Biden administration to target use of antipsychotics in nursing homes

The Biden administration is planning a crackdown to reduce the inappropriate use of antipsychotic medications in nursing homes and the misdiagnosis of schizophrenia in patients, the Centers for Medicare and Medicaid Services (CMS) announced Wednesday.

Beginning this month, CMS will conduct targeted audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis, the agency said.

The initiative is part of a larger administration effort to improve the safety and quality of nursing home care, ensure adequate staffing levels and hold nursing homes accountable if they provide unsafe care.

There has been growing evidence from nursing home safety advocates that facilities inappropriately diagnose patients and overprescribe antipsychotic drugs as a way to sedate patients. 

“We have made significant progress in decreasing the inappropriate use of antipsychotic medications in nursing homes, but more needs to be done,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medications.”

Nursing home residents erroneously diagnosed with schizophrenia are at risk of poor care and prescribed inappropriate antipsychotic medications, CMS said. Antipsychotic medications are especially dangerous among the nursing home population due to their potential devastating side effects, including death.

The use of antipsychotic medications among nursing home residents is an indicator of nursing home quality and used in a nursing home’s Five-Star rating. But the rating excludes residents with schizophrenia, which gives an incentive to code residents as having the disease when they do not. 

“No nursing home resident should be improperly diagnosed with schizophrenia or given an inappropriate antipsychotic. The steps we are taking today will help prevent these errors and give families peace of mind,” Health and Human Services (HHS) Secretary Xavier Becerra said in a statement.

The federal government has been working to try to reduce the use of powerful antipsychotic medications — a type of psychotropic drug — among nursing home patients. 

A government watchdog report issued in November found about 80 percent of Medicare’s long-stay nursing home residents were prescribed a psychotropic drug from 2011 through 2019.

But despite efforts to reduce the use of antipsychotic medicines, the prescribing of another type of psychotropic drug — anti-seizure drugs — increased, likely in an effort to reduce regulatory scrutiny, the report from the HHS Office of Inspector General found. 

In addition, the report found the number of residents reported as having schizophrenia and those without a corresponding diagnosis increased 194 percent from 2015 to 2019, and was concentrated in relatively few nursing homes. 

In 2019, the unsupported reporting of schizophrenia was concentrated in 99 nursing homes in the country, which reported that 20 percent or more of their residents have the disorder.

The rating scores for nursing homes that have a pattern of inaccurately coding residents as having schizophrenia will be negatively impacted, CMS said.