WASHINGTON -- On Wednesday, the Centers for Medicare & Medicaid Services (CMS) unveiled initiatives that would increase oversight of antipsychotic prescribing in nursing homes and alert patients about citations the facilities are contesting.
According to a news statement from HHS Secretary Xavier Becerra, "President Biden issued a call to action to improve the quality of America's nursing homes, and HHS is taking action so that seniors, persons with disabilities, and others living in nursing homes receive the greatest quality care."
"No resident of a nursing home should ever receive an incorrect schizophrenia diagnosis or an inappropriate antipsychotic.
The actions we are taking right now will assist avoid these mistakes and provide families with security."
Beginning this month, according to CMS, "perform focused, off-site assessments to see if nursing facilities are correctly diagnosing and classifying patients with schizophrenia. Nursing home residents who receive an incorrect antipsychotic medicine prescription and a false diagnosis of schizophrenia are at risk for receiving subpar treatment "since the negative consequences can be fatal, they should not be given to nursing home residents.
Although his organization has "always supported accountability around the appropriate use of antipsychotic medications," Chris Laxton, executive director of AMDA — The Society for Post-Acute and Long-Term Care Medicine, told MedPage Today that capturing overall antipsychotic use is a crude indicator of appropriate care.
In terms of their patient populations, no two facilities are comparable, according to Laxton.
Some people might require more suitable antipsychotic prescriptions.
Antipsychotics "are useful and not labeled as inappropriate for people with dementia and psychosis," he continued.
He also cautioned that because it would raise their overall cost and draw more attention, facilities would become reluctant to accept patients with valid diagnoses and a need for antipsychotics.
There's certainly a question about inappropriate diagnoses of schizophrenia and antipsychotic prescribing," Laxton said. "On the other hand, we need measures that don't create a situation where nursing homes refuse to accept patients or where diagnoses are driven by a desire not to be penalized."
David Gifford, MD, MPH, chief medical officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said in a statement that antipsychotic use in nursing homes has fallen by 40% over the last decade, and noted: "In many cases, physicians not directly affiliated with the long-term care facility are diagnosing patients and prescribing these medications."
LeadingAge, a group representing more than 5,000 nonprofit aging services providers, applauded CMS's action. "LeadingAge supports efforts to address the issue of inappropriate antipsychotic drug use among providers of all types," Katie Smith Sloan, the organization's president and CEO, said in a statement. She noted that LeadingAge led the creation of the National Partnership to Improve Dementia Care in Nursing Homes, a program that CMS supervised.
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