In January, the Office of Inspector General accused nursing homes of cheating Medicare on reimbursement classifications.
Then in March it published some downright scary findings about the number of convicted criminals employed by SNFs—92 percent employ a convict!
Most recently, this May OIG report says skilled nursing facilities are improperly prescribing and billing for psychotropic medications.
So, by OIG's version of reality, nursing homes are full of crooks, swindlers and negligent killers. We can only imagine how this fuels mistrust among wary individuals who typically know little else about skilled nursing care until they need to seek a facility for a loved one.
The most recent OIG report reflects the typical fearmongering and false or absent context.
The report finds that 14% of elderly nursing home patients made had Medicare claims for atypical antipsychotic medications. Scary? Well, the vast majority of 86% aren't on the meds. And without additional context, that number alone neither alarms nor comforts—who's to say if that's too many?
Aha! It's too many because 83% of those prescriptions were off-label (prescribed by a doctor for use other than the approved use). In this case, many prescriptions were for agitation in dementia patients, a difficult symptom to manage, and one that there is no specific drug approved to treat.
This is where OIG really wrenched up the panic.
“Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, inspector general of the Department of Health and Human Services, in announcing the audit results. He further cited how more than half of these "potentially lethal" (aren't they all potentially?) antipsychotic drugs were not supposed to be covered under Medicare.
Dr. David Gifford, AHCA's senior vice president of quality and regulatory affairs, explains why off-label prescribing isn't such a bad thing. And in one of the best responses to this report, Dr. Daniel Carlat soberly and rationally defends the practice of prescribing antipsychotic medications to ease the suffering and improve the quality of life for elderly dementia patients. Does it create tough choices related to patient care and mortality? Of course. Have there been faulty practices in manipulating prescription patterns by pharmaceutical companies? Even Dr. Carlat concedes the point, but firmly stands up to Levinson on this OIG report:
"In this particular case, the Office of the Inspector General has it wrong, and Levinson's statements on behalf of Health and Human Services reflect an astonishingly poor understanding of the workings of medical care in general and psychiatric care in particular."
For me, this latest OIG report reinforces a frustrating pattern of accusation and confrontation that diminishes the agency's stated mission of "protect(ing) the integrity of Department of Health & Human Services (HHS) programs as well as the health and welfare of program beneficiaries." We've said it before here—it's a tough enough business running a nursing home as it is. Even in its role as the watchdog arm of HHS, we think the OIG could serve everyone, right down to the patients needing compassionate care, by reporting findings objectively, toning down the combative outrage, and working with the dedicated professionals in post-acute care to find solutions together.
