Q:
I heard a rumor that the antipsychotic QMs are about to go through a complete change. Is this true?
A:
Not entirely – but there is an important change on the horizon. In a recent memorandum, CMS announced a significant update to the long-stay antipsychotic measure. Currently, this measure is calculated solely from MDS data. However, beginning October 29, CMS will begin supplementing MDS data with Medicare and Medicaid claims data, as well as Medicare Advantage encounter data. This change aims to better capture underreported antipsychotic use and reduce inappropriate exclusions due to overreported schizophrenia diagnosis on the MDS. These additional data sources will help identify antipsychotic prescriptions that fall outside of the MDS’s 7-day look-back period.
Facilities should continue to monitor their antipsychotic management programs for effectiveness and ensure that Gradual Dose Reduction (GDR) processes are consistently followed. Proactive, intentional monitoring-along with strong advocacy for at-risk residents-is key to preventing unnecessary antipsychotic use. Always ensure that non-pharmacological interventions are fully explored and documented before initiating antipsychotic medications.
Next Steps:
Join Proactive’s Driving QMs Through Clinical Excellence training series for key insights into improving and sustaining Quality Measures.
Written By:
Chris Calo
Clinical Consultant
Proactive LTC Consulting
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