ALTERNATIVES TO OVERUSE OF ANTIPSYCHOTICS IN NURSING HOMES FOCUS OF SENATE HEARING

December 6, 2011

U.S. Senator Herb Kohl, Chairman of the Special Committee on Aging, held a hearing examining the widespread inappropriate use of antipsychotics among nursing home residents suffering from dementia, high costs to taxpayers and the efforts to find safe and effective alternatives.

“When properly prescribed, antipsychotics can offer beneficial treatment for individuals suffering from mental illness,” Kohl said. “However, we have a responsibility to patients and their families to ensure that elderly nursing home residents are free from all types of unnecessary drugs, and we have a responsibility to taxpayers to be certain that they are not paying for drugs that are not needed.”

The hearing highlighted two recent investigations by the Department of Health and Human Services Office of Inspector General (HHS OIG) that looked at the prevalent use of atypical antipsychotics in the face of a Food and Drug Administration (FDA) “black box” warning and the high costs to taxpayers.

In examining medical records over a six-month period, Daniel Levinson, Inspector General of the Department of Health and Human Services, testified that 14 percent of all nursing home residents, or nearly 305,000 patients, had Medicare claims for atypical antipsychotic drugs and that half of these claims should not have been paid for by Medicare because the drugs were not used for medically accepted indications. He said that for one in five drug claims, nursing homes dispensed these drugs in a way that violated the government's standards for their reimbursement.

“These findings indicate that Medicare is paying for drugs that it should not and Part D prescription drug plans are not able to adequately prevent inappropriate payments for drugs, including antipsychotics, for uses that do not meet coverage requirements,” Levinson said. “In addition, nursing homes often fail to comply with regulations designed to prevent overmedication of these powerful and at times dangerous drugs.”

Over the six-month study period, Levinson said that claims totaling almost $116 million did not meet Medicare coverage requirements for medically accepted indications. He recommended that the Centers for Medicare and Medicaid Services (CMS) should consider enhancing claims data to ensure accurate coverage and reimbursement determinations, hold nursing homes accountable for unnecessary drug use through the survey and certification process, and explore other options, such as incentive programs and provider education, to promote compliance with quality and safety standards.

The hearing also included testimony from CMS Chief Medical Officer Dr. Patrick Conway, and four dementia experts who highlighted the problem and urged improved training, enforcement and support.

“Very few people working in health care, including physicians, receive any training in understanding and responding to challenging behaviors by any means other than medication,” said Dr. Jonathan Evans, incoming president of the American Medical Directors Association. “In fact, few physicians practicing in this country today received any meaningful training in nursing homes and other long-term care settings during medical school or residency training.”

Kohl said he would continue working with colleagues on the committee, and Sen. Charles Grassley, who spoke at the hearing, to make significant progress in improving the quality of dementia care provided in nursing homes and in all other long-term care settings.