title: New Mandated Centers for Medicare and Medicaid Services Requirements for Sepsis Reporting: Caution from the Field.
abstract: BACKGROUND
  The release of the Center for Medicare and Medicaid Service's (CMS) latest quality measure, Severe Sepsis/Septic Shock Early Management Bundle (SEP-1), has intensified the long-standing debate over optimal care for severe sepsis and septic shock. Although the last decade of research has demonstrated the importance of comprehensive bundled care in conjunction with compliance mechanisms to reduce patient mortality, it is not clear that SEP-1 achieves this aim. The heterogeneous and often cryptic presentation of severe sepsis and septic shock, along with the multifaceted criteria for the definition of this clinical syndrome, pose a particular challenge for fitting requirements to this disease, and implementation could have unintended consequences.
  
  
  OBJECTIVE
  Following a simulated reporting exercise, in which 50 charts underwent expert review, we aimed to detail the challenges of, and offer suggestions on how to rethink, measuring performance in severe sepsis and septic shock care.
  
  
  CONCLUSIONS
  There were several challenges associated with the design and implementation of this measure. The ambiguous definition of severe sepsis and septic shock, prescriptive fluid volume requirements, rigid reassessment, and complex abstraction logic all raise significant concern.
  
  
  CONCLUSIONS
  Although SEP-1 represents an important first step in requiring hospitals to improve outcomes for patients with severe sepsis and septic shock, the current approach must be revisited. The volume and complexity of the currently required SEP-1 reporting elements deserve serious consideration and revision before they are used as measures of accountability and tied to reimbursement.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, Massachusetts.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Aaronson
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Filbin
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
authors.affiliation: Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, Massachusetts.
authors.forename: Kathy
authors.initials: K
authors.lastname: Tobin
authors.affiliation: Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mort
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000331:legislation & jurisprudence*; D006801:Humans; D019984:Quality Indicators, Health Care / Q000331:legislation & jurisprudence / Q000639:trends; D012107:Research Design / Q000639:trends*; D018805:Sepsis / Q000401:mortality* / Q000628:therapy; D014481:United States
keywords: access and evaluation; health care quality; health care quality assessment; quality indicators; sepsis