On January 18, 2023, CMS issued a Quality, Safety & Oversight Group memorandum announcing its initiative to improve nursing home safety and transparency. Specifically, CMS will conduct audits to determine whether nursing homes are appropriately diagnosing and coding patients for schizophrenia, and based on the audit findings, CMS will adjust the quality measure star ratings if inaccurate coding is discovered. Additionally, CMS will post all citations that a nursing home receives on the Nursing Home Care Compare website to provide consumers with transparency. In a pilot audit of nursing homes conducted earlier this year, CMS found several issues related to inaccurate coding and diagnosis of residents with schizophrenia, including a lack of comprehensive psychiatric evaluations and misdiagnosis based on conditions or behaviors related to dementia, rather than schizophrenia. Accordingly, CMS will launch off-site audits of nursing homes to identify problematic coding and diagnosis, with the goal to reduce the use of unnecessary antipsychotic drugs, which CMS indicates are often prescribed to residents who are erroneously diagnosed with schizophrenia.
