By Staci Hemesath, Board Certified Specialist in Renal Nutrition, Registered Dietitian
Have you heard the good news? On May 12, CMS announced its final rule stating that “all patient diets, including therapeutic diets, must be ordered by a practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition professional as authorized by the medical staff and in accordance with State law governing dietitians and nutrition professionals.
What Does This Mean For You?
If you are an RD/RDN or qualified nutritional professional (per State law) working in a hospital, you will have the independent authority to order therapeutic diets for your patients, including home-delivered meals, as long as you are granted privileges from your medical institution. No more delays in tracking down the busy physician or mid-level practitioner to discuss recommendations or have an order co-signed. If you identify a patient that would benefit from a therapeutic diet order or nutrition supplement, you will be able to order it on the spot.
A hospital can also grant dietitians/qualified nutrition professionals the privilege to order lab tests to monitor the effectiveness of dietary plans and orders, in accordance with individual state laws. Therefore, if you write orders for enteral or parenteral nutrition, you may also be able to write the follow-up laboratory orders to monitor blood glucose, pre-albumin, LFTs, etc. Upon reviewing results, you can then alter the diet order as warranted.
What Does This Mean For Your Patients?
How many times have your patients waited hours to have their diet liberalized, to advance from NPO, for nutrition support to be initiated, or for a supplement to be delivered, only because of a delay in tracking down a physician to co-sign a diet order? This greatly reduces patient satisfaction and jeopardizes their health.
CMS expects this new rule to greatly improve the efficiency and efficacy of nutritional care. CMS states, “The addition of ordering privileges enhances the ability that RDs already have to provide timely, cost-effective, and evidence-based nutrition services as the recognized nutrition experts on a hospital interdisciplinary team.”
Cost Savings Underestimated
The ruling could save up to $459 million in annual hospital costs, CMS estimates. However, this dollar amount is based solely on the difference in labor cost between a physician/MLP and RD ($291,104,100) and the estimated cost of reducing inappropriate parenteral nutrition usage ($167,730,675).
The savings is likely much greater when accounting for the reduced morbidity and mortality benefits, as predicted in some professional literature. Imagine a patient who lacks appropriate nutritional care while in the hospital, gets discharged in a malnourished state, suffers a fall at home, and is readmitted with a hip fracture. The cost of hospital readmissions, caused by poor nutrition, isn’t even factored into this cost savings estimate.
What You Can Do Now
The ruling officially takes effect on July 11, 2014. In the meantime, RDN’s will need to work on obtaining diet and laboratory ordering privileges from their medical institution.
If you don’t know how to get privileges granted to you, The Academy of Nutrition & Dietetics (AND) will be offering resources to assist in this effort. For now, the ruling only applies to hospital dietitians, but AND will be working with CMS to extend authority to those working in long-term care facilities as well.
This policy change is a huge step forward for nutrition professionals. Dietitians ordering diets for their patients makes sense, doesn’t it?