Some nursing homes are adding inappropriate diagnoses of schizophrenia to patient charts to mask their misuse of antipsychotic drugs and inflate their CMS ratings, an Office of Inspector General report found.
The report, published March 19, is based on a review of 40 nursing home inspections completed by CMS.
A nursing home resident who is given antipsychotic drugs is not counted toward the facility’s CMS quality measure if they have a diagnosis of schizophrenia, the report noted. Antipsychotic drugs are not approved by the FDA to treat dementia and come with a boxed warning for such patients due to the increased risk of falls, strokes and death, but physicians can prescribe them off-label, and caregivers can in turn administer them if patients become violent.
“We found that nursing homes inappropriately diagnosed schizophrenia to mask their misuse of antipsychotic drugs, artificially inflate their star rating, and skirt established safeguards meant to protect residents,” the OIG report said. “As a result, nursing homes compromised residents’ care.”
Here are five things to know:
1. In a companion report by the OIG, inspectors found several cases of nursing homes using antipsychotics without first trying non-pharmacological interventions. Some nursing home staff admitted to using antipsychotic drugs on patients who did not exhibit dangerous or distressing behaviors to lighten their workload.
2. Some facilities developed protocols in an “orchestrated effort” to add inappropriate schizophrenia diagnoses to the records of patients who were given antipsychotics. Staff received EHR alerts identifying residents given the drugs who lacked a diagnosis, prompting nurses to add it. In other cases, staff printed out lists of residents and had clinicians add the diagnosis.
“On a single day at one nursing home, a nurse practitioner added schizophrenia diagnoses to the records of dozens of residents given antipsychotic drugs,” the report said.
3. Families of patients were often not informed when a facility made a schizophrenia diagnosis.
4. The report admonished the facilities’ medical directors, saying they violated professional standards by not following protocols and signing off on diagnoses without evaluating patients or reviewing medical records.
5. The American Health Care Association, a Washington-based lobbying group for nursing homes, criticized the findings in a statement to The Washington Post.
“These OIG reports are based on a very small subset of specifically selected nursing homes and are not indicative of national trends,” Holly Harmon, AHCA’s senior vice president of quality, regulatory and clinical services, told the Post. “Antipsychotic medications are sometimes deemed necessary and beneficial to certain residents based on their clinical condition and shared decision-making with the resident and their medical provider. We support the appropriate use of medications to meet individual resident needs, with the right medications at the right times.”
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