Value-Based Purchasing (VBP) and SEP-1: What you should know

Improving sepsis care improves the bottom line

Sepsis is the most expensive and resource-intensive medical inpatient condition. It is consistently in the top five for hospital case volumes, is among the worst cases for cost of care vs. reimbursement, and drives significant total cost of care as patients with severe sepsis or septic shock often have significant post-sepsis care needs. Approximately 2/3 of sepsis cases are paid by CMS, and with the significant impact of sepsis on total cost and patient outcomes, CMS has focused on sepsis quality for years via the SEP-1 quality measure.

Hospitals have reported SEP-1 via the Inpatient Quality Program since 2018, but now it has been added to the Value-Based Purchasing program as a measure in the Safety Domain. With this change to VBP, there are direct financial implications for your hospital's sepsis performance. 

What is SEP-1?

SEP-1 (The Severe Sepsis and Septic Shock Management Bundle) is a quality measure that establishes a treatment protocol for clinicians treating sepsis. SEP-1 is a multi-step measure that focuses on timely sepsis recognition and early intervention to improve patient outcomes. The emphasis on early treatment is critically important, as with each hour of delay before treatment risk of mortality for patients with sepsis increases by about 8%.

SEP-1 Compliance is proven to improve care outcomes

Numerous studies prove that the use of the SEP-1 bundle improves patient outcomes.

• A 2019 study revealed patients treated according to protocols were 15% less likely to die than those patients whose care did follow the protocols.
• A 2022 study found that compliance with SEP-1 was associated with lower 30-day mortality and lengths of stay.

Why do hospitals struggle to achieve SEP-1 compliance?

The SEP-1 measure is a complex, multi-step bundle of care measure that requires care steps that are delivered over several hours. Although evidence supports the importance of delivering care according to SEP-1 nationwide, the average SEP-1 bundle compliance rate is only 50%. More than 80% of sepsis cases treated in the hospital are detected in the Emergency Department (ED), and as sepsis patients are transferred to the floor for treatment without technology to help them, the team may lose sight of their SEP-1 timeline.

A few key challenges hospitals face with SEP-1 include the following:

• It can be difficult to identify the early signs of sepsis to begin treatment
• The sepsis bundle has multiple steps with specific timelines, and tracking progress against bundle requirements proactively in a busy hospital is challenging
• Care teams lack real-time management tools to help them track the steps of the bundle and deliver evidence-based protocols on time.

How is SEP-1 being introduced to VBP?

Medicare’s VBP Program measures hospital performance across four program domains: Clinical Outcomes, Personal and Community Engagement, Safety, and Efficiency and Cost Reduction. SEP-1 has been added to the Safety Domain with calendar year 2024 as the first performance year.  Sepsis has always been a significant financial driver, but with its inclusion in VBP, poor performance can have an even bigger impact. Poor total performance for VBP can result in penalties, but the good news is that high performance can result in payment bonuses. As mentioned, various studies have shown that higher SEP-1 compliance can lower length of stay (LOS), mortality, and readmissions – all of which improve a hospital’s bottom line. Studies have demonstrated decreased length of stay, fewer days in the ICU, and lower rates of complications, leading to potential cost savings, which may mean that improving SEP-1 performance could also benefit a hospital by improving performance on the Efficiency and Cost Reduction domain's total cost measure.

VBP Program participation is mandatory, and quality results can affect hospital payments. Hospitals that perform well receive a bonus funded by the hospitals that do poorly. Results are publicly reported via Medicare.gov. 

How can I prepare my hospital to improve SEP-1 performance?

Quality leaders must proactively manage SEP-1 to increase or sustain improvements. It is a complex measure that requires active management to comply with. With 2024 as the first performance period that will include SEP-1, there's no time to waste. Hospitals should start now to increase their focus on having the right people in key roles to support performance improvement, intentionally designing processes that drive performance, and implementing technology that can automate sepsis identification and SEP-1 monitoring as three interdependent factors in improving sepsis performance.

People

It’s essential to ensure the right people on your team are engaged – primarily the sepsis coordinator – working alongside other team members, including providers, nursing, abstractors, coders, and quality management. Ongoing training and feedback on sepsis care make clinicians aware of and hold them accountable for best practices.

Process

Creating efficient sepsis workflows and order sets throughout the hospital – not just the emergency department and intensive care unit – provides dedicated clinicians with solid systemic support.

Technology

Identifying and implementing the right sepsis surveillance technology supports your people and processes to optimize sepsis care. A sophisticated sepsis surveillance solution offers two components necessary to achieve sepsis improvements: 1) identifying patients with sepsis, and 2) delivering alerts to care teams about the hospital’s sepsis care policies ensuring SEP-1 bundle care protocol delivery at the right time. By watching over the entire patient population and accurately alerting clinicians with guidance on best care steps, technology helps optimize care every hour of the day, 365 days a year.