The Centers for Medicare and Medicaid Services is working with health care providers and patient advocacy groups to reduce the improper use of antipsychotic drugs in nursing home residents 15% across the country by the end of this year.

The agency’s new initiative emphasizes enhanced training, education campaigns and public transparency efforts, including posting individual facilities’ utilization rates on a Medicare website that aids consumers in choosing nursing homes. It follows CMS’ recent decision not to go forward with a regulation to require consultant pharmacist independence as a means to help ensure appropriate prescribing.

The efforts reflect the agency’s long-running concern that antipsychotic overprescribing presents a serious health risk for nursing home residents and unnecessarily increases Medicare spending.

Joining CMS in a May 30 media call to unveil the education and training initiative, called the Partnership to Improve Dementia Care, were representatives of the American Health Care Association, a non-profit affiliation of state health organizations, LeadingAge, an association of non-profit advocates for the elderly and the Legal Aid Justice Center.

The agency did not provide details on whether specific facilities might be targeted for greater reductions based on high prescribing or other factors or how it might determine when a rate of prescribing is appropriate. CMS also did not say how much it will spend on the new programs.

In early April, the agency announced it would not move ahead with an earlier regulatory proposal requiring that consultant pharmacists maintain independence from long-term care facilities or drug firms and that the agency would rely instead on voluntary efforts by long-term care providers to halt overprescribing or improper prescribing in those facilities Also see "Nursing Home Overprescribing: CMS Urges Voluntary Remedies, Withholds Regulation" - Pink Sheet, 9 April, 2012.. CMS explained that although it believes change is needed, it was persuaded by stakeholder comments that the disruption caused by the independence requirement would outweigh the benefits produced. The agency is accepting comments on its decision until June 11.

In Congress, the Senate Special Committee on Aging has held hearings on the overprescribing issue but no legislation to address change has advanced very far. Most recently, members of the committee, including Chairman Herb Kohl, D-Wis., circulated an amendment to FDA user fee reauthorization legislation that would require CMS to set protocols for obtaining informed consent, or authorization, from patients or their designated health care agents, acknowledging possible risks and side effects associated with an antipsychotic, as well as alternative treatment options, before administering the drug for off-label use. The Senate, which passed the user fee package May 30, did not take up this amendment for a vote.

A recent CMS report on nursing home residents found that 39% of patients with signs of dementia, but no diagnosis of psychosis, received antipsychotic drugs at some point in 2010, according to the agency. CMS data from 2010 also showed that more than 17% of nursing home patients had daily doses exceeding recommended levels.

The partnership will aim to reduce improper use of antipsychotics through distribution of a worker training series for nursing homes that emphasizes “person-centered care, prevention of abuse, and high-quality care for residents,” the agency said. CMS also is providing training focused on behavioral health to state and federal surveyors. In its materials, CMS emphasizes non-pharmacological alternatives for nursing home residents, including potential approaches such as consistent staff assignments, increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.

In addition, CMS will make data on each nursing home’s antipsychotic drug use available on its Medicare “Nursing Home Compare” website starting in July. The website is designed to help patients and their caregivers choose an appropriate nursing home.

Use of antipsychotics in nursing homes will be tracked through Medicare claims data and the rate of use at the end of this year will be compared to the 2011 fourth quarter, CMS Deputy Chief Medical Officer Shari Ling said during the call. CMS also is planning a study in 20 to 25 nursing homes to “better understand the decision to use or not to use antipsychotic drugs in residents with dementia,” the agency said. Findings will help target and implement approaches to improve the overall management of residents with dementia, including reducing the use of antipsychotics.

CMS Plan To Reduce Antipsychotic Use In Nursing Homes By 15% Plays Up Non-Regulatory Approaches

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