The Centers for Medicare and Medicaid Services is cracking down on nursing homes that overprescribe antipsychotic drugs, the agency announced Wednesday.
CMS will begin targeted audits this month to confirm whether nursing home residents taking the drugs are correctly diagnosed with schizophrenia. This is latest action from President Joe Biden's plan to improve quality and safety in nursing homes.
Antipsychotics have been linked to a higher risk of death when used by older adults. CMS began tracking antipsychotic use at nursing homes in 2012, but the data exclude the drugs' use for patients with schizophrenia.
“No nursing home resident should be improperly diagnosed with schizophrenia or given an inappropriate antipsychotic. 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 news release.
The industry has come under scrutiny for misdiagnosing patients with schizophrenia so that facilities can administer antipsychotics without affecting their Five-Star Quality Measure Ratings. If an audit shows a nursing home misdiagnosed a patient with the neurological condition, the quality element of its score will drop to one star, which would translate into an overall lower rating.
This announcement follows a November report from the HHS Office of Inspector General that showed misreported schizophrenia diagnoses among nursing home residents increased from 2015 to 2019. The rise was concentrated in 99 facilities, at which 20% or more of residents had a schizophrenia diagnosis that didn't align with Medicare claims.
The American Health Care Association and National Center for Assisted Living, an association representing long term and post-acute care providers, expressed support for increased transparency but raised concern about how scoring changes could influence how patients and families choose nursing homes.
"We appreciate CMS’s effort to enhance the Five-Star Quality Rating System. However, dramatically downgrading entire ratings based on a single measure results in misleading information and causes more consumer confusion," AHCA/NCAL Chief Medical Officer Dr. David Gifford said in a statement.
CMS also said it will publish survey citations that facilities dispute, even before the processes are resolved. This information, which will go live on the Care Compare website Jan. 25, will help patients and families make informed decisions when selecting a facility, according to the agency.
LeadingAge, an association representing nonprofit aging services 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 antipsychotic use among providers of all types. Our members often tell us of having to admit residents who’ve been prescribed these meds while under the care of other providers. Healthcare is a team sport; all providers in the system must be held to the same expectation,” LeadingAge President and CEO Katie Smith Sloan said in a news release.
Biden pledged to implement a series of initiatives to improve nursing home care in his State of the Union address last year. Recently, CMS announced poor-performing nursing homes will have to meet higher standards while showing quality improvements and be subject to punishments including exclusion from Medicare and Medicaid. The agency is also using payroll data to ensure facilities are fulfilling staffing requirements and launched a public database tracking the ownership of 15,000 skilled nursing facilities. Other elements of Biden's plan, such as staffing ratios, have yet to come to fruition.
