Nutrition Focused Medical Exams Result in Increased Reimbursement for Health Care Systems

November 14, 2017

CHICAGO – A new pilot project has been developed by the Academy of Nutrition and Dietetics that trains registered dietitian nutritionists to perform a nutrition-focused physical exam that is used to diagnose malnourished hospitalized patients. According to a new article in the Journal of the Academy of Nutrition and Dietetics, proper identification of malnutrition can increase revenue from reimbursement to facilities.

RDNs play a crucial role in diagnosing patients with malnutrition and reducing the risk of associated negative health effects, according to the article, "Increased Knowledge, Self-Reported Comfort, and Malnutrition Diagnosis and Reimbursement as a Result of the Nutrition-Focused Physical Exam Hands-On Training Workshop." Malnutrition is associated with many adverse outcomes, including impaired wound healing, muscle-wasting and increased risk of complications and mortality.

The Academy of Nutrition and Dietetics recently developed the Nutrition-Focused Physical Exam Hands-on Workshop to teach RDNs to perform the exams at a hospital in a train-the-trainer model. Between May 2015 and March 2017, more than 600 RDNs attended training workshops at 32 sites. The article's authors estimate nearly 2,000 RDNs have been trained by their peers. The Academy currently has 24 trainers who can lead workshops for health care facilities across the country.

"This publication provides evidence to support hands-on training on the Nutrition-Focused Physical Exam," said Alison Steiber, chief science officer at the Academy of Nutrition and Dietetics and co-author of the article. "The study demonstrates that, with this training, RDNs improve their accuracy in diagnosing and coding patients with malnutrition and thereby increase the amount of reimbursement for their facilities."

Facilities where RDNs completed the training had an increase in reimbursement for malnutrition as a major comorbidity or complication by 292.3 percent, while it was 171.6 percent higher for malnutrition as a secondary diagnosis. In health care, comorbidity is the existence of more than one disorder or disease at the same time. The reimbursement increase resulted in an increase of $57.2 million in revenue for the health system during the one-year period.

According to data published in 2013, 20 percent to 50 percent of adults are at risk of malnutrition or are malnourished upon admission to the hospital, yet only 7 percent are diagnosed and documented in the patient's medical record – more than double the 3.2 percent rate of diagnosis in 2010.

Malnourished hospitalized patients are five times more likely to die in the hospital and have a 54 percent higher likelihood of 30-day readmissions, compared to non-malnourished patients, according to two recent AHRQ Hospital Cost Utilization Project analyses. The cost per readmission for patients with malnutrition was $17,500 – 26 percent to 34 percent higher than patients readmitted without malnutrition.

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All registered dietitians are nutritionists – but not all nutritionists are registered dietitians. The Academy's Board of Directors and Commission on Dietetic Registration have determined that those who hold the credential registered dietitian (RD) may optionally use "registered dietitian nutritionist" (RDN) instead. The two credentials have identical meanings.

The Academy of Nutrition and Dietetics is the world's largest organization of food and nutrition professionals. The Academy is committed to improving the nation's health and advancing the profession of dietetics through research, education and advocacy. Visit the Academy at eatright.org.