The Hybrid Antipsychotic Measure: How SNFs Can Lead Through a Flawed System
Skilled nursing facilities are being asked to respond to something entirely new, and understandably, many are struggling to wrap their arms around it.
The Long-Stay Antipsychotic Medication Quality Measure is CMS’s first-ever hybrid quality measure, blending MDS data with claims from outside providers. That alone makes it different. But what’s proving most challenging for SNFs is this: facilities are now being held accountable for antipsychotic use that may have occurred outside their building, ordered by providers they don’t employ, and reported through claims they have no ability to verify or audit for accuracy.
Effective with the anticipated January release of the Five Star reports, this measure is already influencing Five-Star Quality Measure reports. Many SNFs are seeing increases in their QM percentile on their Facility and Resident Level iQIES reports, not because care declined, but because CMS has expanded how antipsychotic use is captured and attributed. For facilities doing the right things clinically, it can feel like being penalized for factors entirely beyond their control.
What Changed, and Why It Feels So Different
This measure was designed to reduce unnecessary antipsychotic use nationwide, a goal SNFs have supported for years. But the way CMS is measuring it is new.
Antipsychotic use is now identified not just through the MDS, but through claims data from multiple sources, including hospitals, emergency departments, physicians, and pharmacies. In other words, medication use that occurs outside your building may still count against your quality score.
SNFs are once again being asked to absorb accountability for a system they don’t fully control.
For a deeper dive into the structure of the hybrid measure, click here to read our detailed breakdown of the Long-Stay Antipsychotic Medication Quality Measure or download the CMS Quality Measure Manual for additional technical detail.
The Real Challenge: Visibility Without Control
One of the most difficult aspects of this hybrid measure is that facilities cannot audit external claims for accuracy. If an antipsychotic appears on a resident’s claim, even if it was ordered in the ER or during a physician visit, it is included in the measure.
Preview reports can confirm that your numbers have shifted, but they won’t necessarily explain where the use originated or why it appears in your data. That lack of transparency can feel discouraging, especially for teams that work hard to manage antipsychotics responsibly.
Still, this is where SNFs do what they’ve always done best: adapt, lead, and focus on what can be controlled.
Where Your Leadership Makes the Difference
While you can’t manage every claim that follows a resident, you can tighten the processes inside your four walls:
- Know who is ordering antipsychotics in your building
- Examine what medications are being ordered—and for what purpose
- Avoid PRN antipsychotics whenever clinically appropriate
- Identify residents currently receiving antipsychotics and reassess ongoing need
- Discontinue PRN orders when no longer justified
These steps don’t just protect your quality measure, they reinforce strong clinical practice.
Where Celtic Consulting Comes In
We work alongside SNFs navigating exactly these kinds of changes. Our role is to help you see risk sooner, ask better questions, and build processes that hold up even when the system doesn’t feel fair.
This hybrid measure may not perfectly reflect nursing home quality. But with the right oversight, interdisciplinary communication, and support, facilities can still demonstrate responsible medication management and protect their outcomes.
The Bottom Line
SNFs didn’t create this measure. But they can lead through it.
By focusing on internal controls, thoughtful prescribing, and proactive review, facilities position themselves for success, despite the limitations of claims-based data. And you don’t have to do it alone.
We’re here to help guide the way – today, and as this measure continues to develop. Got questions about recent QM shifts or what to expect in the January Five-Star reports? Let’s connect.
