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CMS Looking at Nursing Home Medication Use

elderly-woman-sorting-medicationAntipsychotic medications are intended to help control psychosis and mental health conditions such as schizophrenia. They also frequently used to treat dementia in elderly patients. But, these drugs have proven to have serious side effects for elderly persons. Why exactly are they frequently prescribed in nursing homes then—and often to patients who don’t even require them?

Antipsychotic drugs are being inappropriately prescribed to nearly 150,000 Americans every year, according to the Alzheimer’s Association. This misuse leads to an estimated 1,800 annual fatalities.

In 2012, the Centers for Medicare & Medicaid Services (CMS) started the National Partnership to Improve Dementia Care in Nursing Homes. The main goal of this initiative is to reduce the use of antipsychotics in long-term facilities across the country.

From its inception to the end of 2013, the initiative generated a 15.1% reduction of antipsychotic medication use in nursing homes. In the fourth quarter of 2014, CMS announced future goals of a 25% reduction by the end of 2015 and 30% by the end of 2016.

However, some fear that the focus is merely on the goals instead of the regulations that will achieve them.

While the CMS quality measure assesses the amount of nursing home residents that are being prescribed antipsychotic medication, a common concern is that the measure does not adequately consider all forms of suitable mental cases. The quality measure considers schizophrenia, Tourette’s syndrome and Huntington’s disease as appropriate disorders to treat with antipsychotic drugs.

To test the effectiveness of the CMS quality measurement, a study was conducted using information from the 2004 Minimum State Data set. The sample set from the data was used to assess nursing homes in seven highly populated states. The results found that under the current measurement parameters, the percentage of inappropriate antipsychotic prescriptions may be overstated.

According to CMS’ current measurements, 85% of the sampled nursing home residents receiving antipsychotic medication did not met the qualifications for appropriate use. But, what about the additional syndromes that the Food and Drug Administration feel are acceptable to be treated with antipsychotic medication, such as bipolar disorder and severe aggression that leads to self-harm or the harm of others?

When the same data set was reprocessed to include these additional parameters, only 52% of nursing home residents were considered as unfit to receive antipsychotic medication.

Significantly reducing the amount of a commonly used medication in nursing homes nationwide is no easy task, but it’s one that will leave an everlasting benefit on the entire industry and its patients. While the quality measurements and goals of the CMS may not be perfected just yet, the fact remains that its intention to reduce the use of potentially harmful drugs is the right one.

Is your long-term care facility in need of assistance to get on track to meet the changing standards? Contact General Medicine, The Post Hospitalist Company. Our specialized post-hospitalists always ensure your patients are receiving the highest level of quality of care.

Tom Prose