CMS targets nursing homes' overuse of antipsychotic drugs

The CMS will push nursing homes to reduce their use of antipsychotic medications by 25% by the end of 2015 and plans to incorporate a measure of the drugs' use to its star-rating system for consumers.

“We know that many of the diagnoses in nursing home residents do not merit antipsychotics but they were being used anyway,” Dr. Patrick Conway, deputy administrator for innovation and quality and the CMS' chief medical officer said Friday. He said the agency has set “ambitious goals” and that ultimately, nursing homes should “rethink their approach to dementia care.”

Of 2.1 million elderly nursing home residents, about 14% (304,983) had at least one Medicare claim for an atypical antipsychotic drug between Jan. 1 2007 and June 30, 2007, according to a 2011 analysis by HHS' inspector general's office. Claims for elderly nursing home residents accounted for 20% of the total 8.5 million claims for atypical antipsychotic drugs for all Medicare beneficiaries, a cost of $309 million, the OIG found.

The CMS has also estimated that 39.4% of nursing home residents who had cognitive impairment and behavioral issues but no diagnosis of psychosis or related conditions received antipsychotic medications between July 2010 and September 2010.

In response to concerns that the facilities were routinely administering the drugs inappropriately, the CMS established a public-private alliance two years ago called the National Partnership to Improve Dementia Care in Nursing Homes.

Since then the CMS has measured a 17.1% reduction in the national prevalence of antipsychotics in long-stay nursing home residents by the first quarter of 2014. The agency will seek to cut their use 25% by the end of next year and 30% by the end of 2016.

The partnership includes the American Health Care Association, the American Health Quality Association, LeadingAge, the American Medical Directors Association and Advancing Excellence.

Dr. Adrienne Mims, president of the American Health Quality Association said it's important to note that the goal is to reduce unnecessary use of the drugs by nursing homes rely on them for convenience or because they lack of knowledge about how to manage patients. “The absolute number is not zero,” she said.

The frequency that a nursing home uses antipsychotic medicines on patients with dementia will be posted on the CMS Nursing Home Compare website and in 2015 the CMS plans to add a measure to the calculations used in the five-star quality rating system.

The number of Americans with Alzheimer's disease and related dementias is rising rapidly. The population is expected to grow from 5.5 million in 2010 to 8.7 million in 2030, according to a new 500-page report called “Dying in America” from the Institute of Medicine. People suffering from mental disorders or cognitive impairments, like Alzheimer's disease and other dementias are at heightened risk of poor-quality, high-cost end-of-life care, the report said.

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