CMS releases a new rule for hospitals, healthcare organizations criticize the decision, the rule goes into effect anyway, and the cycle continues. Peter Pronovost, MD, PhD, wants to see this story be rewritten.
For example, the CMS will require hospitals to adopt its severe sepsis/septic shock management bundle, known as SEP-1, by 2026. Several organizations have pushed back on the rule, including the American Hospital Association, the Infectious Disease Society of America, the American College of Emergency Physicians, the Pediatric Infectious Diseases Society, the Society for Healthcare Epidemiology of America, the Society of Hospital Medicine and the Society of Infectious Diseases Pharmacists.
Opponents say some of the SEP-1 measures are outdated, adding that early adopters experienced "increased broad-spectrum antibiotic use, lactate measurements and aggressive fluid resuscitation for patients with suspected sepsis but [did not have] decreased mortality rates."
Hospitals that do not comply could lose thousands of dollars in Medicare and Medicaid funding.
Dr. Pronovost, chief quality and clinical transformation officer of Cleveland-based University Hospitals, told Becker's the sparring between healthcare organizations undermines quality care.
"That is a tension I think that we need to avoid because, besides not being good for patients, it really hurts the whole credibility of all quality improvement as something to gain or it's just a box to check," he said.
"What I would love to see is for measures where that tension exists, having CMS have a process to resolve," Dr. Pronovost added. "Right now, docs or AHA will raise these issues, CMS will explain why they think their logic is right and [they are] typically talking past each other."
Before finalizing any rule, CMS calls for feedback on a proposed draft. In response to the SEP-1 draft, commenters said the measure's documentation expectations would burden hospitals and potentially create incentives for the overuse of antibiotics.
In its final draft, CMS stated, "We respectfully disagree with commenters who believe the burden of the severe sepsis and septic shock: management bundle measure outweighs the benefits."
Instead of organizations speaking into their own microphones and ignoring one another, Dr. Pronovost recommends that CMS organizes expert panel discussions, pilots new measures and sets up a process for continuous feedback.
"Are we going to respect each other's wisdom and bring people together to stop the problem? When you do that, you solve problems better, faster, cheaper," Dr. Pronovost said. "I'd love to see a more dynamic approach to quality measurement where we shorten the cycle time for all the approvals … I get that CMS is large, but the consequences are also very large."