Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic
Medications in Nursing Homes Residents
A Centers for Medicare and Medicaid Services (CMS) Video Streaming Event
Premieres Thursday, March 29, 2012
1:00pm EST – 2:00pm EST
CMS is developing a national action plan to improve behavioral health management and to safeguard nursing home
residents from unnecessary antipsychotic drug use. Through a multidimensional approach including research, public
reporting, raising public awareness, regulatory oversight and technical assistance/training, we hope to enhance
person-centered care for nursing home residents, particularly those with dementia-related behaviors.
Goals
CMS will provide an overview of the national initiative, resources for technical assistance, and plans for upcoming
educational offerings on this topic.
Handouts
Handouts for this broadcast will be available at the following website: http://surveyortraining.cms.hhs.gov after
March 20.
Objectives
•
Introduction of national initiative
•
Discussion of behavioral health management opportunities
•
Announcement of upcoming training sessions
Target Audience
CMS Regional Offices, State Survey Agencies, residents and family members, nursing home staff, clinicians,
providers, advocates, and others (Non-Mandatory)
Registration and Viewing Instructions
Individual and Site registration is available today. For registration and viewing instructions go to:
http://surveyortraining.cms.hhs.gov.
Video Streaming Information
This program will be available for viewing up to one year following March 29 at http://surveyortraining.cms.hhs.gov.
CMS' National Initiative to Improve Behavioral Health and
Reduce the Use of Antipsychotic Medications for Nursing Home
Residents
AGENDA – VIDEO STREAMING MARCH 29, 2012
Welcome & Overview
Dr. Patrick Conway, CMS
First Group:
Case Study Presentation
Dr. Peter Rabins, Johns
Hopkins Medical Center
Primary Care/Geriatrics Perspective
Advocates’ Perspective
Advocate**
Dr. Susan Levy, AMDA
Sarah Greene Burger, RN,
Pharmacist’s Perspective
Thomas Clark, PharmD
Resident/Family Perspective
(film clip)
Second Group:
Provider Perspective
Morris Kaplan, NHA
Surveyor/QAPI Perspective
Debra Lyons, RN
CMS Initiative components
Shari Ling, CMS
Hand in Hand*
Wrap-Up: Challenge
Alice Bonner and Dr.
Moderator: Nicole Brandt, PharmD, University of Maryland
**representing advocacy for both direct care workers/nurses and
residents/families
(*DVD for certified nursing assistants developed by CMS on person-centered
dementia care)
Speaker Biographies – Video Streaming March 29, 2012
Patrick Conway, MD, MSc, is Chief Medical Officer for the Centers for Medicare & Medicaid Services
(CMS) and Director of the Office of Clinical Standards and Quality. This office is responsible for all quality
measures for CMS, value-based purchasing programs, quality improvement programs in all 50 states, clinical
standards and survey and certification of Medicare and Medicaid health care providers across the nation, and
all Medicare coverage decisions for treatments and services. The office budget exceeds $1.5 billion annually
and is a major force for quality and transformation across Medicare, Medicaid, CHIP, and the U.S. health care
system. Previously, he was Director of Hospital Medicine and an Associate Professor at Cincinnati Children’s
Hospital. He was also AVP Outcomes Performance, responsible for leading measurement, including the
electronic health record measures, and facilitating improvement of health outcomes across the health care
system. Previously, he was Chief Medical Officer at the Department of Health and Human Services (HHS) in the
Office of the Assistant Secretary for Planning and Evaluation. In 2007-08, he was a White House Fellow
assigned to the Office of Secretary in HHS and the Director of the Agency for Healthcare Research and Quality.
As Chief Medical Officer, he had a portfolio of work focused primarily on quality measurement and links to
payment, health information technology, and policy, research, and evaluation across the entire Department.
He also served as Executive Director of the Federal Coordinating Council on Comparative Effectiveness
Research coordinating the investment of the $1.1 billion for CER in the Recovery Act. He was a Robert Wood
Johnson Clinical Scholar and completed a Master’s of Science focused on health services research and clinical
epidemiology at the University of Pennsylvania and Children’s Hospital of Philadelphia. Previously, he was a
management consultant at McKinsey & Company, serving senior management of mainly health care clients on
strategy projects. He has published articles in journals such as JAMA, New England Journal of Medicine, Health
Affairs, and Pediatrics and given national presentations on topics including health care policy, quality of care,
comparative effectiveness, hospitalist systems, and nurse staffing. He is a practicing pediatric hospitalist,
completed pediatrics residency at Harvard Medical School’s Children’s Hospital Boston, and graduated with
High Honors from Baylor College of Medicine.
Peter Rabins, MD, MPH, is currently Richman Family Professor for Alzheimers and Related Dementias
and Director of the Division of Geriatric Psychiatry and Neuropsychiatry. Dr. Rabins has focused his career on
the study of psychiatric disorders in older persons. His current research focuses on the effectiveness of current
therapies for Alzheimers disease, the development of measures of quality of life in persons with Alzheimer
disease, and care of patients with late stage dementia. Dr. Rabins is the author of more than 275 articles and
book chapters. He is co-author of The 36 Hour Day, first published in 1981, Practical Dementia Care published
in 2000 and, Getting Old Without Getting Anxious, published in February 2005. Dr. Rabins received a BA in
Political Science from the University of Florida in 1969, an MD from Tulane University in 1973 and an MPH from
Tulane University School of Public Health in 1974. After a psychiatry residence at the University of Oregon, he
completed a one-year fellowship in consultation/liaison and neuropsychiatry at the Johns Hopkins School of
Medicine and has been on the faculty there since 1978. He is Professor in the Department of Psychiatry and
has joint appointments in the Departments of Medicine Health Policy & Management and Mental Health.
Susan Levy, MD, CMD, AGSF, joined the full-time medical staff at Levindale Hebrew Geriatric center
and Hospital in Baltimore, Maryland in December 1998 as Medical Director/VP Medical Affairs. Dr. Levy
graduated from the University of Maryland and did her Internal Medicine residency at the Medical University
of South Carolina. She completed a geriatric fellowship at the Mount Sinai Medical Center in New York. She
worked at Franklin Square Hospital in Baltimore County, Maryland, a community teaching hospital as section
chief of geriatric medicine prior to taking her position at Levindale. Dr. Levy is a member of the American
Medical Directors Association and is a Certified Medical Director since 1996. She has participated in and/or
chaired the Pain, COPD, Infection and the Health Care Maintenance clinical practice guidelines (CPG). She is
currently assisting with the revision of the Urinary Incontinence CPG. Dr. Levy is board certified in Internal
Medicine and Geriatrics. She also holds a faculty appointment at The Johns Hopkins University as Instructor in
Medicine. She has served as the President of the Maryland Medical Directors Association from 2004 to 2008
and is now on the AMDA Board of Directors. She is a longstanding member of AGS.
Sarah Greene Burger, RN, C, MPH, FAAN, has a broad background in implementing national
initiatives that have had national implications for long term care practice, research and education. She is the
former executive director of The National Citizens' Coalition for Nursing Home Reform (NCCNHR). In that
capacity and as Associate for Program and Policy, she helped build a coalition that focused Congressional
attention on important consumer issues: reducing physical and chemical restraint use and malnutrition and
dehydration. In 1997, she brought NCCNHR's consumer minimum staffing standard to a consensus meeting
called by Hartford Institute for Geriatric Nursing, New York University, College of Nursing. This minimum
standard with enhancements and confirmed by the Center for Medicare and Medicaid Services research has
now been recommended for nursing homes by the 2004 IOM report, "Keeping Patients Safe." She continues to
work on developing and implementing policy on a range of issues including nurse-aid training, nurse staffing,
resident assessment and care planning. She has authored many consumer materials and guides and coauthored two nursing home consumer books. Currently, she is also the coordinator for the Hartford Institute's
Coalition of Geriatric Nursing Organizations, whose 28,000+ nurses seek to improve the quality of care and life
for elders wherever they receive their care.
Thomas Clark, RPh, MHS, CGP, is Director of Clinical Affairs for the American Society of Consultant
Pharmacists and the ASCP Foundation. He is also the Executive Director for the Commission for Certification in
Geriatric Pharmacy. He has worked for ASCP since 1994, previously serving as Director of Policy and Advocacy
and Director of Professional Affairs. Prior to working for ASCP, he was Vice President of Consulting for a large
long-term care pharmacy company. He has also worked in hospital and ambulatory care pharmacy. Mr. Clark
has also served on a number of expert panels relating to medication use in the elderly, including those in
nursing homes and assisted living. He served on expert panels involved in the revision of the nursing home
State Operations Manual, for pharmacy services, unnecessary drugs, and the quality assessment and assurance
committee. He worked closely with CMS staff and other stakeholder organizations on issues relating to
implementation of the Medicare drug benefit, especially those relating to long-term care residents. He served
as co-chairman of the Long-Term Care Continuum Cluster Group of the Pharmacy Quality Alliance and served
on the Council of the Convention for the United States Pharmacopeia. He is a recipient of the George F.
Archambault award and has been elected as a Distinguished Practitioner to the National Academies of Practice
in Pharmacy. Tom has created, edited, or authored a variety of resources for ASCP members, including the
Consultant Pharmacist Handbook, the 100% Immunization Campaign Resource Manual, the Medication Guide
for the Long Term Care Nurse, and a series of clinical reference cards. He is a graduate of the University of
Illinois College of Pharmacy and has a Master’s degree in health care administration from Mississippi College.
He is also a Certified Geriatric Pharmacist.
Morris Kaplan, Esq., NHA, is currently the Operating Partner of Gwynedd Square Center for Nursing &
Convalescent Care, Lansdale, PA. Mr. Kaplan is an attorney and licensed nursing home administrator. He
pioneered the nationally recognized Alzheimer’s Special Care Program at Gwynedd Square Nursing Center in
Lansdale, PA. This program was designated as a “Model Program for Alzheimers Care” by the national
Alzheimers Association in 1993. Gwynedd Square was one of only ten of Pennsylvania’s 700-plus nursing
homes to be designated by the PA Department of Health as a Model of Best Practices in February 2002.
Gwynedd Square was honored as a 2002 PA Governor’s Silver & Gold Award Finalist for Quality of Life in Long
Term Care. The PA Patient Safety Authority has recognized Gwynedd Square as a best practices leader in two
different areas in 2011 and 2010. Gwynedd Square has consistently earned the highest rating from the US
Department of Health & Human Services, 5 Stars out of 5 Stars. Gwynedd Square has also been honored by US
News & World Report as one of America’s Best Nursing Homes 2011. Gwynedd Square has in the past been
selected as a study site for best practice research by the Office of Inspector General, US Dept. of Health &
Human Services, and CMS. Mr. Kaplan served for more than a decade as a Board Member of the Alzheimers
Association, Delaware Valley Chapter (Southeastern PA, Southern NJ & DE). He has made numerous
presentations at Alzheimers Association conferences and has testified on behalf of the Association in the PA
legislature. He is also an active member of Consumers Voice for Quality Long Term Care, formerly NCCNHR,
and has made many presentations at NCCNHR annual conferences and has testified on their behalf in the US
Congress. He has also served on a technical expert panel convened by CMS. Mr. Kaplan is a contributing author
of What If It's Not Alzheimer's? A Caregiver's Guide To Dementia edited by Radin, Prometheus Books 2003, and
the author of both “Powerful New Tool For Nursing Home Consumers: The Quality Indicator Report”, The
Quality Care Advocate, Spring 2000, also revised and republished in the Annals of Long-Term Care – A Clinical
Journal of the American Geriatrics Society, June 2002, as well as “The Clinton Health Proposals – Impact on
Long Term Care Consumers & Providers”, Philadelphia Business Journal, October 1993.
Debra Lyons, RN, is a Registered Nurse Consultant with the Division of Nursing Homes. Ms. Lyons has
been a Registered Nurse since 1998. She initially worked as a staff/charge nurse at Springfield State Hospital
Center for acutely ill psychiatric patients. She continued at Springfield Hospital, where she became Head Nurse
on her busy admission unit. In 2003, Ms. Lyons went to the Maryland State Office of Health Care Quality,
becoming a Nurse Surveyor for LTC, Basic Hospital, and Transplant Hospital. From 2006 through 2008, she
provided technical assistance to Maryland nursing homes in the area of Quality Assurance. Ms. Lyons returned
to surveying Nursing Homes, and received her certification in QIS in April, 2010. She joined the CMS team in
July, 2010.
Alice Bonner, PhD, RN, FAANP, has been a geriatric nurse practitioner for the past 20 years. From
2009-2011, Dr. Bonner was the Director of the Bureau of Health Care Safety and Quality at the Massachusetts
Department of Public Health in Boston, MA. She is currently the Director for the Division of Nursing Homes in
the Office for Clinical Standards and Quality within the Centers for Medicare and Medicaid Services (CMS) at
the US Department of Health and Human Services in Baltimore, MD. Her research interests include improving
nursing home quality, patient safety culture in health care organizations, safe medication prescribing and
management, falls prevention and improving care transitions across settings.
Shari Ling, MD, is currently the Centers for Medicare and Medicaid Services (CMS), Deputy Chief Medical
Officer serving in the Office of Clinical Standards and Quality (OCSQ), responsible for assisting the CMS Chief
Medical Officer in the Agency’s pursuit of higher quality health care, healthier populations, and lower cost
through quality improvement. Dr. Ling’s long-standing focus is on the achievement of meaningful health
outcomes through delivery of high quality beneficiary-centered care across all care settings, with a special
interest in the care of persons with multiple chronic conditions and functional limitations, and reducing health
disparities. Dr. Ling has served as the lead coordinator and facilitator of the OCSQ Measures Forum. Dr. Ling
represents CMS on the Health and Human Services (HHS) Multiple Chronic Conditions workgroup, and the
National Quality Forum Measures Application Partnership – Post-acute Care/Long-term Care workgroup, and
chairs the Measures and Data sources sub-workgroup for the HHS Action Plan for Healthcare Associated
Infection (HAI) Prevention in Long-term Care facilities. Dr. Ling also serves as the clinical sub-group lead for the
HHS National Alzheimer’s Project Act. She is a Geriatrician and Rheumatologist who received her medical
training at Georgetown University School of Medicine where she graduated as a member of the Alpha Omega
Alpha Honor Society. Dr. Ling received her clinical training in Internal Medicine and Rheumatology at
Georgetown University Medical Center, and completing Geriatric Medicine studies at Johns Hopkins
University., remaining on faculty at Johns Hopkins for 5 years, after which she joined the Intramural Research
Program of the National Institutes of Health at the National Institute on Aging as a Staff Clinician for 8 years
studying human aging and age-associated chronic diseases with attention to musculoskeletal conditions and
mobility function. Dr. Ling continues to serve as a part-time faculty member in the Division of Geriatric
Medicine and Gerontology at Johns Hopkins University School of Medicine, and in the Division of
Rheumatology, Allergy and Clinical Immunology at the University of Maryland. Dr. Ling volunteers at the
Veterans Administration Medical Center in Baltimore. She is a Gerontologist who received her training in Direct
Service from the Ethel Percy Andrus Gerontology Center, at the University of Southern California, and served as
the co-director of the Andrus Older Adult Counseling Center.
Nicole Brandt, PharmD, BCPP, CGP, FASCP, joined the University of Maryland, School of
Pharmacy in 1999. Since joining, she has expanded geriatric training opportunities (e.g. geriatrics pathway,
accredited geriatrics residency, co-investigator on geriatric education consortium). In addition, she has worked
on various interdisciplinary teams through numerous practice settings and currently provides clinical services
at a continuing care retirement community as well as the Baltimore Veterans Affairs. Her passion is promoting
optimal care for older adults and has affected this through her educational, clinical as well as healthcare policy
work. She has directed projects such as Medication Use Safety Training for Seniors
http://www.mustforseniors.org, Assisted Living Medication Management and Safety http://geried.umaryland.edu and Medication Therapy Management Standardized format development. Her public policy
advocacy occurs on both a state and national level. She has worked with the Maryland Board of Pharmacy on
the 2008 Maryland Assisted Living Regulations. In addition, she completed a tenure at CMS as a special
technical director in the Nursing Home Survey and Certification Group, working on interpretive guidance
regarding medication management in nursing homes. She continues to serve as a consultant to both
organizations as well as work on research and guideline initiatives. She has been awarded the 2010 Daily
Record Healthcare Hero and 2007 ASCP Leadership in Education Award. Recently, she has been elected to the
Board of Directors for the American Society of Consultant Pharmacists.