Ask Proactive – My facility Long-Stay antipsychotic percentage increased on my 2026 Quality Measures. What are some best practices for reviewing Psychotropic medications?

Q:

My facility Long-Stay antipsychotic percentage increased on my 2026 Quality Measures. What are some best practices for reviewing Psychotropic medications?

 

A:

It is possible the increase in your QM percentage is not due to a true increase in antipsychotic medication use in your facility. An increase in this measure was anticipated in 2026 because CMS significantly changed how the long stay antipsychotic measure was calculated.

 

Beginning in January 2026, CMS replaced the prior long-stay antipsychotic Quality Measure with a respecified hybrid measure. The previous measure relied primarily on data from the MDS Section N and Section I and limited to a 7-day look back window.  The new hybrid measure incorporates data sources including Medicare Fee For Service claims, Medicaid claims, and Medicare Advantage encounter data in addition to MDS data. Therefore, information is now captured outside the MDS 7-day look back window.

 

This change does not only impact the percentage of antipsychotic medication use data, it may also impact the QM exclusions. CMS is now cross-checking claims data for diagnosis exclusions, Schizophrenia, Huntington’s, and Tourette’s. If MDS coding isn’t supported by diagnosis claims history, those residents that were previously excluded from this measure could now be included in the measure numerator.

 

Best Practices for Monitoring and Managing Psychotropic Medications:

• • Ensure each psychotropic medication order has a clearly documented diagnosis, clinical indication, and supporting rationale.
  • Review psychotropic medication use routinely on at least a weekly basis rather than waiting for a monthly review.
  • Involve the resident, his or her representative, and direct care staff in the medication management process to help identify underlying causes, possible triggers and non-pharmacological interventions.
  • Do not rely on the pharmacy for psychotropic dose reduction recommendations.
  • Track all psychotropic medications on a Gradual Dose Reduction log including:
    • last attempt at GDR,
    • outcome of the attempt
    • specific documentation if the GDR was unsuccessful. Documenting that the resident is stable on the medication is not sufficient.
  • Validate Quality Measure data is accurate:
    • Compare data sources: MDS, pharmacy claims, diagnosis exclusions, supporting physician or practitioner documentation and claims history.

 

 

 

Next Steps:

1. Register for the virtual training Navigating Psychotropics, Depression and Behaviors on May 6, 2026
2. Schedule a psychotropic drug review with Proactive to identify potential issues and implement corrective actions

 

 

 

 

Written By:

 

 

LeeAnne Lee, RN, BSN, LNHA

Clinical Consultant

Proactive LTC Consulting

 

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