Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.
In 2012, CMS launched the National Partnership to Improve Dementia Care, which includes stakeholders from regulatory entities, providers, advocacy groups and professional organizations. The very important goal of the partnership is to promote adoption of practices that enhance the quality of life for long-term care residents while promoting goal directed, person centered care for each individual. One important strategy is to promote the use of non-pharmacological care and reduced antipsychotic medication use in long-stay nursing home residents. To support this effort, CMS announced in March 2019 their “initiative of enhanced enforcement for nursing homes that continued to show high rates of antipsychotic usage with little to no reduction in these rates since 2011. The goal was for these ‘late adopters’ to reduce antipsychotic utilization rates by 15% by the end of 2019” (Eyigor, 2020). This survey program is continuing in 2020.
Continuing as part of the National Partnership, providers will continue to see “focused surveys” in 2020, with a priority placed on schizophrenia-focused surveys with dementia-focused surveys also occurring—“these surveys are generally completed by a CMS contractor, though the state agency may also participate or conduct the survey. Similar to standard or complaint surveys, a focused survey will be unannounced, and a provider will receive a Statement of Deficiencies for which they may be required to submit a Plan of Correction. Surveys will examine the use of antipsychotic medications, appropriateness of schizophrenia diagnoses, and availability of appropriate care and services for residents diagnosed with dementia” (Eyigor, 2020).
These surveys are a burden for long-term care facilities, but the long-term achievements of the program are impressive. In 2019, CMS released their results, sharing that “In 2011Q4, 23.9 percent of long-stay nursing home residents were receiving an antipsychotic medication; since then there has been a decrease of 40.1 percent to a national prevalence of 14.3 percent in 2019Q2” (CMS, 2019). There is some indication of unintended consequences, “specifically higher rates of reported schizophrenia [than would be expected in this population]. That’s one of the excluded illnesses [for which anti-psychotic medication usage is approved], along with Tourette’s syndrome and Huntington’s disease” (Newman, 2016). Nevertheless, the survey effort is helping the Partnership achieving its goal of an overall reduction in unnecessary medication use.
This blog post continues a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:
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