Friday, June 18, 2021

CMS Sepsis Measure SEP-1: Under Summer Review at the NQF

The CMS SEP-1 measure is under review at National Qualify Forum this summer, with open comment periods and with committee meetings scheduled.   This blog provides some links and resources for the reader.

To cut to the chase, the public NQF agenda weblink is here:

Measures 101: Hospital Quality Measures

The US has a complicated system for quality measures.  Any one can develop a quality measure, but it's usually groups like medical specialty associations.   Then, they are reviewed by the National Quality Forum, and if reviewed favorably (by an academic committee), they are incorporated in a library of measures at NQF.   Health plans (including Medicare) can then cherry pick their most valued measures and use them in the payor-provider relationship.   Technically, Medicare can make up its own measures, but Congress instructs Medicare to use publicly validated and curated measures whenever feasible, to help be sure that the provider measurements used by Kentucky Medicaid, Florida BCBS, Medicare, and Cigna might all be the same, drawn from a common library.

CMS SEP-1 Measure (NQF 0500 Measure)

One somewhat controversial measure is CMS measure "SEP-1," also known as NQF Measure 0500.   It's one of the only chart-based hospital measures still used by CMS.  Sepsis early management and rapid intervention is enormously important, while specifics of SEP-1 have been criticized by some major bodies (like the infectious disease association, IDSA).    In early comments to NQF, the AMA recommended that SEP-1 not be continued in its present form.  

SEP-1 (0500) is unusual in that it is curated by Henry Ford Hospital, not by a body like IDSA, AMA, etc.   I'm not sure what it means, but Henry Ford Hospital itself receives a low ranking on SEP-1 performance.  (My original blog here; I saw the same data recently and it only changes incrementally.  Currently HFH is at 41%, national average 60%, scale to 100%.) 

A simple search of SEP-1 as a title word in PubMed lists about 35 titles (simple list here).  As a chart-based measure, the accuracy (or consistency) of measurement has been critiqued, with a low correlation value (kappa between two raters, only .4) (here).  Barbash et al. 2021 found low impact of SEP-1 implementation in one health system (here.)   IDSA's position paper on SEP-1 improvements is here.  See a pair of 2021 Op Ed's, by Harvard's Jeremy Faust here and Harvard's Michael Klompas here.

Important organizations like Sepsis Alliance are urging the re-endorsement of SEP-1 and providing detailed rationales, here.  They provide a range of impressive educational materials about sepsis (here).

NQF Agenda Pages for SEP-1 Review

NQF last reviewed SEP-1 in 2017, where it "passed" (remains in the library) but the votes on different aspects of SEP-1 were heavily split.

See the Summer 2021 NQF agenda pages here:

On this home page, see measure under review 0500, Severe sepsis and septic shock.  The current status (2017) is "endorsed."  There is a Zip file on this home page with several documents, a few from 2017, others from 2021.   

But see also:  The tabs at the top, which link to Events and additional Materials.   Spring 2021 measures will be discussed at an Event on June 24 (also June 25).  Comments are open here, until September 9.  There will be a "post comment web meeting" on 13 October.  SEP-1 (0500) is filed under Patient Safety measures, so the Patient Safety committee will be in charge of discussion and voting.

I don't have an opinion here, but it seems to me the committee may want to focus not so much on the original trials 10+ years ago, which have a substantial secondary "critique" and "pro/con" literature, but on the years of implementation data that SEP-1 has an active hospital measure.  


For a 2020 blog on Congressional report language regarding SEP-1, here.