Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions

A new report is calling into question the sustainability of recent reductions in antipsychotic use among nursing home residents, and whether providers have shifted from antipsychotics to other less scrutinized but similarly risky medications.

In a Viewpoint article published online Thursday in JAMA, experts with the University of Massachusetts Medical School, the Massachusetts Executive Office of Elder Affairs and the Institute for Healthcare Improvement took a closer look at CMS’ initiatives to curb antipsychotic use in nursing homes.

At the end of 2011, prior to the start of CMS’ National Partnership to Improve Dementia Care in Nursing Homes, nearly 24% of long-stay residents received an antipsychotic medication. In the years since that rate has dropped by more than a third, reaching a national prevalence of 16% at the end of 2016. Those reductions varied by state and region, according to CMS data.

While the article’s authors, including Alice Bonner, Ph.D., RN, noted that CMS’ multifaceted initiative could “provide a blueprint for addressing other quality of care issues in nursing homes, as well as other healthcare settings,” they raised “unanswered” questions that still surround antipsychotic reduction efforts.

Chief among those questions is whether the recent declines in the use of the drugs is sustainable, and how low of a usage rate the industry can actually achieve. They also wondered what factors are behind the “substantial” variations among antipsychotic use between regions, states and individual providers.

The other questions raised in the report are:

  • Has the drop in antipsychotic use had effects on adverse outcomes, such as falls or stroke, or patient-centered outcomes like function and behavioral issues?
  • Have providers shifted to giving residents other sedatives that don’t receive the same level of scrutiny that antipsychotics do, but still pose risks to safety?
  • Has the National Partnership to Improve Dementia Care in Nursing Homes’ efforts impacted antipsychotic use in other care settings, such as assisted living facilities?
  • Which of the partnership’s interventions were key to the decline in drug use, or “was it the totality of effort that was important?”

Click here to read the full Viewpoints article.