Assisted living residents with dementia receiving too many antipsychotics, GAO says

The Centers for Medicare & Medicaid Services could do more to improve the quality of its data on antipsychotic use in nursing homes, according to a new report by the Department of Health and Human Services’ Office of the Inspector General.

CMS has acknowledged inconsistencies in the Minimum Data Set, which includes prescribing information that is self-reported by nursing homes. It also has encouraged a reduction in antipsychotics use ever since the OIG raised quality and safety concerns in 2011, according to the report, released May 3.

But troubles appear to remain, according to an OIG comparison of 2018 Medicare claims with MDS records. For nursing home residents aged 65 or more years, the MDS does not always provide complete information, investigators found.

For example, residents’ use of antipsychotics may not have been detected in the following cases, they reported:

  • Approximately 5% of all Medicare Part D beneficiaries who were long-stay residents aged 65 and older had a Part D claim for an antipsychotic drug but were not reported in the MDS as receiving one. 
  • Nearly one-third of residents who were reported in the MDS as having schizophrenia (a diagnosis that excludes them from CMS’ measure of antipsychotic drug use) did not have any Medicare service claims for that diagnosis. 
  • Important details about antipsychotic use were not included for residents whose use of the drugs was reported in the MDS.

The MDS should not be CMS’ sole data source to determine the number of nursing home residents using antipsychotic drugs, the OIG investigators said. The agency must take additional steps to validate the information reported in MDS assessments and supplement these data with additional information sources, they concluded. 

CMS concurs with these recommendations, according to the OIG.