The Office of the Inspector General (OIG) updated its Work Plan in May 2020. One of the items added is a new report expected to be issued in FY 2021, “Monitoring Psychotropic Drug Use in Nursing Homes.” Despite the significant improvements by nursing homes, as evidenced by the continued achievements cited by the National Partnership to Improve Dementia Care, the OIG Work Plan states that The Centers for Medicare & Medicaid Services (CMS) and researchers are concerned that some nursing homes continue to underreport antipsychotic drug use in their facilities and that facilities may be inaccurately reporting certain diagnosis data so CMS monitoring will not be triggered. CMS, for instance, developed a “Late Adopter” program in 2018 to provide additional oversight and enhanced enforcement to nursing homes that still had high levels of antipsychotic use in their facilities. CMS Administrator Seema Verma noted when she announced the Agency’s Five-Part Plan for Ensuring Safety and Quality in America’s Nursing Homes that enhanced enforcement and oversight for facilities such as those who are late adopters would be a tenet of the Plan.
The OIG report is expected to determine two things:
- The extent of any inconsistencies (if any) in Medicare claims data for nursing home residents who are prescribed antipsychotic drugs when compared to nursing home’s self-reported data on these residents.
- The extent of any inconsistencies (if any) between Medicare claims data related to diagnoses that exclude nursing home residents from monitoring as part of the antipsychotic Quality Measure and nursing homes’ self-reported data on these residents.
The OIG has reported on antipsychotic use in nursing homes before, including when it identified trends in nursing home deficiencies about a year ago in 2019. In that report, the OIG found that Unnecessary Meds was the sixth-most frequently cited deficiency type for CY 2013- CY 2017. This area continues to be in the top most frequently cited deficiencies on survey in nursing homes, and tends to focus on the lack of appropriate rationale or adherence to PRN order limits. That fact and this upcoming report should serve as a reminder to providers that even though the major focus has been on COVID-19 in recent months, that as more states open and survey priorities change, these high-risk areas will still be tracked and reviewed.