The Office of the Inspector General (OIG) released a report on November 14th on the use of psychotropic drugs in nursing homes. The report utilized Minimum Data Set (MDS) data and Medicare claims data to examine patterns and characteristics of psychotropic drug use in long-stay nursing home residents aged 65 years and older from 2011 – 2019. The analysis found that about 80% of long-stay nursing home Medicare beneficiaries were prescribed a psychotropic drug. There also appeared to be a negative correlation between the use of antipsychotic and anti-convulsant medications, with anticonvulsant use increasing as antipsychotic use decreased. OIG also found that in 2019, nursing homes with lower RN staffing ratios were associated with higher use of psychotropic drugs and the number of unsupported schizophrenia diagnoses increased and was concentrated in relatively few (99) nursing homes.
We note that these findings seem to support actions by CMS in recent years, such as the adoption of the long-stay antipsychotic quality measure in 2015, focused schizophrenia surveys conducted by CMS from 2016 – 2021, and most recently, updated surveyor guidance related to inaccurate MDS coding and diagnosis of schizophrenia, warnings about increases in other psychotropic medications when antipsychotic usage decreases, and recommendations that high levels of sedative medications could be indicative of staffing issues.
OIG recommends the following:
1) CMS should evaluate the use of psychotropic drugs among nursing home residents to determine if additional action is needed
2) use data to identify and focus oversight on nursing homes / nursing home characteristics associated with higher use of psychotropic drugs where trends may signal inappropriate use
3) expand the required data elements on Medicare D claims to include diagnosis codes.
CMS concurred with the first 2 recommendations and did not concur with the third. Read the report here.
