Headshot of CMS Administrator Chiquita Brooks-LaSure
CMS Administrator Chiquita Brooks-LaSure

The Centers for Medicare & Medicaid Services announced Wednesday morning that it will conduct targeted audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis.

The off-site enforcement will begin this month.

“We have made significant progress in decreasing the inappropriate use of antipsychotic medications in nursing homes, but more needs to be done,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medications.”

In addition, CMS said it plans to begin publicly displaying survey citations that facilities are disputing on Care Compare. Currently, when a facility disputes a survey deficiency, that deficiency is not posted to Care Compare until the dispute process is complete. 

“Displaying this information while it is under dispute can help consumers make more informed choices when it comes to evaluating a facility,” CMS said, noting that the change will go into effect in one week, on Jan. 25. While citations will be publicly displayed, they will not be included in the Five-Star Quality Rating calculation until dispute resolution is complete.

Schizophrenia diagnoses targeted

CMS in November agreed to increase its oversight of the use of psychotropic drugs following a highly critical report from the Health and Human Services Inspector General’s Office. An investigation found CMS needed to pay closer attention to certain psychotropic drugs, including anticonvulsants, often prescribed to epileptics. Even as the use of some antipsychotics by nursing homes fell, many residents were being prescribed other types. The report also found unsupported schizophrenia rates increased and were concentrated in a small number of nursing homes.

On Wednesday, CMS said nursing home residents erroneously diagnosed with schizophrenia are at risk of poor care and being prescribed inappropriate antipsychotic medications. Antipsychotic medications are especially dangerous among the nursing home population due to their potentially devastating side effects, including death, the agency noted.

Officials described Wednesday’s action as furthering the Biden Administration’s objective to improve the accuracy of nursing home quality information. The use of antipsychotic medications among nursing home residents is an indicator of nursing home quality and used in a nursing home’s Five-Star rating, however it excludes residents with schizophrenia.

If an audit identifies that a facility has a pattern of inaccurately coding residents as having schizophrenia, the facility’s Five-Star Quality Measure Rating on the Care Compare site will be negatively impacted, CMS announced.

For audits that reveal inaccurate coding, CMS will downgrade the facility’s Quality Measure ratings to one star, which would drop their Overall Star Rating as well. CMS said it will be monitor every facility’s data to determine whether identified issues are addressed. Downgrades could be reversed.

This is a developing news story. Please check back for more details.