Breaking News: Inappropriate antipsychotics will now drop you to one star in QMs

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Good morning. CMS announced last week they would be introducing and utilizing offsite audits of SNFs to validate and scrutinize their inappropriate use of antipsychotics.

Here is what we need to know and how to respond, as operators.

Let's dive in.

Elevate your regulatory performance 

The press release can be found here.

Here is what you need to know.

• CMS will be using MDS data to perform offsite audits
• Audits will scrutinize improper diagnoses of schizophrenia
• Audits will investigate the inappropriate use of antipsychotics
• Results will be called out publicly on CMS nursing home compare
• Discrepencies could result in your QM star rating dropping to 1 star

What does this change?

Ultimately nothing.  The regulations and your practices shouldn't change.  What will change is how much focus your state agencies are putting forth to evaluate your process.  

If your process is sloppy and hasn't been looked at before, consider this your fair warning.

Steps you should take this week.

1. Call a QAPI meeting to discuss your process specifically.  Ensure your medical director and psych providers are present.
2. Before the QAPI meeting, have your DON and Medical Director complete a sample audit of schizophrenia diagnoses and antipsychotic use within your community. 
   • Are diagnoses accurate?
   • Are dignoses current?
   • Are GDR's occurring appropriately?
   • Is there supporting documentation for the need of antipsychotics?
   • Have non pharmacological interventions been tried and documented?
   • Does the MDS match the medical record?
3. Have your DON and medical director  present their findings as well as areas of opportunity and breakdowns in the process.
4. Review and ensure your current processes match your policy and preocedure.
5. If issues or areas of opportunity are present, use this opportunity to write your plan of correction and document it within your QAPI minutes.
6. Follow your internal correction plan, continue reporting the findings to QAPI, and pivot as needed based on those findings.

That's it.  Follow these steps now and save yourself a lot of anxiety and headaches in the future.

Partners We Love

Together With HealthDrive

HealthDrive has over 30 years of experience as the leading provider of on-site healthcare services in long-term care. With nearly 500 medical and dental professionals and one million patient encounters per year, HealthDrive is fulfilling its mission "to elevate health outcomes and improve the quality of life." HealthDrive offers a variety of Dental, Podiatry, Optometry, Audiology, and Mental Health services within their markets. Innovative technology, administrative and regulatory support, as well as reliability, are just a few of the things that drive HealthDrive's commitment and continued success.

Not only is HealthDrive a partner of NHA Stand-Up, but they're also a partner I have utilized in the communities I support for years. Their model, ability to execute consistently, and reliability are spectacular. If you're interested in learning more, visit their website here and reach out to Rachel Wells at rwells@healthdrive.com.

Grab your coffee and make it a great day.  We appreciate you and your dedication to your team and residents. -Thank you!