Association Reports A 22 Percent Reduction In Off-Label Antipsychotics Use
Bill Myers
8/11/2015
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.”