The Centers for Medicare & Medicaid Services is targeting skilled care facilities that are not reducing residents’ antipsychotic use rates as quickly as the government would like.

Federal officials outlined their latest strategy in a memo to state survey agencies earlier this month. The document notes that while the use of antipsychotics in long-stay residents has dropped 38.9% since 2011, about 10% of the facilities are “late adopters” with high rates of use and lagging improvement efforts.

CMS pinpointed 235 providers on that list with two or more citations for noncompliance of antipsychotic regulations since 2016. The agency says it will initiate a period of enhanced oversight of those facilities, which could result in denied payments for new admissions.

A second part of the strategy will have CMS working more closely with corporate nursing home chains that own a significant number of facilities identified as late adopters.

These stepped up enforcement actions come after Rep. Richard Neal (D-MA) sent a letter in January to CMS, expressing concerns that nursing homes aren’t working quickly enough to address prescribing rates. “Unfortunately, CMS’ data are still extremely disappointing, showing that progress reducing inappropriate use of antipsychotics in nursing homes has slowed,” he wrote. A recent study, in Aging & Mental Health, also claimed that SNFs are underreporting antipsychotic prescribing, a conclusion that industry advocates disputed.

Trade groups continued to tout those gains in the wake of CMS’ new approach to weeding out late adopters. Since 2011, more than half of the American Health Care Association’s members have received a 30% reduction in the use of these drugs, said Holly Harmon, vice president of quality, regulatory and clinical services.

“AHCA and our members have been an active partner in this effort to reduce the unnecessary use of antipsychotic medications,” she said this week.  

CMS’ new efforts are targeting just 1.5% of nursing homes, with the vast majority making huge strides in improving prescribing patterns, added Barbara Gay, vice president of public policy communications with LeadingAge. The group — which posted a summary of the new memo — also emphasized that antipsychotic overuse is not confined to nursing homes.

“Our members often tell us of having to admit residents who’ve been prescribed these meds while under the care of other providers. Healthcare is a team sport; all providers in the system must be held to the same expectation,” Gay told McKnight’s.