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Nov 15 2013
ACA Medicare Reimbursement Policies: Why Nutrition Intervention Must Be Prioritized
Kelly Tappenden, PhD, RD, FASPEN, Alliance representative from the Academy of Nutrition and Dietetics

As key provisions of the Patient Protection and Affordable Care Act (PPACA) are fully implemented, particularly Medicare reimbursement policies, hospitals are exploring an array of measures to improve patient outcomes and reduce readmissions in order to be compliant with these new regulations. In particular, PPACA invokes hospital penalties based on readmissions for three conditions: acute myocardial infarction, heart failure, and pneumonia – that commonly affect patients aged 65 and older. One area that continues to be largely underutilized, yet can have significant and positive effects on improved patient outcomes, decreased length of stay, decreased episode cost, and now at the forefront - reduced readmissions - is nutrition intervention.

A new study conducted by leading researchers at University of Southern California, Stanford University, The Harris School at The University of Chicago and Precision Health Economics, and supported by Abbott, found that the use of oral nutritional supplements decreased the probability of 30-day hospital readmission, length of stay and costs among hospitalized Medicare patients aged 65 and over.

Particularly of interest, the results from the study demonstrated oral nutrition supplements were associated with a decreased probability of 30-day readmission midst Medicare patients 65 years of age or older with:

  • 8.4 percent reduction for patients with any diagnosis.
  • 10.1 percent reduction for congestive heart failure patients.
  • 12.0 percent reduction for acute myocardial infarction patients.

These cost savings from 30-day readmissions may help some hospitals meet the new ACA reimbursement policies for Medicare patients. Nationally, one in five Medicare patients is readmitted to a hospital annually at an estimated $17.5 billion. The current penalty is 2 percent for hospitals whose number of readmitted patients, within 30 days, exceeds the national average, specifically for issues related to heart failure, heart attack and pneumonia. According to federal data estimates, $227 million in fines will be levied by Medicare against 2,225 hospitals alone in 2013.

As demonstrated in this study, prudent nutrition intervention practices can have demonstrably positive effects on improved health outcomes, which, by extension, help hospitals meet these new measures. The Alliance to Advance Patient Nutrition continues to advocate for more rigorous screening standards, as well as greater collaboration among nurses, physicians, registered dietitian nutritionists and other healthcare providers, to standardize nutrition intervention processes.

While registered dietitian nutritionists have long advocated for this type of comprehensive nutrition intervention in hospitals, this research and the growing body of scientific evidence make our assertions clear and undeniable. Nutrition treatment is a low-cost, effective solution for improving patient outcomes and reducing costs. It’s time for clinicians to heed this call-to-action for the sake of our patients.