The Centers for Medicare and Medicaid Services is cracking down on nursing homes overprescribing antipsychotics, the agency announced Wednesday.
CMS will begin a targeted audit this month to confirm whether nursing home residents taking medication are correctly diagnosed with schizophrenia. It’s the latest in President Joe Biden’s plan to improve quality and safety in nursing homes.
Antipsychotics are associated with a higher risk of death in older adults. CMS began monitoring antipsychotic use in nursing homes in 2012, but the data exclude drug use in patients with schizophrenia.
“No nursing home resident has been misdiagnosed with schizophrenia or given inappropriate antipsychotic medication. The steps we are taking today will help prevent these errors and give families peace of mind,” Health and Human Services Secretary Xavier Becerra said in a press release.
The industry has come under scrutiny for misdiagnosing patients with schizophrenia so facilities can administer antipsychotics without affecting their Five-Star Quality Metric Rating. If an audit found that a nursing home had misdiagnosed a patient with a neurological condition, the quality factor in its score would drop by one star, which would result in a lower overall rating. .
The announcement comes after a report in November from the HHS Office of Inspector General found that misreported diagnoses of schizophrenia among nursing home residents increased from 2015 to 2019. increased concentration in 99 facilities, where 20% or more residents were diagnosed with schizophrenia that did not meet Medicare requirements.
The American Healthcare Association and the National Center for Life Support, an association representing long-term and post-acute care providers, expressed support for increased transparency. transparent but raised concerns about how changes in scores could affect how patients and families choose nursing homes.
“We appreciate CMS’s effort in enhancing the Five-Star Quality Rating System. However, significantly downgrading the entire rating based on a single measure leads to misinformation and causes confusion. added confusion for consumers,” AHCA/NCAL Chief Medical Officer Dr David Gifford said in a report. declare.
CMS also said it will publish survey citations that the facilities dispute, even before the processes are resolved. According to the agency, this information will be posted online on the Compare Care website on January 25, which will help patients and families make informed decisions when choosing a facility.
LeadingAge, an association representing nonprofit aging service providers, also commended the government’s efforts to improve nursing home safety but said more needs to be done.
“We urge CMS to address the issue of inappropriate use of antipsychotics between providers of all types. Our members often tell us about having to accommodate residents who have been prescribed these drugs while receiving care from other providers. Wellness is a team sport; All providers in the network must have the same expectations,” LeadingAge President and CEO Katie Smith Sloan said in a press release.
Biden pledged to take on a series of initiatives to improve nursing home care during his State of the Union speech last year. CMS recently announced that underperforming nursing homes would have to meet higher standards while also showing improvements in quality and be subject to penalties including exclusion from Medicare and Medicaid. The agency is also using payroll data to ensure facilities are meeting staffing requirements and has launched a public database that tracks ownership of 15,000 skilled nursing facilities. Other elements of Biden’s plan, such as staffing ratios, have yet to materialize.
