Nursing home oversight gets a boost with CMS proposal

At the White House Conference on Aging, the Centers for Medicare and Medicaid (CMS) proposed new rules to improve the care of approximately 1.5 million elderly who reside in more than 15,000 long-term care (LTC) facilities nationwide.

The proposal aims to reduce unnecessary hospital readmissions and infections, improve quality care, and strengthen safety measures for these Medicare and Medicaid beneficiaries, according to statement from the Department of Health and Human Services (HHS).

Psychiatric pharmacist helps to optimize patient care

The proposed rule, which was released on July 13, is a major overhaul of nursing home care and is expected to cost the industry approximately $729 million in the first year and $638 million in the second year.

“We’re proposing some new guidelines to improve high quality care in long-term care facilities across the country,” wrote HHS Secretary Sylvia Mathews Burwell in a recent HHS blog post. “There are 15,000 facilities across the country that we will reach with these new measures, which means many more Americans will get higher quality care, and many nurse aides will be able to access new training on handling dementia patients and preventing elder abuse.”

Pharmacist services

The proposal includes a requirement that a pharmacist review a LTC resident’s medical chart at least every 6 months, at the time the resident is new to the facility, when a prior resident returns or is transferred from a hospital or other facility, and during each monthly drug regimen review when a psychotropic drug or antibiotic is prescribed.

The pharmacist must document in a written report any irregularities during the drug review and share this information with the attending physician and the facility’s medical director and nursing director. The attending doctor must document the review of the identified irregularity in the resident’s medical chart.

“If there is to be no change in the medication, the attending physician should document his or her rationale in the resident’s medical record,” the proposal noted.

In addition, CMS wants to limit the use of psychotropic drugs. If a resident is not using psychotropic medicine, that resident should not be given psychotropic drugs unless it is medically necessary. CMS also wants residents who are using these drugs to receive gradual dose reductions and behavioral intervention, eventually eliminating the need for these medications.

Psychotropic drugs prescribed as PRN-as needed-should be limited to 48 hours, according to the CMS proposal. “Orders could not be continued beyond that time unless the primary care provider reviewed the need for medication prior to renewal of the order, and documented the rationale for the order in the resident’s clinical record,” CMS noted.

For more information, download the proposed rule.