Members of the National Union urged the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to revisit what was deemed a flawed measure of the CMS' five-star rating system, saying it caused “unintended consequences” for nursing home residents and their families.
Project pause in Wednesday's letter The quality measurement of long-term antipsychotic drugs detailed that SNF residents, particularly access to appropriate and evidence-based care for neuropsychiatric symptoms (NPs) associated with neurocognitive impairment.
The letter was addressed to HHS Director Robert F. Kennedy Jr. and newly appointed CMS administrator Mehmet Oz.
“We are opposed to the intended but misdirected measures that together with one voice, patients, healthcare providers, caregivers and advocates, misinterpret how drug therapy is being used and ultimately risk access to good care for patients,” Chad Wars, CEO of the American Association of Consultants, said in a statement sent by McKnight's Long-Term Care News. “This letter is added to the growing chorus that includes members of Congress and HHS OIG, encouraging CMS to revise courses and ensure quality measures are meaningful and lead to better access to the care they actually need.”
Group – Members include organizations that regularly advocate for long-term care providers and residents, including the voices of Leadingage, Aliance for Aging Research, American Association of Activity Care Nursing, Caregiver Action Network, and Alzheimer's.
They hope that when measurements are removed and stacked up with other measurements in the CMS STAR rating system, they will accused them of “interfering with clinically meaningless treatments and having “oversized effects.”
Exchange suggestions
The group listed several ideas in a letter to eliminate or replace this measure, such as “restricting the use of inappropriate and unnecessary antipsychotics, but not limiting medically necessary treatments,” in order for CMS to enact a proven policy.
Overhauling the measure is not outside the jurisdiction of the CMS, Pause said.
“The CMS believes that if the CMS is against the patient's outcome or is not in line with clinical best practices, a clear regulator has previously revised, stopped or retired certain quality measurements before, and therefore a clear regulator has a clear regulator to eliminate this quality measurement,” the group said.
The coalition added that revisions can also be made via promulgated methods such as clinical standards and quality “QSO” memos to directors of state research agencies and quality “QSO” memos and five-star quality assessment system for nursing homes in designing care: Technical User Guide.
Extending the minimum dataset was another solution that the group proposed to roll back measures. This requires additional data to ensure that surveyors are clinically undocumented, allowing them to properly identify all prescriptions and all prescription antipsychotics.
And starting next year, they have recommended that the MDS antipsychotics review section be changed.
New category: “Documented use of clinically appropriate drugs and doses.” Here, nursing homes will explain why gradual dose reductions have not been attempted. Also, for physicians and pharmacists, if gradual dose reductions are not attempted, “the requirement that progressive dose reductions must be independently documented that either progressive dose reductions are clinically contraindicated or that drug and dose use is clinically appropriate.
Negative rating
In the letter, the group has educated federal officials on the myriad negative effects that arose from the measures, including the decline in facilities faced by facilities facing a schizophrenia coding audit enacted by the Biden administration in 2023.
The decline in ratings could have an unfair impact on beneficiaries and their families when examining how safe local nursing homes are, they said.
In fact, the letter revealed that the overall rating of the average facility fell from 5 stars to 3 after a coding audit for schizophrenia. When analysing long-term stay measures, the average nursing home rating fell from 3 stars to 1 star (6 months).
