Feds Urge Cuts in Use of Anti-Psychotic Drugs for Seniors

Cheryl Clark, for HealthLeaders Media , April 19, 2012

ICU Staff "Not Neurologically Sophisticated"
A big problem is the use of anti-psychotics in the elderly treated in intensive care units, Caplan explains. "The people running the ICUs are not neurologically sophisticated, so that they don't pay as much attention to neurospsychological aspects. They would much rather look at computers and see blood gas levels and do imaging rather than examine patients neurologically," Caplan says.

Because hospitals are segmented, the people who take care of patients in ICUs don't follow patients afterwards, so they don't see the longer-term effects of these drugs, he says.

Often, a hospital physician's prescription follows a patient to a nursing home where their use is never re-assessed. Family or patient consent for the use of these drugs, required in many states, is often never obtained.

Consider recent developments giving this issue more attention:

CMS's Plans
The Centers for Medicare & Medicaid Services is under pressure to improve its claims processes for use of these 10 anti-psychotic drugs. In its report last May, the OIG said that over a six-month period ending June 30, 2007, "over 726,000 of the 1.4 million atypical anti-psychotic drug claims for elderly nursing home residents did not comply with Medicare reimbursement criteria."

  • As noted, CMS has rolled out an initiative calling for a 15% reduction in the use of anti-psychotic medications in nursing homes by year's end. [CMS video.] Recommended strategies include lower staffing ratios, use of non-pharmacological agents, and at the very least, lower dosing for 72 hours after a patient's episode. Surveyor inspection training to identify noncompliance with federal guidelines is undergoing an update.
  • CMS intends to make it clear in an upcoming campaign that nursing homes aren't their only target. Shari Ling, MD, CMS deputy chief medical officer, said in a statement:

"We know that the overuse of these kinds of drugs is not a sector- or setting-specific problem, and we look forward to teaming our long-term-care colleagues with other caregivers across the continuum to make a positive difference in how we as a health community at large care for patients with behavioral issues, particularly those with dementia."

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