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HEALTH
Prescription Drugs

'A red flag': Biden administration targets antipsychotic drugs dispensed in nursing homes

Ken Alltucker
USA TODAY

The Biden administration this month will begin spot audits of nursing home use of antipsychotic drugs in an effort to cut down on inappropriate prescriptions.

The Centers for Medicare and Medicaid Services will conduct "targeted, off-site audits" to check whether nursing home patients who are prescribed the drugs have a schizophrenia diagnosis.

The initiative is part of the Biden administration's larger effort to address long-standing patient safety and staffing shortcomings at nursing homes, which were among the deadliest places during COVID-19's winter 2020 surge. 

More:Nursing home chain exposed by USA TODAY for high COVID-19 death rates files for IPO

Safety watchdogs have long warned some nursing homes overprescribed the drugs to sedate patients, a practice that can result in dangerous side effects or death to vulnerable patients. 

“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 statement. “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.” 

How will Medicare identify homes with a poor record?

CMS officials will review data to ensure nursing homes are properly assessing and coding residents with a schizophrenia diagnosis. The review is meant to show patients who are taking the schizophrenia drugs have a legitimate diagnosis.

In 2011, the U.S. Department of Health and Human Services Office of Inspector General found the vast majority of nursing home patients on schizophrenia meds were inappropriately prescribed the drugs. 

In a follow-up report last November, the Inspector General identified 99 nursing homes where about 1 in 5 residents were described as schizophrenia patients, even though Medicare claims data contradicted such a diagnosis. 

What will Medicare do with the data?

If a home has a pattern of inaccurately coding residents as having schizophrenia, Medicare will dock the home's rating on the agency's five-star Care Compare website. Consumers can use the website to evaluate a home's overall performance, which is derived from ratings on health inspections, staffing and quality measures. 

Homes that use such medications inappropriately won't be immediately fined. However, Medicare will share the information with state inspectors who conduct routine checks on safety and quality of homes, a senior CMS official said. 

In another new initiative, Medicare will post inspection citations to Care Compare even as the nursing home disputes such findings. That's a change from the past when Medicare would not post such findings to the public website until the dispute concluded. Such cases typically take about two months to resolve, so families who used the website to evaluate a home were kept in the dark for 60 days or longer.

Consumer advocates sought sanctions

Consumer and patient advocates said the nursing homes long have put patients at risk by inappropriately prescribing these medications.

People with schizophrenia typically exhibit symptoms as young adults, so "it's a red flag that something fishy is going on" when clusters of seniors are diagnosed after they are admitted to a nursing home, said Richard Mollot, executive director of the  Long Term Care Community Coalition.

Mollot said analyzing data patterns is the right way to tackle the problem rather than relying on individual inspectors to uncover such patterns during surveys.

"I would hope that that down the road, if not immediately, that this comes with automatic penalties," Mollot said. "It is widely known and acknowledged, even by the industry, to be a significant disservice to residents and a waste of taxpayer dollars."

LeadingAge, an association of nonprofit nursing homes and other providers of aging services, said its members have long supported efforts to curtail inappropriate prescribing.

"We understand the challenges of implementing alternatives to drugs, particularly if programs that reduce the use of antipsychotics require more or specialized staff," LeadingAge said in a statement  "There is a workforce shortage in skilled nursing. However, this is a serious quality of care and quality of life issue for residents." 

Nursing homes turn to another class of drugs: anticonvulsants

Medicare's new initiative does not address another class of drugs, anticonvulsants, that homes have increasingly used. The Inspector General last November found 80% of Medicare nursing home residents were prescribed some type of psychotropic drug, a broad category that includes anticonvulsant or antipsychotic medications. 

Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, has applauded the Biden administration's efforts to improve nursing home safety and impose minimum staffing requirements. 

But she would like to see tougher penalties assessed to nursing homes that run afoul of regulations and laws.

"This industry needs to have a financial penalty to get their attention," Edelman said. 

Ken Alltucker is on Twitter at @kalltucker, or can be emailed at alltuck@usatoday.com.

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