Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
“(OIG) found that the Centers for Medicare and Medicaid’s (CMS’s) use of the Minimum Data Set (MDS) as the sole data source to count the number of nursing home residents using antipsychotic drugs may not always provide complete information. By analyzing a separate data source—Medicare claims—(OIG) found that using the MDS did not always result in a complete assessment of the number of residents who are prescribed antipsychotic drugs. Specifically, in 2018, 12,091 Part D beneficiaries who were long-stay residents aged 65 and older—5 percent of all such beneficiaries—had a Part D claim for an antipsychotic drug but were not reported in the MDS as receiving an antipsychotic drug. Even for those residents included in the MDS counts, the MDS does not provide important details about the drug use (e.g., which antipsychotic drugs were prescribed; at what quantities and strengths; and for what durations).
These analyses are not comparable to the CMS quality measure. Further, (OIG) determined the extent to which there were inconsistencies between residents’ MDS-reported diagnoses of schizophrenia, Huntington’s disease, or Tourette’s syndrome-three diagnoses that exclude residents from CMS’s quality measure regarding antipsychotics-and these residents’ Medicare claims in 2017 and 2018 for each respective diagnosis.
These findings suggest that CMS could enhance the information it uses to monitor antipsychotics in nursing homes by using additional data sources in its measurement of this complex issue that is critical for resident health and safety.
So that CMS can enhance the information it uses to monitor antipsychotic drugs in nursing homes, (OIG) recommend that CMS (1) take additional steps to validate the information reported in MDS assessments and (2) supplement the data it uses to monitor the use of antipsychotic drugs in nursing homes. CMS concurred with both recommendations.”
Appendix B of the complete report provides the full text of CMS’ comments.
The following are 2 graphics found in the OIG report:
Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare