The Role of Nutrition in Maintaining Health in the Nation's Elderly Evaluating Coverage of Nutrition Services for the Medicare Population (2000) / Chapter Skim
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15 Overall Findings and Recommendations
15 Overall Findings and Recommendations
Pages 310-324
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From page 310... ...
The charge to the committee was to evaluate evidence and make recommendations regarding technical and policy aspects of the provision of comprehensive nutrition services, including the following: · coverage of nutrition services provided by registered dietitians and other health care practitioners for inpatient care of medically necessary parenteral and enteral nutrition therapy; · coverage of nutrition services provided by registered dietitians and other health care practitioners for patients in home health and skilled nursing facility settings; and · coverage of nutrition services provided by registered dietitians and other trained health care practitioners in individual counseling and group settings, including both primary and secondary preventive services. For the purposes of this report, the committee considered the term "nutrition services" to consist of two levels.
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From page 311... ...
Conditions evaluated for which data at this time are lacking or insufficient to support a recommendation for nutrition therapy included cancer and osteoporosis. In the case of osteoporosis, although nutrition intervention through calcium and vitamin D supplementation has clearly been found to improve health outcomes, there is a lack of available evidence to suggest that nutrition therapy, as opposed to basic nutrition education from various health care professionals, would be more effective.
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From page 312... ...
Likewise, medical conditions which individually might not warrant nutrition therapy may well require intervention from a trained nutrition professional when these conditions occur in combination. An underlying factor for the recommendation that coverage be included for nutrition therapy upon physician referral for any condition, including those not reviewed in this report, is that 87 percent of Medicare beneficiaries over 65 years of age have diabetes, hypertension, and/or dyslipidemia.
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From page 313... ...
For these reasons it is recommended to Congress that reimbursement for nutrition therapy be based on physician referral rather than on a specific medical condition. Recommendations regarding the number of nutrition therapy visits for various conditions, other than for the necessary purpose of producing cost estimates, were not made because it is within the appropriate role of HCFA to establish reasonable limits in accordance with accepted practice.
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From page 314... ...
314 u u cry ._, V)
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From page 315... ...
315 The congressional language that initiated this study requested not only an analysis of the extent to which nutrition services might be of benefit to Medicare beneficiaries but also "an examination of nutritional services provided by registered dietitians..." (see chapter 13~. Available evidence regarding the education and training of registered dietitians as well as other health professionals needed to adequately provide nutrition services was systematically reviewed.
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From page 316... ...
While their involvement contributes to the nutritional management of diabetes, it is considered basic nutrition education and should continue to be viewed as incidental to routine medical care and not specifically reimbursable as nutrition therapy. In addition to providing reimbursable nutrition therapy directly to clients and patients, a registered dietitian should be involved in educating other members of the health care team regarding nutrition interventions and practical aspects of nutrition care.
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From page 317... ...
ADMINISTRATIVE RECOMMENDATIONS REGARDING THE PROVISION OF NUTRITION SERVICES Recommendation 4. HCFA as well as accreditation and licensing groups should reevaluate existing reimbursement systems and regulations for nutrition services along the continuum of care (acute care, ambulatory care, home care, skilled nursing and long-term care settings)
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From page 318... ...
designates the geriatric population as a high-risk group and has emphasized nutrition in its on-site inspections during the last few years, increased attention still has to be drawn to developing and implementing standards related to the process of assessing the nutritional and functional status of elders as well as identifying and correcting inadequacies of care. Nutrition services for Medicare beneficiaries in acute care, home care, and long-term care settings are covered largely through bundled payment systems.
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From page 319... ...
A registered dietitian should be available to serve as a consultant to health professionals providing basic nutrition education and follow-up, as well as to provide nutrition therapy, when indicated, directly to Medicare beneficiaries being cared for in a home setting. Medicare beneficiaries are often discharged from hospitals to home care settings with, or at high risk for, overt malnutrition.
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From page 320... ...
As Medicare shifts to a prospective payment system for skilled nursing and long-term care facilities, the nutrition services provided must not be compromised, but should be improved beyond the current pattern of practice. Some states require that long-term care facilities employ dietitians for so little time (8 hours per month)
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From page 321... ...
The committee identified numerous areas for research, which can be found in the at the end of relevant chapters of this report. ECONOMIC POLICY ANALYSIS Cost to the Medicare program of expanded coverage for nutrition therapy will be directly determined by the specific design of the reimbursement benefit, patient demand, and other factors.
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From page 322... ...
CONCLUDING REMARKS In summary, evidence exists to conclude that nutrition therapy can improve health outcomes for several conditions that are highly prevalent among Medicare beneficiaries while possibly decreasing costs to Medicare. Basic nutrition advice for healthy living and the primary prevention
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From page 323... ...
However, the provision of nutrition therapy requires in-depth knowledge of food and nutrition science. Registered dietitians are currently the primary group of health care professionals with the necessary type of education and training to provide this level of nutrition service.
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