April 19, 2017
CHICAGO – As malnutrition costs rise for older Americans, the Academy of Nutrition and Dietetics and a coalition of senior advocate and patient organizations commend the Centers for Medicare and Medicaid Services for proposing adoption of quality measures that will take action against the hidden epidemic of older adult malnutrition.
On April 14, CMS followed a recommendation by the Academy and the coalition groups that will help improve the health of millions of adults, including half of all older patients who face malnutrition. CMS proposed the adoption of malnutrition-focused quality measures into a future Hospital Inpatient Quality Reporting Program.
"If the proposed rule is finalized, it would be the first time CMS has included malnutrition care in a quality program, which gives health care providers incentives to report performance on quality measures," said registered dietitian nutritionist and Academy President Lucille Beseler. "With disease-associated malnutrition in older adults estimated to cost the U.S. $51.3 billion annually, this rule would make an impact on both patient health and health care costs," Beseler said.
"This is exactly the right public health policy for millions of older Americans who suffer from – or are at risk of – malnutrition. We thank CMS for taking this crucial step that will improve the quality of life for seniors and help them maintain their independence," Beseler said.
CMS has proposed to adopt recommendations of the Malnutrition Quality Improvement Initiative (mqii.today), which developed and tested four malnutrition electronic clinical quality measures. MQii is a collaboration of the Academy Nutrition and Dietetics, Avalere Health and a multidisciplinary group of health care professionals. MQii advances evidence-based, high-quality patient-driven care for hospitalized adults 65 and older who are malnourished or at-risk for malnutrition. Support for MQii was provided by Abbott.
In March, at the annual conference of the American Society on Aging, a diverse group of advocates, released the National Blueprint to Achieve Quality Malnutrition Care for Older Adults, which called for strategies across the health care spectrum, focused on four primary goals: improving quality care practices, improving access, generating research and advancing public health.
"The measures included in CMS' new proposed rule are a key component of this National Blueprint. Given that patients who rely on Medicare experience the highest rates of malnutrition, CMS' action is critical to tackling this epidemic," Beseler said.
CMS will accept public comment on the proposed rule for several weeks before the rule becomes final. Finalization will place a major new national emphasis on the problem of older adult malnutrition and comes on the heels of efforts at the state level to take a closer look at this epidemic. Massachusetts, Vermont and Virginia have recently created new commissions or broadened the scope of an existing commission to better understand the impact of malnutrition, also in response to Academy recommendations.
Facts About Adult Malnutrition
- Between 20 percent and 50 percent of adults are at risk of or are malnourished upon admission to the hospital, yet only 7 percent are diagnosed.
- The gap occurs for a number of reasons, including how malnutrition care information is tracked in electronic medical record systems.
- Malnourished hospitalized patients are up to five times more likely to have an in-hospital death, and have a 54 percent higher likelihood of hospital 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 (versus patients readmitted without malnutrition) was $17,500 – 26 percent to 34 percent higher, depending on the specific type of malnutrition.
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.