Per CMS, Nursing Homes: Misdiagnosis and Coding of Schizophrenia
FROM CENTERS FOR MEDICARE AND MEDICAID SERVICES:
The Centers for Medicare and Medicaid Services (CMS) are responsible for the oversight and health and safety of nursing home residents. Over the past decade, through the work of the National Partnership to Improve Dementia Care, CMS has been monitoring antipsychotic medication use in nursing homes. Though steps have been taken to reduce the use of these drugs, there continue to be concerns that nursing home residents may be inappropriately prescribed antipsychotic medications due to being erroneously diagnosed and coded as having schizophrenia; see the Office of Inspector General report for more information. Antipsychotic medications are dangerous among the vulnerable nursing home population because of their potential side effects, including death.
To increase our focus on this issue, CMS recently announced they will be conducting off-site nursing home audits¹ to assess the accuracy of resident assessments (collected through the Minimum Data Set (MDS)). Specifically, to determine whether or not the facility is appropriately assessing, diagnosing, and coding schizophrenia in the MDS for residents in their facility. These efforts are aligned with the latest actions under The White House Fact Sheet: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Home.
If the audit reveals a pattern of inaccurate coding, this practice will negatively impact a facility’s Five-Star Quality Rating System on Nursing Home Care Compare.
It is rare for individuals older than 40 years of age to be diagnosed with schizophrenia². Nursing homes should work with their psychiatric providers and medical directors to ensure the appropriate professional standards and processes are being implemented related to diagnosing individuals with schizophrenia.
Note: In addition to CMS’ actions, we believe that some of these instances may represent actions that are inconsistent with the expectations of the board of licensure. As such, if there are instances where a practitioner has not followed professionals’ standards of practice for diagnosing individuals and prescribing medications, we believe these practitioners should be referred to their respective state medical boards for investigation.
For questions and to obtain more information, please contact [email protected].
Click HERE to read the official alert from CMS.
¹ Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute
² National Alliance on Mental Illness (NAMI). “Schizophrenia.” Accessed March 2, 2021. https://www.nami.org/Learn-More/Mental-HealthConditions/Schizophrenia