A consultant working in the skilled nursing space, said this week’s announcement by the Office of Inspector General (OIG) for the Dept. of Health and Human Services (HHS) that it has kicked off an audit of state survey agencies and how they manage possible opioid overuse, misuse, or diversion in nursing homes is not the best way to proceed.

HHS OIG said in its announcement that “state survey agencies cited almost half of nursing homes nationwide for pharmaceutical services deficiencies during recent complaint and standard health inspections. If effective systems and procedures to ensure the safe and effective use of medications are not implemented, over 157,000 nursing home residents who receive opioids could be at risk for overuse, misuse, or diversion.”

But Jennifer Napier, practice director for Ohio-based Engage Consulting, said “while we do agree that there could be more oversight on issues surrounding overuse of narcotics and drug diversion to better serve our residents and populations, skilled nursing facilities already have the burden of being audited by state survey entities for complaint and annual survey investigations, in which these matters are already heavily investigated.”

To better remedy the issue, she said HHS OIG has other pathways to explore.

“The problem is already stated and identified, as the OIG objective identifies that …’State survey agencies cited almost half of nursing homes nationwide for pharmaceutical services deficits during recent complaint and standard health inspections,’” she said.

“Rather than an OIG audit being implemented to further investigate this matter, it would be more beneficial to facilities and to resident care to provide skilled nursing facility leadership teams with systems, training and support to be more compliant with these issues.”

Strengthening operational infrastructure and providing practical resources would better promote regulatory compliance, improve medication management practices, and ultimately enhance resident care outcomes, Napier added.

OIG Acts

For its part, HHS OIG said its investigators will determine whether selected state agencies ensured that nursing homes: (1) complied with federal and state pharmacy service requirements to prevent the overuse of opioids by Medicaid and Medicare residents, and (2) implemented effective internal controls to prevent the misuse or diversion of opioids.

They also called pharmaceutical services an “integral part of the care required to meet the needs of each nursing home resident,” and noted nursing homes must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs).

“Nursing homes are also required to: (1) store all drugs in locked compartments; (2) permit only authorized personnel to have access to the keys to secured areas; and (3) provide separately locked, permanently affixed compartments for storage of Schedule II controlled drugs,” HHS OIG said.

AHCA Reacts

Holly Norelli, vice president, quality & regulatory services at the American Health Care Association/National Center for Assisted Living, said "nursing homes are committed to protecting the safety of residents and staff while also doing what they can to help with the opioid crisis in our nation.”

Further, she said “by implementing effective safety protocols that include the appropriate storage, distribution, and management of medications, nursing homes can prioritize the medical needs of residents while providing a safe environment for all.”

The HHS OIG project’s completion date is fiscal year 2028.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.