Understanding How CMS Will Track Antipsychotic Use In Nursing Homes - Part I

We unpack how CMS will monitor antipsychotic use in nursing homes, why the national average is changing, and what datasets will be cross-checked to produce public quality measures. We set the stage for part two, where we dig into practical steps to strengthen documentation, data integrity, and care processes.

• OIG findings and the CMS refocus 
• reasons for increased oversight and risk signals 
• how MDS and claims will be cross-referenced 
• shift in national average to 16.98% 
• implications for star ratings and care compare 
• focus on accurate capture, verification, and data integrity 
• preview of nuts-and-bolts actions in part two

Please feel free to reach out to Verity Consulting at Verity Team.com if you'd like further assistance with your healthcare compliance needs

Chapters

• 0:00 Disclaimers And Host Introduction
• 0:56 Setting Up The Two-Part Series
• 1:34 OIG Report And CMS Response
• 2:17 Why Antipsychotic Use Is Under Scrutiny
• 2:58 How CMS Will Measure The Data
• 3:41 New National Average And Star Ratings
• 4:39 Next Steps And Part Two Preview
• 6:02 Closing And Contact Information

Transcript

SPEAKER_00: 0:18

The views or opinions expressed in his podcast are for informational purposes only, not intended as legal or professional advice, and may not represent those of Verity Consulting. Although we make strong efforts to make sure our information is current, at the time the podcast episode was recorded, Verity Consulting cannot guarantee that all information in this podcast is always complete. All information in this podcast is subject to change without further notice.

SPEAKER_01: 0:46

Hello, I will be your host. My name is Deanna Fi. I am a registered nurse and healthcare analyst. Let's get started. Welcome to Vital Compliance Insights. Today, this topic will be part one of a two-part segment. Part one is going to talk about the CMS Centers for Medicare, Medicaid Services, quality measure related to antipsychotic medication administration. So I'm going to talk about just a background, an overview of that. And then part two, I'll dedicate to talking about what are we going to do now? What can a facility do now? Now that we are looking at data just a little bit differently. So with that said, let me get started. By way of background, okay, I think it's important to know back in May 2021, the Office of Inspector General OIG had uh put together a report, and I'll upload that to the Verity Team website blog. And that report was titled CMS Could Improve the Data It Uses to Monitor Antipsychotic Drugs in Nursing Homes. Okay, so the CMS did respond, and I'll upload the memorandum that really resulted in what's going to happen now. The CMS memorandum is 23-05, so I'll upload that to the Verity Team website blog. The CMS said we're going to look a little bit more closely at the use of the administration of antipsychotic medications, that whole drug class. Okay. Why? Well, there has been historically overuse, and there have been fortunately some not so good outcomes. Now, I am a registered nurse by background. I have a background as a federal health care surveyor. I've also conducted, and I still do, corporate integrity agreement monitoring, where I've looked at the very issues and I have I have observed and found evidence of some of these overuse issues and unfortunate outcomes. So what's happening now is the the CMS has indicated, look, we're really going to focus on quality, this quality measure to capture this data on administration of antipsychotic medications. It's really important to know that the data has been pulled from the MDS. Now that's not new, okay, but there's a few things that are a little more been tweaked. So just know at the end of January 2026, we'll be seeing some data come out on the quality measures for long and short-stay resident populations administered antipsychotic medications. Now, I'll get into more detail on this, but the data period that we'll see reported the end of January will be from July to September of 2025. So that poll from whatever the MDSs say happened in that period. Also, the CMS is looking at Medicare and Medicaid claims for any antipsychotic medication that's been ordered. And they're looking at the entire stay for this resident in the nursing home. So this data is going to be analyzed. There's going to be cross-referencing to see what's been ordered and importantly, what's been given. And what's been given will result in a quality measure. Now, previously, the national average for administration of antipsychotic medications was 14.64%. That's on a national level. But now that's going to be adjusted up to 16.98% national average. So we do know there's going to be a lot of facilities saying, oh my gosh, you know, this is going to make our quality measures indicate maybe some our CMS care compare is going to have lower star ratings and all those things. But I think first things first, let's just make sure we are capturing things correctly and accurately. And in part two, what I'll do is I'll talk a little bit more in detail about some of the nuts and bolts. So I don't think it's the end of the world. I think there's going to be some challenges, but I think if uh facilities can just really have their arms wrapped around this whole matter, good data collection, good data verification processes for data integrity, and to be able to articulate. So with that said, I'm going to wrap up and we'll get ready to walk through some of the antipsychotic issues that are going to result in use and administration. So we'll talk about that. Thank you for listening and stay tuned for the next episode, part two. Thank you for listening. Your time is appreciated. We hope you enjoyed this episode of Vital Compliance Insights and found this to be informative. Please feel free to reach out to Verity Consulting at Verity Team.com if you'd like further assistance with your healthcare compliance needs. Stay tuned for the next episode.