A news article in The Washington Post on Friday said the Centers for Medicare and Medicaid Services (CMS) is reexamining its policies on the use of antipsychotics in nursing homes, possibly setting the stage for a major shift that would allow more prescriptions for drugs that have been increasingly seen less use in the last 15 years.

The report in the newspaper noted that the development, which they sourced to a CMS email, follows the nonbinding language accompanying a congressional spending bill a few months back that instructed CMS to distinguish between appropriate and inappropriate antipsychotic prescribing in nursing homes.

“CMS, led by Administrator Mehmet Oz, said in an email that the agency is reexamining the policy ‘with the goal of supporting clinically indicated use while continuing to discourage inappropriate prescribing.’ It added that the work began before Congress requested it,” the Post article said.

Park Place Live reached out to CMS but received no comment.

Antipsychotic Use Down

The article said the feds estimate about 17 percent of “long-stay” nursing home residents receive antipsychotics, and that the share of such residents on the drugs is down one-third since 2011, the result of a concerted industry and government effort to curtail their prescribing through the government’s Five-Star rating system and other quality efforts.

“Under the current system, all antipsychotic use lowers an individual facility’s star ratings on the government’s Nursing Home Compare website. Greater numbers of patients taking the drugs can lead to a worse rating,” the article said.

Reality Check

This is part of the problem, said Amy Greer, who is an RN Quality Innovative Consultant for Zimmet Healthcare Services Group, in reaction to CMS reexamining its policies. She noted the complexity of the matter and the need to put in perspective what the reality is in nursing facilities, and the condition of residents and meeting their needs.

“I think it is long overdue! For too long, CMS held steady and was unyielding with their antipsychotic reduction program,” Greer said. “What they failed to recognize are several other factors overall - the geriatric population has changed, many people do struggle with anxiety/depression and other psychological disorders, and they have lived long, successful lives while managing those disorders on antipsychotic medications. We simply cannot just stop them because CMS feels they are overprescribed.”

She said the intent of the CMS effort to reduce overprescription of new psychotic medications as a form of chemical restraint is understandable, but the agency has often overlooked the mental, physical, and psychosocial negative effects of stopping these lifelong medications for those who truly need to take them to maintain living their optimal lives.

Facilities in Pinch

“And their punishments to those facilities that they feel have too many residents on psych drugs - their quality ratings get destroyed, which also negatively impacts their Star rating, willingness with hospitals to discharge to their facility, and of course, reputational harm,” Greer said.

Many facilities, in order to stay in compliance with these regulations, will discontinue the psych meds, and often are left with worse, escalating behaviors and having to put them back on the medications, she added.

“And those who have actually worked in skilled nursing facilities will tell you that simply repositioning a resident and offering them a warm glass of milk, and other nonpharmacological interventions is NOT going to alleviate serious psychological problems in our changing geriatric population,” Greer said.

Industry Responds

The response of the skilled nursing industry to the report focused on the big picture and all that is involved with antipsychotics in facilities. Holly Harmon, senior vice president of quality, regulatory, and clinical services for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said, “Long term care providers continue to support the delivery of the right medications at the right time and for the right reasons based on each resident’s unique medical needs.”

She noted that long-term care is “highly regulated with extensive oversight, and providers have been active partners in a national effort to reduce the unnecessary use of antipsychotics in nursing homes while also recognizing these medications are necessary and beneficial to certain residents.”

Still, Harmon said the current CMS quality measure causes concern, as it does not account for the use of antipsychotic medications for conditions that are FDA-approved.

“We will continue to work with CMS on improving this quality measure, so every resident is supported in receiving the specific medications that are necessary and appropriate for their care,” she said.

The Washington Post article is here.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.