Sepsis Core Measures and the New CMS Readmission Measure: An American Data Network Analysis

A patient leaves your hospital after a sepsis stay, with the SEP-1 bundle met. Twelve days later, the patient is admitted to a hospital across town for heart failure. Under the new sepsis readmission measure from the Centers for Medicare & Medicaid Services (CMS), that admission can count toward your hospital’s sepsis readmission rate, even though it has nothing to do with sepsis and may never appear in your electronic health record (EHR).

The clock on that measure is already running. When CMS published the fiscal year (FY) 2027 Inpatient Prospective Payment System (IPPS) final rule on August 4, 2026, hospitals were already one month into the period that will determine the first payment adjustments under the measure. That period opened July 1, so an eligible sepsis discharge today already counts toward FY 2030 performance.

Quality teams therefore need to look beyond sepsis core measures and inpatient care to examine post-hospitalization care in the weeks after discharge. This American Data Network (ADN) analysis explains what the measure counts, how its reporting timeline works, and what quality teams can do while the first payment period is underway.

Key Takeaways

• The first sepsis-related Hospital Readmissions Reduction Program (HRRP) payment calculations begin in FY 2030, but the measurement period opened July 1, 2026.
• The measure counts unplanned inpatient readmissions for any cause within 30 days of a qualifying sepsis discharge, including Medicare fee-for-service and Medicare Advantage patients.
• The Severe Sepsis and Septic Shock Management Bundle (SEP-1) measures inpatient care; the new measure assesses readmissions after discharge. The results may differ.
• A practical first step is a joint Quality and Case Management review of recent sepsis discharges, 30-day readmissions, and discharge destinations to identify one or two recurring issues.

What Does the New Sepsis Readmission Measure Actually Track?

CMS’s new Hospital 30-Day, All-Cause, Risk-Standardized Readmission Rate Following Sepsis Hospitalization measure tracks how often patients who were hospitalized for sepsis are readmitted within 30 days of discharge.

The measure has four main features:

Patient population: Generally, Medicare fee-for-service and Medicare Advantage patients aged 65 or older who are discharged alive after a qualifying hospitalization primarily for sepsis.

Readmissions counted: Any unplanned inpatient admission to an acute-care hospital within 30 days of discharge, regardless of the diagnosis or whether the patient returns to the same hospital.

Exclusions: Planned readmissions are not counted. CMS also excludes certain original sepsis hospitalizations, including cases where patients leave against medical advice, are discharged to hospice, or are already included in the pneumonia readmission measure. The measure’s Partnership for Quality Measurement record outlines the full criteria.

Method: CMS risk-adjusts results using Medicare claims and Medicare Advantage encounter data, so hospitals do not need to submit additional chart-abstracted data. Those results feed the excess readmission ratio used in HRRP payment calculations.

In other words, the measure evaluates readmissions following sepsis, not just readmissions caused by sepsis. In practice, results may depend on post-hospitalization care as much as on the inpatient stay.

Why Does It Matter That the Payment Window Is Already Open?

A report’s fiscal year differs from the discharge dates it covers. According to the CMS fact sheet on the FY 2027 IPPS final rule, hospitals receive two confidential early-look reports before the measure affects HRRP payments. The discharge periods below come from the final rule’s Hospital Readmissions Reduction Program section (91 FR 49885 through 49901).

FY 2028: First confidential early look (July 2024 to June 2026 discharges). This period closed before the rule was published, and the report does not affect payments.

FY 2029: Second confidential early look (July 2025 to June 2027 discharges). This report provides updated measure results and estimated HRRP payment adjustments with the sepsis measure included. These estimates do not affect payments, but they offer another chance to assess performance before the measure enters payment calculations in FY 2030. The discharge period overlaps the first payment window, but the report still describes historical performance.

FY 2030: First payment-determining period (July 2026 to June 2028 discharges). This is the period that matters financially. Performance during these two years can affect Medicare payment reductions beginning in FY 2030.

Early-look reports can show hospitals where they stand. But waiting for them will not stop current cases from entering the FY 2030 calculation. The CMS HRRP page provides the program framework.

In the meantime, hospitals can build a historical baseline. Review prior sepsis discharges and 30-day readmissions using available claims and internal data, separating unplanned from planned returns where possible. When the FY 2028 report arrives, investigate any differences in patient selection or data coverage.

What Should Quality Teams Be Doing Now?

The work centers on sepsis discharges and the 30 days that follow, with the goal of identifying one or two recurring issues for closer investigation. Understanding the differences between inpatient sepsis measures and post-discharge outcomes can help teams interpret what they find.

Connect inpatient and post-discharge information. Bring together Quality, Case Management, and clinical leaders to review recent sepsis discharges, 30-day readmissions, discharge destinations, and available post-discharge follow-up information alongside SEP-1 performance. Look for recurring patterns, but account for differences in which patients each measure includes.

For example, a cluster of readmissions among patients discharged to skilled nursing facilities, together with complaints about medication changes at discharge, may point to a handoff problem worth reviewing.

Use this data checklist to prepare for the first joint review:

• Potentially eligible sepsis discharges since July 1, 2026, for Medicare fee-for-service and Medicare Advantage patients ages 65 and older
• Discharge destination for each case, such as home, home health, or a skilled nursing facility
• Any inpatient readmission within 30 days, including the principal diagnosis and whether it occurred at the same hospital or another facility
• Whether each readmission was planned or unplanned
• SEP-1 bundle compliance for the original hospitalization, where the case was abstracted
• Whether a follow-up appointment was scheduled before discharge and, where available, whether it was completed
• Complaints or grievances related to the discharge within the following 30 days

Review all reasons for readmission. Group returns by major diagnosis, discharge destination, and relevant patient characteristics. Review selected cases to distinguish potential care-transition gaps from clinical events that may not have been avoidable.

Track discharges during the active period. Establish a regular review of eligible sepsis discharges beginning July 2026, using available readmission data as it arrives. Assign responsibility for investigating recurring patterns and for checking whether any process change is reflected in subsequent results.

ADN’s Healthcare Data Analytics Services can help hospitals analyze clinical and quality data to identify patterns, trends, and priorities. Clinical teams remain responsible for interpreting what those findings mean for patient care.

How Does the New Measure Connect to Existing Sepsis Core Measures?

Hospitals now have two measures that assess different aspects of sepsis care. The existing Severe Sepsis and Septic Shock Management Bundle (SEP-1) assesses whether hospitals follow required treatment steps during hospitalization. The new sepsis readmission measure tracks whether patients return to the hospital within 30 days of discharge.

The two measures also sit in different programs. SEP-1 is reported through the Hospital Inpatient Quality Reporting (IQR) Program and scored in the Safety domain of the Hospital Value-Based Purchasing (VBP) Program, while the new readmission measure will affect HRRP calculations beginning in FY 2030. ADN’s guide to the Hospital IQR Program covers the reporting side.

SEP-1 Measures Care During Hospitalization

SEP-1 evaluates whether eligible patients with severe sepsis or septic shock receive required care within specified timeframes. This includes measuring lactate, obtaining blood cultures, and administering antibiotics. Additional treatments, such as intravenous fluids, are required when indicated.

To meet the measure, a hospital must complete all applicable steps for each eligible case. This is known as bundle compliance. Meeting every requirement, however, does not guarantee that a patient will avoid readmission.

Hospitals that abstract with ADN’s Core Measures Application can use its real-time and historical tracking and detailed reports to follow that performance over time.

The Measures Use Different Data

SEP-1 relies on information abstracted from patient medical records, while the readmission measure relies on claims and encounter data. The measures also cover different patient populations. Hospitals can review their results together, but the rates should not be treated as directly comparable.

The article The 36% Problem: Why Sepsis Abstraction Variability Is Costing Your Hospital explains how inconsistent SEP-1 abstraction can distort inpatient performance results.

The Measures Can Point to Different Problems

A hospital might maintain stable SEP-1 compliance even as readmissions rise among patients with complex discharge needs. That pattern warrants a closer review of patient groups and reasons for readmission, rather than assuming the sepsis bundle failed.

ADN’s Clinical Data Abstraction Services support accurate core measure data collection and quality assurance, giving teams a more reliable view of inpatient performance.

Where Does Sepsis Readmission Risk Get Missed?

One gap arises when inpatient sepsis reporting ends at discharge. SEP-1 performance may fall under the Quality department, while Case Management monitors post-discharge follow-up and repeat admissions. If the teams review their results separately, neither may see whether a recurring discharge issue affects a particular group of sepsis survivors.

Another gap is the assumption that sepsis readmissions must involve another infection. Patients may return with kidney problems, worsening chronic disease, or other acute conditions. Not every return is preventable, and the diagnosis alone does not prove a discharge failure. However, a sepsis-only review overlooks much of what CMS counts.

Hospitals may also miss readmissions at other facilities. As in the opening scenario, CMS’s claims and encounter data can capture an admission elsewhere even when it does not appear in the original hospital’s EHR.

Patient feedback can provide additional context. Complaints about medication changes or unclear follow-up instructions may reveal care-transition problems that readmission counts alone cannot explain. The article Reducing Readmissions in Hospitals: How Complaint Data Identifies Discharge Failures explores that connection.

ADN’s hospital complaints and grievances application tracks and trends issue categories, which can help teams spot recurring discharge concerns.

Why Measure Beyond the Sepsis Hospitalization?

Go back to the patient in the opening scenario. Every SEP-1 step was met, and the heart failure admission across town still counts. SEP-1 shows what happened during the stay; the new measure shows what happened after the patient left. It does not replace SEP-1 or the sepsis core measures work behind it. It extends accountability past discharge.

The window to act is open now. Payment adjustments begin in FY 2030, but the discharges that determine them run through June 2028. Start with one joint Quality and Case Management review of recent sepsis discharges, 30-day readmissions, and discharge destinations. Hospitals that connect reliable inpatient measures to post-discharge outcomes now can spot emerging risks, test process changes, and see whether those changes hold before the period closes.

ADN’s Clinical Data Abstraction Services cover SEP-1 abstraction with regular inter-rater reliability (IRR) assessments, while Healthcare Data Analytics Services can help hospitals understand the relationships between data, processes, and outcomes.