Providers respond to report of inadequate government oversight of antipsychotics prescriptions

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J&J to pay $181 million for Risperdal settlement
J&J to pay $181 million for Risperdal settlement

Long-term care organizations have responded to a report that physicians are prescribing antipsychotic medications for seniors without proper oversight from the Centers for Medicare & Medicaid Services. This is hampering efforts to reduce off-label antipsychotic use for dementia care in nursing homes, according to ProPublica, which compiled the report based on a review of Medicare Part D claims.

CMS partnered with the American Health Care Association's Quality Initiative, which called for a 15% reduction in antipsychotic use in nursing homes by the end of 2012. Providers fell far short of that goal, AHCA recently announced. Despite working toward reduce antipsychotics in nursing homes, CMS is not currently focused on oversight of doctors prescribing these medications, Deputy Administrator and Director for the Center of Medicare Jonathan Blum told ProPublica, an independent investigative journalism news organization.

If the report draws more widespread attention to “what we already knew about rampant use of antipsychotics,” that would be positive, AHCA spokesman Greg Crist told McKnight's. The organization has renewed the 15% antipsychotic reduction goal for 2013.

“We have a great collaborative relationship with CMS on this,” Crist said. “Irrespective of who's doing the prescribing, we're trying to reduce the use of antipsychotics when and where it is appropriate.”

The ProPublica report highlighted the case of Miami-based psychiatrist Enrique Casuso. He prescribed more antipsychotics to seniors on Medicare than any other provider in 2010, according to a searchable database of Medicare Part D prescribers unveiled by ProPublica. Many of these seniors had dementia and were living in long-term care facilities, Casuso told ProPublica. The state of Florida removed Casuso from the Medicaid program in 2005, but Medicare Part D insurers have only sent Casuso letters alerting him to government warnings regarding antipsychotics.

“We believe in better guidance for physicians and other prescribers to use medications more appropriate for the older population,” said LeadingAge President and CEO Larry Minnix.

Minnix also said that poly-pharmacy — or seniors taking multiple, often excessive or unnecessary medications — could be reduced with better prescriber guidance.

The ProPublica report was released last Saturday. Click here to access the “Prescriber Checkup” database.