Explore key tips to accurately track antipsychotic use in short-stay residents and prepare for upcoming CMS survey changes in 2025.
Short stay quality measures are essential benchmarks for skilled nursing facilities (SNFs) to ensure high-quality, resident-centered care. In our "Quality Measure Drill Down" series, we analyze MDS coding accuracy and clinical practices that impact a facility's Quality Measure star rating.
Last month in Ask Amanda, we discussed Discharge Function Scores. For further understanding, readers should review the previous article, where we simplified the measure into a 5-step process highlighting crucial practices for optimal resident outcomes.
We are focusing on the percentage of short-stay residents with new orders for antipsychotic medication. This measure reports those receiving antipsychotics during the target period but not on initial assessment. CMS has announced changes to long-term care surveyor guidance effective April 28, 2025. Psychotropic medications will face increased scrutiny under federal regulation F605-Abuse.
Approved exclusions include diagnoses of schizophrenia, Tourette’s syndrome, and Huntington’s disease. Diagnoses coded on the MDS must meet RAI criteria, including physician documentation within the past 60 days and evidence of the diagnosis being active during the 7-day look-back period (e.g., affecting function, behavior, mood, or requiring treatment/monitoring). Facilities should ensure schizophrenia diagnoses are supported by comprehensive clinical documentation, including mental health evaluations and evidence of persistent behaviors prior to medication initiation, especially to withstand surveyor scrutiny under F605.
To review this measure appropriately:
- Ensure the correct coding of the antipsychotic medication on the MDS target assessment by checking the Medication Administration Record (MAR) for the look-back period of the target assessment.
- Confirm the medication was not received during the look-back period of the initial assessment by also reviewing the MAR.
- Ensure accurate coding of exclusion criteria.
- Determine why the medication was initiated after admission to the facility and if there is an appropriate diagnosis.
- Verify proper interventions have been started for the use of the medication such as:
- Least restrictive interventions were attempted and failed before using the antipsychotic medication.
- Gradual dose reduction (GDR) within the first year a resident is admitted on antipsychotic medication or after the facility initiated the medication, and annually unless the physician documents contraindications.
- The facility must attempt a GDR in two separate quarters (with at least one month between attempts) unless the physician documents contraindications.
- Consider non-pharmacological interventions.
- Monitor and address adverse consequences and behavioral symptoms in the medical record.
- Ensure psychological, psychiatric, or other mental health services are provided as needed.
A Resident-Level Quality Measure report, available on IQIES, is a useful monitoring tool to identify residents triggering a particular quality measure. You can use the listed tools to accurately review the triggered quality measures for each identified resident.
Next month's "Quality Measure Drill Down" series will cover the final short stay measure—the percentage of residents with new or worsened pressure ulcers/injuries.
As the post-acute care landscape evolves, we encourage your questions, concerns, and insights. Our goal is to collaborate in finding solutions to support you, your facility, and your residents in achieving optimal outcomes. Your question may be featured in an upcoming article.
Ask Amanda A Question using this link!
