Taking Quality to the Next Level

Skilled nursing centers are taking the lead on quality and we are achieving real results.

Quality is the primary focus of the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL). It has been for many years. We didn’t wait for government regulations to dictate our next move. We know – and have known for a long time – the paramount role quality plays in delivering solutions and improving lives.

That’s why we established the nationwide Quality Initiative. This effort identifies four goals with measurable targets, each focused on a different aspect of quality. One area that we felt needed a long and hard look is the off-label usage of antipsychotic drugs.

These medicines are often used to treat people with dementia as a means to modify challenging behaviors. These medicines can be used as a first resort, placing an unnecessary burden on patients, families, and the health care system.

The Alzheimer’s Association reports that nearly 150,000 Americans are inappropriately prescribed antipsychotic drugs. That’s too many. These medicines are also expensive. A 2011 analysis by the U.S. Department of Health and Human Services’ Office of the Inspector General reported a cost of $309 million. That’s too much.

As part of the Quality Initiative, we set an ambitious, yet attainable goal to safely reduce the off-label use of antipsychotic medications by 15 percent by December 31, 2013.

We took immediate action. We recruited the brightest minds to establish a Quality Department, including Dr. David Gifford and a team of 14 professionals. They worked with the Centers for Medicare & Medicaid Services (CMS) and we have achieved remarkable results.

We not only met our goal of safely reducing the off-label usage of antipsychotics, we beat it. The average rate for AHCA members has decreased by 19.1 percent as of the first quarter of 2014. This means that approximately 29,200 individuals in AHCA member centers no longer receive these medications.

This reduction outpaces the nationwide results of a 17.1 percent decrease for all nursing centers. While we have much to be proud of, our work is not finished.

We’ve established new goals for 2015 and 2016. We will work to safely reduce the off-label use of antipsychotics among long-stay residents by 25 percent by December 2015 and 30 percent by December 2016. Once again, we’ve set the bar high, but not out of reach.

This isn’t all we are doing, though. We recently introduced the new LTC Trend TrackerSM, a web-based tool that allows AHCA/NCAL members to see how they are performing on quality measures. It also allows them to track against their peers and determine where improvements can be made.

Additionally, we continue to work closely with CMS. We meet with them quarterly and brief them on our progress. We also continue to support the AHCA/NCAL National Quality Awards Program. More than 3,000 buildings have achieved this award in the program’s 20 years.

I am confident that we will be successful. It is our responsibility to always strive for improvement within all facets of the long term and post-acute care profession – including quality. This is the only way we will be able to improve the lives of those we serve.


Mark Parkinson is the CEO of American Health Care Association.

Morning Consult