Nutrition in the Changing Healthcare Landscape

peter cayan

by Peter Cayan, MA, RD, CDN, LDN

Senior Director, Nutrition Specialists, Intalere

Nutrition and nutrition therapy have never been more relevant than now in the age of healthcare reform and the changing healthcare landscape. I recently discussed this topic with Dr. Tracy Smith, senior clinical manager for Abbott Nutrition, for a podcast.

According to the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) no longer pays for hospital-acquired conditions such as pressure ulcers, falls and hospital-acquired infections – all of which have strong connections to malnutrition. Malnutrition increases the risk of hospital-acquired conditions and readmissions and can also delay recovery, increase medical complications and extend length of stay – all of which contribute to escalating costs. By identifying and treating malnourished patients upon admission and through discharge, hospitals can significantly improve quality and patient outcomes while reducing costs and meeting healthcare reform provisions.

People entering the hospital with poor nutrition status have poorer outcomes than their nourished peers. Nutrition status often worsens in the hospital, and may not improve on discharge unless the patient is given a post-discharge nutrition plan. The prevention and treatment of hospital malnutrition offer a tremendous opportunity to optimize the overall quality of patient care, improve clinical outcomes and reduce costs.

The interdisciplinary Alliance to Advance Patient Nutrition was formed to highlight the critical role of nutrition intervention in clinical care and to suggest practical ways to promptly diagnose and treat malnourished patients and those at risk for malnutrition.

The alliance has developed a call to action regarding the importance of an interdisciplinary approach to addressing malnutrition both in the hospital and in the acute post-hospital phase. Empowerment of all clinicians, recognition and diagnosis of all patients, same-day automatic intervention for all at-risk patients, education and involvement of patients in their nutrition care, and appreciation of the value of nutrition by all hospital stakeholders is absolutely critical. The alliance plan features a quality improvement program (QIP), which includes an initial screening for risk of malnutrition, communication plans for rapid intervention for those judged at risk and finally, a discharge plan that includes nutritional care.

Several studies have been done recently investigating the effect of implementing a QIP on reducing non-elective 30-day readmissions and healthcare costs for hospitalized patients identified as malnourished. The authors concluded that 30-day non-elective hospital readmissions and healthcare costs from avoided readmissions can be significantly decreased, while hospital and patient savings can be improved among the malnourished inpatient population through a rapid, comprehensive QIP.

To learn more about the importance of nutritional care in the current healthcare environment and plans for early nutrition intervention, listen to our podcast and/or read the transcript.

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