Sepsis Definitions: The Search for Gold and What CMS Got Wrong

Area of Science:

• Critical Care Medicine
• Healthcare Policy
• Infectious Disease

Background:

• The Centers for Medicare and Medicaid Services (CMS) introduced a core measure for septic patient care on October 1, 2015.
• These measures have generated significant controversy among healthcare professionals.
• Existing definitions for sepsis, severe sepsis, and septic shock lack a universally accepted gold standard.

Purpose of the Study:

• To critically evaluate the definitions of sepsis, severe sepsis, and septic shock as established by the CMS.
• To analyze the consistency of CMS-assigned definitions with current evidence-based medical literature.
• To address the controversy surrounding CMS core measures in septic patient care.

Main Methods:

• Literature review of existing definitions and evidence-based guidelines for sepsis, severe sepsis, and septic shock.
• Comparative analysis of CMS definitions against established medical criteria.
• Examination of clinical and research community responses to CMS core measures.

Main Results:

• There is no universally agreed-upon gold standard definition for sepsis, severe sepsis, or septic shock.
• The definitions for severe sepsis and septic shock provided by CMS are considered premature by many experts.
• CMS definitions exhibit inconsistencies when compared to evidence-based medical literature and clinical practice.

Conclusions:

• The CMS core measure for sepsis care, implemented in 2015, is based on definitions that are not yet universally accepted or evidence-based.
• Healthcare providers find the CMS definitions for severe sepsis and septic shock to be premature and inconsistent.
• Further research and consensus are needed to establish standardized, evidence-based definitions for sepsis and its related conditions.