Adapting to the CMS Sepsis Bundle
Although many healthcare leaders applaud the attention CMS is bringing to this deadly condition, some are finding the highly prescriptive measures too constricting.
This article first appeared in the April 2016 issue of HealthLeaders magazine.
In the wake of the October 2015 release of the Centers for Medicare & Medicaid Services' sepsis management bundle, health systems are reviewing their sepsis identification and treatment approaches. And although many healthcare leaders applaud the attention CMS is bringing to this deadly condition, some are finding the highly prescriptive measures too constricting.
"The CMS bundle takes a little bit of the art of medicine out of the hands of the physician," says Nirav G. Shah, MD, FCCP, and director of the pulmonary and critical care fellowship program at the University of Maryland Medical Center, the flagship academic medical center of the 12-hospital University of Maryland Medical System.
Shah has closely studied sepsis and shared his expertise by discussing this topic as part of his grand rounds at his hospital and surrounding hospitals in Baltimore.
He supports the intent of the CMS bundle, though, which is to create a sense of urgency to address the condition.
Sepsis, according to the Centers for Disease Control and Prevention, is the body's overwhelming and life-threatening response to an infection, which can lead to tissue damage, organ failure, and death. There are more than 1 million cases of sepsis each year, and it kills more than 258,000 Americans annually. Sepsis is the primary cause of death from infection and is one of the leading causes of death in intensive care units.
CMS' sepsis management bundle concentrates heavily on treatment and reporting for the first three and six hours—time frames known to be critical in controlling the outcome. Researchers have found that each hour of delay in administering antibiotics results in an average decrease in survival of 7.6%.
Closely aligned with bundles from the Surviving Sepsis Campaign and the National Quality Forum, the CMS bundle requires detailed reporting on diagnosis, fluids, antibiotics, monitoring, outcomes, and more.
Craig Coopersmith, MD, FACS, FCCM, and associate director for the Emory Critical Care Center at Emory University School of Medicine, calls the agency's prescriptive bundle "absolutely fantastic" because it promotes "earlier recognition and earlier treatment."