The leader of a congressional committee overseeing Medicare wants to put nursing homes’ use of antipsychotics under the microscope.
Rep. Richard Neal (D-MA) sent a letter to the Centers for Medicare & Medicaid late last month, asking for explanation on how SNFs and Medicare plans are acting to address such prescriptions, Bloomberg reported Monday. Neal is in a key position to push for change as head of the committee that oversees the federal payment program.
The Ways and Means Committee does not have a particular law switch in mind, but is open to crafting legislation if necessary, an aide said in the report. For now, it wants to start a conversation with CMS officials to address the issue.
The latest CMS data shows that nursing homes are making progress in decreasing antipsychotic prescribing. At the end of 2011, almost 24% of residents received an antipsychotic medication. Since then, there has been a decrease of about 39%, to a national prevalence of 14.6% in the second quarter of 2018, the agency reported.
But Neal is concerned that change isn’t happening fast enough. He wants the agency to specify how many Medicare dollars go toward adverse events stemming from inappropriate prescribing, and any links they might have to nursing home staffing levels.
“Unfortunately, CMS’ data are still extremely disappointing, showing that progress reducing inappropriate use of antipsychotics in nursing homes has slowed,” he wrote. “Moreover, I am concerned that the ‘improvement’ is not the result of changed prescribing behavior but, instead, stems from some nursing homes falsifying psychosis diagnoses, making incidence of this contra-indicated prescribing appear improved when it is, in fact, not.”
Industry advocacy groups, meanwhile, applauded any efforts to further address antipsych use, while also touting the industry’s hard-fought gains. David Gifford, M.D., senior VP of quality and regulatory affairs for the American Health Care Association said his group has asked CMS to expand its efforts to reduce use of these meds in the hospital- and community-based settings. He noted that almost half of antipsychotic use in nursing centers starts prior to admission, and families and doctors are often “reluctant to stop these medications.”
“While more must be done, trends show that the profession is moving in a positive direction,” he said in a statement.
Barbara Gay, LeadingAge VP of public policy communications, added that nursing homes have done “much of the real work” on transitioning away from use of antipsychotics, and have found success, with use dropping “dramatically” the last seven years.
“But the fact is that prescription medications cannot be given to anyone, whether a nursing home resident or any other patient, without a doctor’s order. So we applaud the committee for getting to the bottom of this issue and addressing root causes,” she told McKnight’s Monday.