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 Association Reports A 22 Percent Reduction In Off-Label Antipsychotics Use

Provider advocates at the nation’s largest long term and post-acute care association are using the latest data on the continuing success of eliminating unnecessary antipsychotic medicines to push against proposed regulations that the advocates fear will be too much of a blunt instrument.
 
The Centers for Medicare & Medicaid Services (CMS) has acknowledged that the off-label use of antipsychotic drugs for those suffering from dementia fell nearly 22 percent between the fourth quarter of 2011 and the first quarter of 2015.
 
Leaders of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), the members of which have reduced improper antipsychotics by 23 percent, say that the success of volunteer efforts make across-the-board federal regulations moot.
 
“However, despite the progress we’ve made, CMS is now proposing restrictive documentation regulations on how these medications can be prescribed,” says David Gifford, MD, AHCA’s senior vice president of quality and regulatory affairs and a board-certified geriatrician. “This proposed change will shift the focus away from providing better care for those with dementia. We will continue to work with CMS to recommend solutions to safely decrease the use of antipsychotics and promote more person-centered care.”
 
In Gifford’s brief, the enormous progress made so far proves “how a collaborative partnership between CMS, providers, and consumers can be very successful.”
 
Last month, as the White House Conference on Aging opened, CMS dropped a mammoth, 400-plus-page rulemaking notice that, among other things, would require providers to:
 
·         “Ensure residents who have not used psychotropic drugs not be given these drugs unless medically necessary” (with psychotropic being defined “as any drug that affects brain activities associated with mental processes and behavior”);
·         Lead “gradual dose reductions, and behavioral interventions, unless clinically contraindicated” for those residents already on antipsychotics; and
·         Limit any “as needed” orders for psychotropic prescriptions to 48 hours or less and then requiring “the primary care provider” to review needs and, if he or she decides to continue psychotropic prescriptions, to document “the rationale for the order in the resident’s clinical record.”
 
Gifford says that, while his association must push back against the proposed regulations, “We will continue to work with CMS to recommend solutions to safely decrease the use of antipsychotics and promote more person-centered care.”
 
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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