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Jul 23 2014
CMS Publishes Final Rule Improving the Ordering of Therapeutic Diets in Hospitals

A new rule issued May 7 by the federal Centers for Medicare and Medicaid Services (CMS) will drive improvement in the treatment of malnourished hospitalized patients by allowing qualified registered dietitian nutritionists (RDNs) to order patient diets without the supervision or approval of a physician or other practitioner, if permitted to do so under state law. Addressing the long-standing problem of delays in nutritional therapy due to lack of a diet order, the CMS rule provides the flexibility hospitals need under federal law to grant privileges to qualified dietitians and nutrition professionals to order patient diets, lab tests to monitor the effectiveness of dietary plans, as well as make modifications to nutritional interventions. Under the new rule, which took effect on July 11, hospitals will have the authority to determine who will be privileged.

Issued in direct response to a presidential executive order urging federal agencies to reduce or revise unnecessarily burdensome rules and regulations, CMS said the new rule will “save hospitals significant resources by permitting registered dietitians to order patient diets independently, which they are trained to do, without requiring the supervision or approval of a physician or other practitioner.

Moreover, the rule specifically clarifies that registered dietitian nutritionists (RDNs) may be included on the hospital medical staff, as they "have equally important roles to play on a medical staff and on the quality of medical care provided to patients in the hospital."

Considered “a major policy success” by the Academy for Nutrition and Dietetics (the “Academy”) and members of the nutrition community, the rule is the result of a concerted effort by the Academy going back to 2010. Starting with the production of a detailed analysis of the legal and practice issues surrounding therapeutic diets at both the federal and state levels, the Academy held multiple meetings with CMS and worked with the agency through evidentiary offerings and regulatory comments to bring about this regulatory change.

Melissa Parkhurst, MD, FHM, medical director of the Nutrition Support Service at the University of Kansas Hospital in Kansas City and clinical representative for the Society of Hospital Medicine in the Alliance, was interviewed by The Hospitalist regarding this CMS rule. She stated: “Any time you can allow the different disciplines to work directly with patients to help in that hospital stay, you are not only hopefully bettering the care of the patient, but you're helping the primary attending physicians as well. The idea was not only to hopefully improve the timeliness of getting nutrition intervention started with patients but also to allow everybody to do what they're good at.”

Before an RDN will be legally permitted to order patient diets, he/she must become part of the medical staff or be granted privileges by the hospital to order therapeutic diets. Read the Academy of Nutrition and Dietetics’ guide regarding implementation of the rule and analysis of existing state statutory and legal impediments.

Read the final rule.