HR 5275119th CongressIn Committee

Diagnostic Accuracy in Sepsis Act of 2025

Introduced: Sep 10, 2025

Sponsor: Rep. Kelly, Mike [R-PA-16] (R-Pennsylvania)

Healthcare

Standard Summary

Comprehensive overview in 1-2 paragraphs

This bill, titled the Diagnostic Accuracy in Sepsis Act of 2025, would add blood culture contamination to the list of hospital-acquired conditions (HACs) under Medicare. Starting in fiscal year 2026 and for subsequent years, hospitals would be evaluated for blood culture contamination as part of the Medicare inpatient prospective payment system (IPPS) HAC reduction program. The bill requires the Secretary of Health and Human Services to establish a specific measure for blood culture contamination, with a target threshold that the contamination rate should not exceed 1 percent. If a hospital’s rate is above the threshold, it could affect whether the hospital is classified as an applicable hospital subject to HAC-based payment reductions. The overarching aim is to improve diagnostic accuracy in sepsis-related care by reducing contaminated blood cultures, which can lead to misdiagnosis and inappropriate treatment.

Key Points

1Adds blood culture contamination to the hospital-acquired conditions (HAC) list under Medicare, effective for discharges occurring in fiscal year 2026 and later.
2Establishes a new measure for blood culture contamination that CMS must implement for determining HAC-related payment adjustments; the target rate is set at no more than 1 percent.
3The Secretary is tasked with defining and implementing the blood culture contamination measure for purposes of identifying applicable hospitals under the HAC reduction framework.
4The change is embedded in the Medicare hospital payment rules (Section 1886(p) of the Social Security Act), altering how hospitals are paid if their blood culture contamination rates exceed the established threshold.
5The bill has a focus on improving diagnostic accuracy in sepsis care by reducing erroneous results from contaminated blood cultures and minimizing unnecessary or inappropriate treatments.

Impact Areas

Primary group/area affected- Medicare IPPS hospitals (organization, operations, and reimbursement standings) will be directly affected, as their payments may be adjusted based on their blood culture contamination rates.Secondary group/area affected- Patients in hospitals: potential improvements in diagnostic accuracy for sepsis, reductions in treatment delays or errors caused by contaminated cultures, and overall patient safety benefits.- Hospital laboratories and infection prevention programs: increased emphasis on specimen collection quality, processing, and contamination prevention.Additional impacts- Administrative and compliance burden: hospitals will need to track, report, and possibly audit blood culture contamination rates to meet the new measure; CMS will need to implement and publish the measurement methodology.- Financial implications: potential reductions in Medicare payments for hospitals with higher-than-threshold contamination rates, creating incentives to invest in quality improvement and infection control.- Policy alignment with sepsis care: the bill’s focus on diagnostic accuracy aligns payment policy with efforts to improve sepsis identification and reduce unnecessary antibiotic use driven by contaminated cultures.

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