Use of Potentially Inappropriate Medications (PIMs) by community-dwelling older adults has been associated with an increased risk of hospitalization. The Medicare Part D Medication Therapy Management (MTM) Program is using information, like the updated Beers Criteria, to reduce such PIM-related adverse events. The dissemination, adoption and implementation of this knowledge in the Medicare Fee-for-Service (FFS) environment will help achieve the CMS triple aim of better care for individuals, better health for populations, and reduced costs – without negatively impacting the quality of care.

Palmetto GBA has published an evidence-based Medicare FFS draft Home Health LCD that seeks to prevent the excess morbidity associated with the use of PIMs listed in the Beers Criteria. The excess risks associated with PIMs (e.g. inpatient hospitalization) led the National Committee for Quality Assurance (NCQA) to establish a Healthcare Effectiveness Data and Information (HEDIS) PIM Quality Metric for “Medication Management in the Elderly”. Details are available at the National Quality Measures Clearinghouse

Despite this knowledge there is evidence from Medicare Advantage data sources that Medicare beneficiaries continue to be prescribed these medications. The 2014 NCQA HEDIS Report Card results for “Medication Management in the Elderly” in Medicare Advantage (MA) populations supports the need for education in the Medicare FFS environment regarding the Beers List PIMs.

The Palmetto GBA Draft LCD, titled Skilled Nursing Services for Observation and Assessment Related to the Monitoring of Potentially Inappropriate Medications Listed in the Beers Criteria (DL35782) seeks to 1) increase the dissemination and adoption of the well-accepted, evidence-based knowledge regarding the excess risks associated with the Beers Criteria PIMs and 2) promote the use of alternative treatment regimens that do not include the Beers Criteria PIMs.

The comment period for the draft LCD opens on February 10, 2015 and closes on March 26, 2015. Comments should be submitted using the following contact information:

 

Attn: Medical Affairs, AG-275

Palmetto GBA
PO Box 100238
Columbia, SC 29202-3238
J11A.Policy@PalmettoGBA.com

 

 

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