Medicare, Medicaid to Require Antibiotic Stewardship in Long-Term Care Facilities

On Sept. 29, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that will help combat the growing threat of antibiotic resistance and protect the health of an estimated 1.7 million patients in the United States who live in long-term care (LTC) facilities. This “condition of participation” rule, an update to care standards that nursing homes and assisted-living facilities must meet in order to receive Medicare and Medicaid reimbursement, includes new antibiotic stewardship requirements aimed at ensuring the appropriate use of antibiotics, minimizing adverse effects from their use, and slowing the spread of resistance.

These changes to CMS’ standards will help the approximately 15,000 LTC facilities across the country to mitigate the risks posed by antibiotic resistance, and they mark a significant step forward in safeguarding both individual and public health against bacteria that are becoming increasingly resistant.

The use and misuse of antibiotics across all settings drives the development of antibiotic-resistant bacteria, and research shows that a significant proportion of antibiotics used in LTC facilities is inappropriate or altogether unnecessary. Implementing antibiotic stewardship programs to ensure that these drugs are prescribed only for indicated uses will help to slow the growth of resistance. Such efforts are particularly important in long-term care settings, where residents tend to be older and more vulnerable to antibiotic-resistant infections.

Pew’s recent report, A Path to Better Antibiotic Stewardship in Inpatient Settings, profiles a diverse group of health care centers across the country, including long-term care facilities that are already using antibiotic stewardship programs. The report highlights how institutions of various sizes, and with different levels of financial and staff resources, have been able to implement programs that reduce rates of drug resistance, lower total medical costs, and improve patient outcomes. As more long-term care facilities start to build and refine their stewardship programs, we hope that this report will serve as a resource for them.

Pew applauds the CMS for finalizing these new standards and encourages the agency to also finalize its similar rule proposed for hospitals. Both rules represent important progress toward establishing robust antibiotic stewardship programs in all health care facilities across the country, as called for in the National Action Plan for Combating Antibiotic-Resistant Bacteria, and have the potential to drive measurable improvement in the fight against superbugs.

David Hyun, M.D., works on The Pew Charitable Trusts’ antibiotic resistance project, focusing on research and policy development pertaining to human stewardship of antibiotics.