As many as one in seven elderly nursing home residents, most of whom have dementia, are being prescribed expensive, powerful antipsychotic medications that increase the risk of death, according to a report from the federal Office of the Inspector General. Providers counter that the research reflects outdated practices.
The audit found that 51% of the antipsychotics paid for by Medicare were “erroneous,” in the first half of 2007, costing the federal program $116 million. Additionally, 83% of the claims were associated with off-label use and 88% were to treat patients with dementia, for whom the medications can be fatal.
In a letter from Sens. Charles Grassley (R-IA) and Herb Kohl (D-WI) to Donald Berwick, MD, director of the Centers for Medicare & Medicaid Services, the senators asked why Medicare has paid out millions of dollars in claims for drugs that are being used inappropriately. The Centers for Medicare & Medicaid Services said that some of the inappropriate use stems from drug makers’ paying kickbacks to nursing homes to increase prescriptions for certain medications, The New York Times reports.
The IG audit calls for more aggressive provider education efforts regarding the use of psychotropic medications, which include antipsychotics such as Seroquel, Zyprexa, Risperdal and Abilify.
Provider groups such as the American Medical Directors Association acknowledge that the use of psychotropic drugs in nursing homes is a challenge, but caution that the report does not reflect 2011 standards. The OIG study evaluated the first six months of 2007, says Kathleen Wilson, Ph.D., AMDA’s director of government affairs. Wilson told McKnight’s that F-tags (surveyor regulations and guidance) for unnecessary drugs and pharmacy services were significantly revised in late 2006, with surveyors receiving training in December of that year.
“It is reasonable to expect that education to the facility level would not have rolled out until sometime in 2007,” Wilson said. “In April 2005, the Food and Drug Administration issued an overall health advisory concerning an increased risk of death in patients with dementia who are treated with second-generation antipsychotics.”
By June 2008, the warning had been expanded to include all antipsychotic medications, she said. “With these points in mind, the data being collected is being viewed in the context of old and current policy and regulations.”
