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⭒ New Developments

Federal Antipsychotic Quality Measure is Unreliable

recent report from the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services concludes that antipsychotic drug data used by the Centers for Medicare and Medicaid Services (CMS) is inaccurate, hampered by fraud, and gives a misleading impression of chemical restraint use in nursing homes.

Since 2012, CMS has used data that is self-reported by nursing homes to compile an antipsychotic drug “quality measure.” The idea of the quality measure is to report the percentage of residents receiving an antipsychotic drug at least once a week, excluding “appropriate” drug uses, which includes treating schizophrenia, Huntington’s disease, and Tourette’s syndrome. The self-reported data purports to show that inappropriate antipsychotic use has declined by 41% since 2011. 

The OIG report criticizes CMS for relying exclusively on facility self-reported data. Facilities often misreport data, either by error or for their own self-interest, i.e., to make themselves look good. OIG cross-checked self-reported facility data with residents’ Medicare prescription drug claims and found two significant accuracy problems. The first accuracy problem is that many residents (over 12,000!) received an antipsychotic drug according to their Medicare claims but the facility did not report the drug use to CMS. The second accuracy problem is that many residents (over 29,000!) were reported to have schizophrenia but their Medicare claims indicated they did not. In other words, nursing homes are hiding their antipsychotic drug use by making up phony schizophrenia diagnoses. Much of the concerns about CMS’s antipsychotic quality measure was previously covered by CANHR.

The recommendations made by the OIG were sensible: CMS should obtain more data about antipsychotic use, like drug brand, dosage, and duration of use, to get a more complete picture of antipsychotics in nursing homes. The OIG also recommended CMS supplement facilities’ self-reported data with data from other sources, such as the Medicare claims data.

CMS’s response to the OIG findings were tone deaf. While acknowledging the wisdom of improving the accuracy of the data, CMS touted the same unreliable data to brag about the reduction in nursing home antipsychotic drug rates. When it comes to reducing antipsychotic drug use in nursing homes, CMS is trumpeting success that it knows has not really been achieved. Despite all of CMS’s self-reported efforts, 20% of all nursing home residents still receive an antipsychotic drug and the vast majority of those residents are receiving them inappropriately.