The CMS says it has surpassed its goal for reducing the use of antipsychotic medications in nursing homes. Patient advocates, however, are expressing skepticism over the claim.
In 2014, the agency said it would strive to reduce use of the drugs by 25% by the end on 2015. The agency beat that goal by cutting use of the drugs 28.8% nationally by the end of last year, according to a report (PDF).
The analysis aimed at focusing on inappropriate use of the drugs by excluding patients diagnosed with schizophrenia, Huntington's disease or Tourette's syndrome.
Industry was pleased with the progress. “This is a large change impacting thousands of residents, who are no longer receiving these antipsychotic medications that often are unhelpful and potentially harmful,” said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, a nursing home trade group.
For years reports were pouring in from nursing homes around the country of patients not suffering for mental illness receiving antipsychotic drugs to suppress residents from acting out or showing signs aggression. The drugs are approved mainly to treat serious mental illnesses like schizophrenia and bipolar disorder.
When given to other patients not suffering from a serious mental illness, such as those with Alzheimer's disease and related dementias, there has been a noted increased risk of falls due to impaired mobility, heart failure, infections and death.
The CMS says its reduction estimates are based on the minimum data set (MDS), which is a standardized, primary screening and assessment tool used to asses care in a Medicare/ Medicaid-certified long-term-care facilities.
However, the CMS has noted instances past that MDS data can be inaccurate when compared to a patient's medical records. For instance, a report last year found there were instances where the MDS data didn't match a patient's medical record 25% of the time.
Concerns over the CMS' data source has resulted in advocates expressing some skepticism on whether there been a major drop in inappropriate use of antipsychotics in nursing homes.
“The reduction in inappropriate administration of antipsychotic drugs is good, but too many nursing home residents, more than a quarter of a million people, continue to take these drugs and the overwhelming majority of residents should not be taking them,” Toby Edelman, senior policy attorney at the Center for Medicare Advocacy. “We have a long way to go to solving this problem.”
AARP also raised concerns about the data used but gave the CMS some credit that at least some progress is being made.
“It's great that it's going in the right direction, but the pace of change has been slow, especially given the potential consequences of the drugs,” said Kelly Bagby, senior counsel for AARP Foundation Litigation. “For people with dementia, use of the drug is especially dangerous because they can possibly die.”
In 2011, HHS' Office of the Inspector General found 83% of atypical antipsychotic drug claims were for elderly nursing home residents who had not been diagnosed with a condition for which antipsychotic medications were approved by the Food and Drug Administration.
In response to concerns that the facilities were routinely administering the drugs inappropriately, the CMS established a public-private alliance in 2012 called the National Partnership to Improve Dementia Care in Nursing Homes.
The partnership includes the American Health Care Association, the American Health Quality Association, LeadingAge, the American Medical Directors Association and Advancing Excellence.
Under the initiative, outreach is performed providers and provider associations, clinicians, researchers, advocates, government agencies, residents and families in every state about the dangers of off label use of the drugs.
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 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.
