Increased Reporting of Exclusionary Diagnoses Inflate Apparent Reductions in Long-Stay Antipsychotic Prescribing

ABSTRACT

Objective: Over the two years following the 2012 introduction of CMS’s National Partnership, combined rates of schizophrenia, Tourette’s, and Huntington’s in US long-stay residents increased 12%. We evaluated trends in reporting of these diagnoses for the subgroup of long-stay residents on antipsychotics.

Methods: Retrospective analysis of Virginia Medicaid claims identified annual utilization rates of psychiatric diagnoses for long-stay seniors on antipsychotics. Chi-square analysis compared rates for the year before March, 2012 with the same 12-month period 1 year later. A 5-year pre-existing baseline rate was also obtained.

Results: Diagnosis rates for 2011 were unchanged from baseline. Comparing 2011 with 2013, diagnoses rates for schizophrenia, Tourette’s, and Huntington’s combined increased 40% (p < .0001), primarily because schizophrenia reporting nearly doubled (p < .0001).

Conclusions: For long-stay seniors on antipsychotics, reporting of schizophrenia, Tourette’s, and Huntington’s began increasing in 2012 and at almost triple the rate CMS described for the general long-stay population. The increased reporting of these diagnoses described by CMS since 2012 appears to be new and concentrated in residents on antipsychotics

Clinical Implications: Since antipsychotics prescribed for schizophrenia, Tourette’s, and Huntington’s are excluded from quality-measure auditing, apparent reductions in inappropriate long-stay antipsychotic use since the National Partnership may be exaggerated.

KEYWORDS:

• Antipsychotics
• Centers for Medicare and Medicaid Services
• data interpretation
• health policy
• nursing home
• Medicaid
• statistical

Funding

Supported in part by Commonwealth of Virginia’s Alzheimer’s and Related Diseases Research Award Fund [Award 15-2], Virginia Center on Aging, School of Allied Health Professions, Virginia Commonwealth University.

Additional information

Funding

Supported in part by Commonwealth of Virginia’s Alzheimer’s and Related Diseases Research Award Fund [Award 15-2], Virginia Center on Aging, School of Allied Health Professions, Virginia Commonwealth University.