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 Senate Panel Examines Overuse Of Antipsychotics In Nursing Homes

​The Senate Special Committee on Aging examined what its chairman believes is a dangerous situation in U.S. nursing homes with residents being prescribed antipsychotic drugs for off-label uses at too high of a rate, leading to possible health concerns and acting as a cost burden to the Medicare program.

Committee Chairman Herb Kohl (D-Wis.) convened the hearing in the wake of a report released this past spring by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) on Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents (OEI-07-08-00150).

Kohl_thumb.jpgKohl said it was important for the health of nursing home residents as well as the financial costs of overprescribing to get a handle on the situation now, just as millions of baby boomers are entering senior citizen status and looking for long term care.

Daniel Levinson, inspector general of HHS, told the committee while he did not think doctors and providers were overprescribing for any reason other than to help care for patients, the high rate of off-label use of antipsychotics was a problem in need of addressing.

Referring to recent HHS OIG reports, Levinson said findings indicate that Medicare is paying for drugs that it should not and Part D prescription drug plans are not able to adequately prevent inappropriate payment for drugs, including antipsychotics, for uses that do not meet coverage rules.
“In addition, nursing homes often fail to comply with regulations designed to prevent overmedication of these powerful and at times dangerous drugs,” he noted.

Patrick Conway, director and chief medical officer for the Centers for Medicare & Medicaid Services (CMS), said the agency has already taken steps to eliminate the inappropriate use of antipsychotic drugs in nursing homes, updating guidance relating to Survey and Certification of nursing homes to better measure and address potentially inappropriate prescribing.

He said further steps would be taken to educate providers, patients, and families on antipsychotic drug prescribing, eliminating conflicts of interest in the pharmacy community, and working with states to ensure overuse of such drugs is eliminated, among other measures.

When asked by Kohl if the problem was solveable, Conway said it was, though fixing the situation was complex. “It is solveable, but must be worked on as part of a collaborative quality improvement effort,” Conway said, noting all parties, including patients’ families, should know about non-pharmacological means to treat many of the health issues currently being treated by antipsychotic drugs.

Levinson said including diagnosis information as part of the prescription would make a big difference in helping to curb overuse, giving more background to each patient’s medical condition.
In a statement to Kohl, the American Health Care Association (AHCA) said it believes the overall increased use of antipsychotic medications in all care settings warrants review and is working with other professional associations and CMS to reduce the use of such drugs.

“AHCA has incorporated this effort as a significant part of our ongoing quality improvement and member education initiatives,” the association said.

AHCA noted, however, that the HHS OIG report released in May 2011 reveals that a majority of nursing home residents—86 percent--were not on antipsychotic drugs.

“Of the 14 percent of residents receiving such medications, OIG found 22 percent of related Medicare claims did not meet the medication administration standards outlined by [CMS], which is approximately 3 percent of such claims for all nursing home residents,” AHCA said.

These discrepancies are important, but what should not be overlooked is that OIG did not indicate such instances reflect any impropriety from a clinical or patient care perspective.

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