Senators Seek Answers from HHS on Efforts to Stop Potential Overuse of Anti-Psychotic Drugs among Dementia Patients

WASHINGTON –  U.S. Senators Tom Carper (D-Del.), Ranking Member of the Homeland Security and Governmental Affairs Committee, and Susan Collins (R-Maine), Chairman of the Special Committee on Aging, sent a letter Thursday seeking more information from the Department of Health and Human Services (HHS) on its efforts to address the potentially improper prescribing of antipsychotic medications to seniors with dementia, and the cost to taxpayers of paying for these prescriptions through Medicare Part D.

The bipartisan letter to Secretary Sylvia Mathews Burwell follows up on a recent Government Accountability Report (GAO) that found among elderly adults with dementia in 2012, nearly 30 percent living in nursing homes and nearly 14 percent living outside of nursing home care received potentially improper anti-psychotic medications to treat their symptoms. Most of the medications prescribed have specific warnings that they not be given to patients with dementia due to an increased risk of falls or death, and their use in treating symptoms of dementia has not been approved by the Federal Drug Administration (FDA). According to GAO, Medicare Part D spent $363 million on these anti-psychotic prescriptions for elderly adults with dementia in 2012.

“We are deeply troubled by these findings,” the senators wrote. “Caring for seniors who suffer from dementia is a difficult job – and a sacred one. We all want to know that our loved ones are receiving the quality of care and attention they deserve from the professionals to whom we entrust their care, and that their health and safety are not being put at risk because of poor oversight.”

The senators commended Secretary Burwell on the Department’s initiatives to combat the practice, specifically through the National Partnership to Improve Dementia Care in Nursing Homes. Through the National Partnership, the Centers for Medicare & Medicaid Services (CMS) are working with the relevant agencies and organizations to reduce antipsychotic use in this population by 30 percent by the end of 2016. Many states are already on the way to reaching this goal.

“But there is still more work to be done to address this urgent problem,” the senators continued.

Based on GAO’s recommendations, Senators Carper and Collins asked the Department to provide information on how the necessary reduction rates were determined; steps it is taking to address the risk factors that lead to these prescriptions; efforts by the government to explore alternative treatments for dementia; how the National Partnership’s actions will affect the nursing home rating system; and ways CMS can help ensure that seniors with dementia outside of nursing homes received appropriate prescriptions.  

The text of the letter follows below:

April 2, 2015

The Honorable Sylvia Mathews Burwell
Secretary
U.S. Department of Health and Human Services

Dear Secretary Burwell:

We are writing to obtain more information regarding efforts by the Department of Health and Human Services (HHS) to address the potentially improper prescribing of antipsychotic medications to seniors with dementia, and the cost to taxpayers of paying for these prescriptions through Medicare Part D.

In an effort to learn more about this critical issue, we requested that the Government Accountability Office (GAO) investigate the use of antipsychotic drugs to treat dementia in nursing homes, assisted living facilities and outside of nursing homes. The study, released by the GAO on March 2, 2015, found that nearly one-third of elderly nursing home residents with dementia received prescriptions of antipsychotic medications. Overall, including seniors with dementia living outside nursing homes, the total cost to taxpayers through Medicare Part D for these prescriptions was $363 million in 2012. As you know, the U.S. Food and Drug Administration (FDA) has not approved these medications to treat seniors with dementia, and warns that use of these medications among those seniors is associated with an increased risk of falls or death.

We are deeply troubled by these findings. Caring for seniors who suffer from dementia is a difficult job – and a sacred one. We all want to know that our loved ones are receiving the quality of care and attention they deserve from the professionals to whom we entrust their care, and that their health and safety are not being put at risk because of poor oversight.

However, we are encouraged by the efforts HHS has made to address this problem through the National Partnership to Improve Dementia Care in Nursing Homes. As you know, through the National Partnership, the Centers for Medicare & Medicaid Services (CMS) works with federal and state agencies, nursing homes, and others to provide outreach and education in order to reduce antipsychotic use by 30 percent by the end of 2016. These efforts have led to some success. For example, all 50 states showed some improvement between 2011 and 2014, and many states reduced their rates of medication use by more than 25 percent. These outcomes were achieved in many cases through investments in staff training and other measures to ensure proper care.

But there is still more work to be done to address this urgent problem. GAO recommends that HHS increase efforts to reduce prescriptions of these medications to the over 1.2 million seniors with dementia who live outside of nursing homes and to continue the progress that has been made in nursing homes.

In order to better evaluate this report and ensure that our seniors are receiving appropriate and effective care without being exposed to unnecessary or risky prescriptions, we request that the appropriate HHS officials provide a written response to the following questions:

• How were the reduction rates set by the National Partnership to Improve Dementia Care in Nursing Homes determined? Please describe any plans HHS has to work with states that have not yet achieved targeted reductions in prescription rates.

• The GAO report highlights certain risk factors associated with an increased likelihood that a nursing home patient with dementia will receive a prescription for antipsychotic medication.

• What steps has HHS taken to examine and address the risk factors determined to increase the likelihood of using antipsychotic prescriptions as treatment for dementia, as determined by the GAO report?

• In February, we were encouraged to see the CMS announce that it was adding two quality measures for antipsychotic medication use in nursing homes in a larger set of reforms to improve the Nursing Home Compare 5 Star Quality Rating System. How do you anticipate that actions taken by the National Partnership to Improve Dementia Care in Nursing Homes to mitigate the problem of overprescribing will impact CMS’s Nursing Home Compare rating system? How will the rate of prescription of antipsychotic drugs affect the nursing homes’ star rating? Are there any safeguards in place to ensure that beneficiaries will continue to receive appropriate care as actions are taken to mitigate overprescribing of these medications? Is HHS involved in any efforts to explore alternative or behavioral treatments available to treat dementia? Would these treatments be available for use for patients in and outside of nursing homes?

• Given the risk associated with these prescriptions, how can the CMS work with states, nursing homes, local communities, medical providers and individual caregivers to ensure that those beneficiaries living outside of nursing homes with dementia are receiving the appropriate type and amount of medications?