominator Statement v5.6

712/11/2018

Inpatients age 18 and over with an ICD-10-CM Principal or Other Diagnosis Code of Sepsis, Severe Sepsis, or Septic Shock.

Excluded Populations v5.6

812/11/2018

• Directive for Comfort Care or Palliative Care within 6 hours of presentation of severe sepsis

• Directive for Comfort Care or Palliative Care within 6 hours of presentation of septic shock

• Administrative contraindication to care within 6 hours of presentation of severe sepsis

• Administrative contraindication to care within 6 hours of presentation of septic shock

• Length of Stay >120 days

Excluded Populations v5.6 (continued)

912/11/2018

• Transfer in from another acute care facility• Patients enrolled in a clinical trial for sepsis, severe

sepsis or septic shock treatment or intervention• Patients with severe sepsis who are discharged within

6 hours of presentation• Patients with septic shock who are discharged within 6

hours of presentation• Patients receiving IV antibiotics for more than 24 hours

prior to presentation of severe sepsis

SEP-1: Completing The Bundles

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Required ActionSevere Sepsis Septic Shock

3-Hr Bundle 6-Hr Bundle 3-Hr Bundle 6-Hr Bundle

Initial Lactate Collection YesMust be completed

within 3-hrs ofSevere Sepsis Presentation

Blood Culture Collection Yes

Initial Antibiotic Started Yes

Repeat Lactate Collection(if Initial Lactate is > 2) N/A Yes Completed within 6-hrs of

Severe Sepsis presentation

30 mL/kg Crystalloid Fluids Started N/A N/A Yes

Completed within 3-hrs of initial hypotension and/or septic

shockVasopressor Given(if hypotension persists) N/A N/A Completed

within 6-hrs of septic shock

Yes

Repeat Volume Status Assessment N/A N/A Yes

12/11/2018

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1st Q 2017 2nd Q 2017 3rd Q 2017 4th Q 2017 1st Q 2018

SEP-1: Early Management Bundle, Severe Sepsis/Septic Shock Overall Performance

Benchmark Rate National Rate11

SEP-1 Benchmark Report

34.4%39.5%

44.0%40.4% 43.7% 47.0% 49.1% 50.9% 51.4% 53.4%

65.6%60.5% 56.0% 59.6% 56.3% 53.0% 50.9% 49.1% 48.6% 46.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q4-15 Q1-16 Q2-16 Q3-16 Q4-16 Q1-17 Q2-17 Q3-17 Q4-17 Q1-18Pass, All Eligible Bundles Did Not Pass, All Eligible Bundles

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Breakdown of SEP-1:Overall Performance for Eligible Population

N = 111,243

v5.1

N = 101,599

v5.0b

N = 96,516v5.0b

N = 104,166

v5.0b

N = 104,993

v5.1

N = 118,670v5.2b

12/11/2018

N = 112,906v5.2b

N = 112,798v5.2b

N = 118,863 v5.2b

N = 123,033

v5.3

CMS Current and Future Plans

• Ongoing evaluation of sepsis literature to inform measure updates as necessary

• Formation of an Expert Workgroup through CMS’ measure support contractor

• Ongoing sepsis webinars • Collaborating with other Agencies on sepsis• Responding to articles about sepsis • Future plans to develop a sepsis mortality measure

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1-Hour Bundle Updates

• Recent New England Journal of Medicine, Journal

Watch Article

§ Introduced proposed changes to the Surviving Sepsis

Campaign Guideline – 1-hour bundle

• 1-hour bundle is NOT part of CMS’ IQR Program

• Any substantive measure changes must go through

CMS’ pre-rulemaking process before being adopted

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Questions commonly asked

• Is CMS looking into better strategies for stratification of sepsis patients with data and/or biomarkers to better define what is the best protocol for a patient's specific health state?

• Are there any plans at CMS to adopt the Sepsis-3 Definition?• Are penalties coming to accompany the Sepsis Core

Measure?• What will be the longer term strategy for future CMS sepsis

protocols? Will you most likely be following Surviving Sepsis Campaign or other organization recommendations?

5/9/2018 15

Final Thoughts

CMS is§ committed to improving the care of patients with severe

sepsis and septic shock§ committed to reducing mortality associated with severe

sepsis and septic shock§ committed to improving the SEP-1 measure and

implementing measure updates as appropriate, necessary, and based on empirical evidence

§ committed to working with clinicians, stakeholders, and the public to raise awareness about sepsis

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How to contact CMS

• Please submit questions about the SEP-1 measure via the Question and Answer page available on www.QualityNet.org.

• Webinars: 3-4 times a year. Information available on www.QualityNet.org

5/9/2018 17

Questions?Reena Duseja, MD, MSChief Medical Officer for Quality Measurement and Value-Based Incentives Group in the Centers for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services

Robert Dickerson, RRT, MSHSA Lead Program Analyst at Mathematica

Cheetah Medical Innovation Webinar

Fluid Management: New Insights & Breaking Data

July 11 at 2 pm ET

Speaker:Douglas M. Hansell, MD, MPHChief Physician Executive Cheetah Medical Inc.

Webinar SeriesSepsis: Across the Continuum of Care

Registration opens soon: www.sepsiswebinar.org

Sepsis Power Hour: Converting Resistance to Buy-in

July 25 at 2 pm ET

Speaker:Melissa Lin, MS, CPHQ, LSSBBVirginia Mason Institute

Sepsis Alliance gratefully acknowledges the support provided for the Sepsis: Across the Continuum of Care webinar series by bioMérieux

Sepsis Prevention

Date: TBD

Speaker: Angel O. Coz, MD, FCCPAssociate Professor of Medicine University of KentuckyPulmonary and Critical Care Specialist Lexington Veterans Affairs Medical Center

The information in this webinar is intended for educational purposes only. The presentations and content are the opinions, experiences, views of the specific authors/presenters and are not statements of advice or opinion of Sepsis Alliance. The presentation has not been prepared, screened, approved, or endorsed by Sepsis Alliance.

Webinar SeriesSepsis: Across the Continuum of Care

Sepsis Alliance gratefully acknowledges the support

provided for the Sepsis: Across the Continuum of Care webinar

series by bioMérieux