Life Science Compliance Update

March 02, 2018

CMS Releases Data on Antipsychotic Drugs Used in Nursing Homes


According to data from CMS, the percentage of long-term nursing home residents being given antipsychotic drugs dropped from about 24 percent in late 2011 to under 16 percent last year. CMS says the data show its National Partnership to Improve Dementia Care in Nursing Homes, created in 2012, has served its goal to reduce unnecessary antipsychotic medications in nursing homes.

The Partnership

CMS explains its National Partnership utilized a multidimensional approach which included public reporting, partnerships and state-based coalitions, research, training for providers and surveyors, and revised surveyor guidance to empower and build upon the efforts of organizations across the country. The initial focus of the partnership was on reducing antipsychotic medications. However, it eventually grew into a larger mission of enhancing the use of non-pharmacologic approaches and person-centered dementia care practices.The National Partnership to Improve Dementia Care announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction by the end of 2019 for long-stay residents in those homes with currently limited reduction rates.

Data Trends

CMS reports that between the end of 2011 and the end of quarter one of 2017, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 34.1 percent, decreasing from 23.9 percent to 15.7 percent nationwide. All 50 states showed improvement. Some states showed much more improvement than others. The states that have reduced their rate by the most percentage include the District of Columbia (47.8 percent), Tennessee (43.5 percent), California (43 percent), and Arkansas (41.6 percent).


As reported, there was mixed reaction to the news from CMS. Dr. Jerry Gurwitz, chief of geriatric medicine at the University of Massachusetts Medical School, is quoted as describing the decrease as “one of the most dramatic changes I’ve seen in my career.” Gurwitz suggests that some nursing homes might be finding other medications that sedate their patients into passivity without drawing the same level of scrutiny as antipsychotics.

Advocacy groups like the Washington-based Center for Medicare Advocacy and AARP Foundation Litigation say even the lower rate of antipsychotic usage is excessive, given federal warnings that elderly people with dementia face a higher risk of death when treated with such drugs.

“Given the dire consequences, it should be zero,” said attorney Kelly Bagby of the AARP foundation, which has engaged in several court cases challenging nursing home medication practices. Bagby contends that the drugs are frequently used for their sedative effect, not because they have any benefit to the recipients.

February 08, 2018

CMS Improper Payment Rate Dips Below 10%


In 2017, the improper payment rate for fee-for-service Medicare dropped to 9.5%, the first time since 2013 that figure has been below 10%. By comparison, the rate was 11% in 2016, and there was a $4.9 billion year-over-year decrease in estimated improper payments, according to a blog post by Kimberly Brandt, principal deputy administrator for operations at the Centers for Medicare & Medicaid Services.

Last year, CMS officials said the improper payment rate dropped from 12.1% in 2015 to 11% in 2016 chiefly because of the two-midnight rule, which set a new benchmark for impatient hospital claims. But in both of those years, it failed to reach the target of less than 10% established in the Improper Payments Elimination and Recovery Act of 2010. An independent audit released in May 2016 said the rate exceeded 12% in 2015 mainly because of a spike in improper payments for home health claims.

FY 2017 Medicare FFS Improper Payments (in Millions) and Percentage of Improper Payments by Monetary Loss and Type of Error


The above figure provides information on Medicare FFS improper payments that are a known “monetary loss” to the program (i.e. medical necessity, incorrect coding, and other errors). The estimated known “monetary loss” improper payment rate is 3.0 percent, representing an estimated known monetary loss of $11.3 billion out of the total estimated improper payments of $36.2 billion.  In the figure, “unknown” represents payments where there was no or insufficient documentation to support the payment as proper or a known monetary loss.

Improper Payments

Brandt notes that improper payments are not always indicative of fraud, nor do they necessarily represent expenses that should not have occurred. As an example, there are cases where there is no documentation to support the payment as proper and is cited as improper payments under the current OMB guidance. The blog post points out that the majority of Medicare FFS improper payments are due to documentation errors and CMS could not determine whether the billed items or serves were actually provided, were billed at the appropriate level, and/or were medically necessary. A smaller portion of these payments are for claims that CMS determined should not have been made or made in a different amount.

February 06, 2018

Tomorrow: CMS To Host Open Payments Webinar/Q&A


Tomorrow, February 7, 2018, the Centers for Medicare and Medicaid Services (CMS) will be hosting a Webinar and Question and Answer session with CMS Open Payments program experts from 2:00 pm to 3:00 pm EST. CMS has been hosting these every few months for stakeholders to get some of their important questions answered.

During this webinar/Q&A session, the Open Payments team will present an overview of system enhancements and data submission activities and will then be able to respond to your questions about the 2017 Open Payments program year.

If you have a question, you must go online and register at least fifteen minutes prior to the webinar here. Once you are registered, you will receive an email with instructions on how to join the call and ask a question.

If you do not have a question, but want to listen to the call to gain insightful information, you can dial in to (844) 396-8222 and enter meeting number 900 984 780 when prompted.


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