diff --git a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/BaseHapiTerminologySvcImpl.java b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/BaseHapiTerminologySvcImpl.java
index 35dbff47e18..c33a6c3bc57 100644
--- a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/BaseHapiTerminologySvcImpl.java
+++ b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/BaseHapiTerminologySvcImpl.java
@@ -1862,7 +1862,7 @@ public abstract class BaseHapiTerminologySvcImpl implements IHapiTerminologySvc,
 					TermValueSet refreshedValueSetToExpand = myValueSetDao.findById(valueSetToExpand.getId()).get();
 					return getValueSetFromResourceTable(refreshedValueSetToExpand.getResource());
 				});
-				expandValueSet(valueSet, new ValueSetConceptAccumulator(valueSetToExpand, myValueSetConceptDao, myValueSetConceptDesignationDao));
+				expandValueSet(valueSet, new ValueSetConceptAccumulator(valueSetToExpand, myValueSetDao, myValueSetConceptDao, myValueSetConceptDesignationDao));
 
 				// We are done with this ValueSet.
 				txTemplate.execute(t -> {
diff --git a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/ValueSetConceptAccumulator.java b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/ValueSetConceptAccumulator.java
index 92bf64b6453..c63788f3cf7 100644
--- a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/ValueSetConceptAccumulator.java
+++ b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/term/ValueSetConceptAccumulator.java
@@ -22,6 +22,7 @@ package ca.uhn.fhir.jpa.term;
 
 import ca.uhn.fhir.jpa.dao.data.ITermValueSetConceptDao;
 import ca.uhn.fhir.jpa.dao.data.ITermValueSetConceptDesignationDao;
+import ca.uhn.fhir.jpa.dao.data.ITermValueSetDao;
 import ca.uhn.fhir.jpa.entity.TermConceptDesignation;
 import ca.uhn.fhir.jpa.entity.TermValueSet;
 import ca.uhn.fhir.jpa.entity.TermValueSetConcept;
@@ -38,13 +39,15 @@ public class ValueSetConceptAccumulator implements IValueSetConceptAccumulator {
 	private static final org.slf4j.Logger ourLog = org.slf4j.LoggerFactory.getLogger(ValueSetConceptAccumulator.class);
 
 	private TermValueSet myTermValueSet;
+	private ITermValueSetDao myValueSetDao;
 	private ITermValueSetConceptDao myValueSetConceptDao;
 	private ITermValueSetConceptDesignationDao myValueSetConceptDesignationDao;
 	private int myConceptsSaved;
 	private int myDesignationsSaved;
 
-	public ValueSetConceptAccumulator(@Nonnull TermValueSet theTermValueSet, @Nonnull ITermValueSetConceptDao theValueSetConceptDao, @Nonnull ITermValueSetConceptDesignationDao theValueSetConceptDesignationDao) {
+	public ValueSetConceptAccumulator(@Nonnull TermValueSet theTermValueSet, @Nonnull ITermValueSetDao theValueSetDao, @Nonnull ITermValueSetConceptDao theValueSetConceptDao, @Nonnull ITermValueSetConceptDesignationDao theValueSetConceptDesignationDao) {
 		myTermValueSet = theTermValueSet;
+		myValueSetDao = theValueSetDao;
 		myValueSetConceptDao = theValueSetConceptDao;
 		myValueSetConceptDesignationDao = theValueSetConceptDesignationDao;
 		myConceptsSaved = 0;
@@ -83,11 +86,13 @@ public class ValueSetConceptAccumulator implements IValueSetConceptAccumulator {
 			}
 			myValueSetConceptDao.deleteById(concept.getId());
 			myTermValueSet.decrementTotalConcepts();
+			myValueSetDao.save(myTermValueSet);
 			ourLog.info("Done excluding [{}|{}] from ValueSet[{}]", concept.getSystem(), concept.getCode(), myTermValueSet.getUrl());
 
 			ourLog.info("Flushing...");
 			myValueSetConceptDesignationDao.flush();
 			myValueSetConceptDao.flush();
+			myValueSetDao.flush();
 			ourLog.info("Done flushing.");
 		}
 	}
@@ -104,7 +109,7 @@ public class ValueSetConceptAccumulator implements IValueSetConceptAccumulator {
 			concept.setDisplay(theDisplay);
 		}
 		myValueSetConceptDao.save(concept);
-		myTermValueSet.incrementTotalConcepts();
+		myValueSetDao.save(myTermValueSet.incrementTotalConcepts());
 
 		if (myConceptsSaved++ % 250 == 0) { // TODO: DM 2019-08-23 - This message never appears in the log. Fix it!
 			ourLog.info("Have pre-expanded {} concepts in ValueSet[{}]", myConceptsSaved, myTermValueSet.getUrl());
@@ -129,7 +134,7 @@ public class ValueSetConceptAccumulator implements IValueSetConceptAccumulator {
 		}
 		designation.setValue(theDesignation.getValue());
 		myValueSetConceptDesignationDao.save(designation);
-		myTermValueSet.incrementTotalConceptDesignations();
+		myValueSetDao.save(myTermValueSet.incrementTotalConceptDesignations());
 
 		if (myDesignationsSaved++ % 250 == 0) { // TODO: DM 2019-08-23 - This message never appears in the log. Fix it!
 			ourLog.info("Have pre-expanded {} designations for Concept[{}|{}] in ValueSet[{}]", myDesignationsSaved, theConcept.getSystem(), theConcept.getCode(), myTermValueSet.getUrl());