In an April 11, 2014 S&C Letter, “Interim report on the CMS National Partnership to Improve Dementia Care in Nursing Homes: Q4 2011 – Q1 2014” (Ref: S&C 14-19-NH), CMS summarizes its initiative to reduce the off-label use of antipsychotic medications in nursing homes. An OIG report in 2011 spurred this initiative when it found that 83% of nursing home residents on antipsychotic medications did not have diagnoses that warranted the use of such medications. Since then, CMS has been working to collaborate with the States and various agencies to encourage nursing homes to reduce their atypical antipsychotic use.
This interim report on the National Partnership to Improve Dementia Care shows positive strides being made in nursing homes across the country. Most importantly, in an 18 month time period, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1%. Every CMS region showed improvement in this area. CMS has also been reviewing citations at F-329, and while this tag includes all drugs, not just antipsychotic drugs, there has also been a decrease in the number of F-329 citations at actual harm levels. In 2009, 1.91% of the F-329 citations were at a G or higher, and that percentage was down to .93% in 2013, which is a total of slightly more than 85,000 citations. Another area where CMS has seen success is in using Quality Assurance and Performance Improvement (QAPI) principles within the Partnership. It found that many nursing homes have selected gradual dose reductions as their Performance Improvement Projects (PIPs) and have seen positive results.
Since the national goal of 15% has been achieved for long-stay prevalence of antipsychotic drug use, CMS will be selecting a new goal as one of its next steps. Additionally, CMS will be evaluating whether Dementia Care Practices should be separated out from the surveyor guidance at F-309 and/or separate out antipsychotic drug use from F-329. The Agency had issued updated dementia care guidance in May 2013.