The true value of a registered dietitian

Dietitians working in acute and long-term care facilities make a huge impact on the patients and residents they serve. There is rarely a specific dollar amount associated with their influence. Rather, a dietitian’s interventions and expertise can affect clinical outcomes, reimbursement, quality of life and more.

Training and expertise

Although many health professionals have some nutrition knowledge and are able to provide nutrition education, only dietitians and physicians are able to provide medical nutrition therapy.^1,2 Dietitians are able to assess nutritional needs, identify nutrition problems, and prescribe nutritional interventions for each individual to treat specific medical conditions.² Dietitians’ level of training, clinical knowledge, exposure to other healthcare disciplines, and breadth of expertise make them the best professionals for addressing nutritional concerns in acute and long-term care.¹

Quality of care

In many situations, dietitians are able to write and manage their own nutrition-related healthcare orders. This includes therapeutic diet orders and enteral and parenteral nutrition support. Because of this level of independence and competency, facilities reap the benefits.

When registered dietitians manage therapeutic diet and nutrition support orders, complications and medical errors are reduced, and the execution of nutrition orders is improved.^3,4 Improved delivery of nutrition care, specifically related to registered dietitians managing nutrition support orders, has been shown to reduce length of stay, readmissions, and mortality.⁴

Clinical outcomes

Negative clinical outcomes are often observed in patients who are at risk for malnutrition. Compared to adequately nourished patients, malnourished patients have longer lengths of stay, higher incidence of hospital readmission, and higher rates of mortality. Dietitians have an integral role in improving patient outcomes, as they can provide interventions to improve nutritional status.

A prospective study completed at Johns Hopkins Hospital that focused on identification of malnourished patients and early nutrition intervention was successful in reducing length of stay by an average of 3.2 days for severely malnourished patients.⁵

Reimbursement and cost savings

Appropriate and accurate diagnosis of malnutrition can have a dramatically positive financial impact on a hospital. A pilot study targeting the correct identification and diagnosis of malnutrition was completed at the University of Iowa Hospital. This four-month-long pilot increased the hospital’s reimbursement by $660,000 (over $3,000 per patient) and earned the hospital an additional 172 LOS days.⁶

These results have been duplicated at a multi-center hospital system that experienced a $57.2 million increase in their reimbursement over a one year period after implementing a dietitian-led malnutrition program.⁷

A dietitian’s interventions can also result in cost savings for a healthcare facility. Early nutrition intervention provided in the Johns Hopkins study referenced above resulted in a cost savings of $1,514 per patient.⁵

Similarly, cost-benefit analysis completed by the Centers for Medicare & Medicaid Services (CMS) estimated cost savings of approximately $45,641 per hospital, if dietitian order-writing privileges were implemented.³

Quality of life

Dietitians help improve their patients’ quality of life, especially in long-term care, by offering individualized approaches to nutrition problems.⁸ Food is an essential component to quality of life; an unpalatable or unacceptable diet can lead to poor food and fluid intake, resulting in malnutrition and related negative health outcomes.⁸ Considering the patient’s or resident’s preferences, health goals, and individuality allows dietitians to choose the best nutrition interventions.

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References

Institute of Medicine (US) Committee on Nutrition Services for Medicare Beneficiaries (2000). Providers of Nutrition Services. The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington DC: National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK225306/

The Academy of Nutrition and Dietetics (August, 2006). MNT vs Nutrition Education. https://www.eatrightpro.org/payment/coding-and-billing/mnt-vs-nutrition-education

Phillips W, Doley J. Granting order-writing privileges to registered dietitian nutritionists can decrease costs in acute care hospitals. 2017;117(6):840-847.

Hassell JT, Games AD, Shaffer B, Harkins LE. Nutrition support team management of enterally fed patients in a community hospital is cost-beneficial. 1994;94(9):993-8.

Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. JPEN. 2011;35(2):209-216.

Drapeaux B, Robertson D. Malnutrition: making the case for more dietitians. Support Line. 2017;39(3):10-12.

Mordarski BA, Hand, RK, Wolff J, Steiber AL. Increased knowledge, self-reported comfort, and malnutrition diagnosis and reimbursement as a result of the nutrition-focused physical exam hands-on training workshop. JAND. 2017;117(11):1822-28.

Dorner, B. & Frederick, E.K. (2018). Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings. J Acad Nutr Diet. 118:724-735. https://www.eatrightpro.org/media/press-releases/positions-and-issues/nutrition-services-for-older-adults-long-term-care-post-acute-other-settings