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CMS Seeks Reductions in Antipsychotic Drug Use in Nursing Homes

By Jane Norman, CQ HealthBeat Associate Editor

May 31, 2012 – Medicare officials announced an initiative last week to improve dementia care for residents of nursing homes, including a goal to reduce the use of antipsychotic drugs by 15 percent by the end of the year.

Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services, said the agency will seek to work with state regulatory officials, nursing homes, advocacy groups and caregivers as part of the Partnership to Improve Dementia Care. "We want our loved ones with dementia to receive the best care and highest quality of life possible," Tavenner said in a written statement.

Overuse of antipsychotics in nursing homes is a major problem, medical professionals testified at a November hearing of the Senate Special Committee on Aging. Jonathan M. Evans, vice president of the American Medical Directors Association, which represents long-term-care doctors, said that he and other physicians "feel tremendous pressure in all care settings to prescribe medication to make patients with dementia behave."

The Department of Health and Human Services inspector general in 2011 found that 14 percent of nursing home residents, or more than 300,000 patients, had Medicare claims for atypical antipsychotic drugs. Half of the claims, totaling almost $116 million, should not have been paid, because they were not used for medically accepted indications, the inspector general said.

Medicare officials said they believe that more than 17 percent of nursing home residents in 2010 had daily doses of antipsychotic drugs exceeding recommended levels. Another CMS survey in 2010 found that almost 40 percent of residents with signs of dementia received such drugs even if there was no diagnosis of dementia.

The goal of a 15 percent reduction in use by the end of year, which Tavenner called "ambitious," will include a training series for nursing home staff members that emphasizes prevention of abuse and high-quality care. The agency also will better train state and federal regulators on behavioral health.

In addition, data on every nursing home's antipsychotic drug use will be available beginning in July on Medicare's "nursing home compare" website, and Medicare officials who work with nursing homes will emphasize alternatives other than drugs for nursing home patients. Those alternatives will include consistent staff assignments, so staff members are familiar with the patients they see; more exercise or time outside; and better management of acute and chronic pain.

A CMS research study is under way as well in about two dozen nursing homes to gain better understanding of the process through which nursing homes decide to use antipsychotic drugs.

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