Dietitians who work with nursing home patients are urging the Centers for Medicare & Medicaid Services not to remove critical coding that helps identify seniors either with malnutrition or at risk for it. The coding helps offset the costs of assessment and treatment.
CMS this spring requested comments on a proposal to remove several conditions from the Patient Driven Payment Model’s Non-Therapy Ancillary category. Nursing homes whose patients are coded for specific diagnoses are paid a corresponding NTA add-on to help cover the cost of additional services and supplies.
Both malnutrition and at-risk for malnutrition have received one point toward increased pay since the advent of PDPM. But CMS, looking to refine its list, asked for comments on removing those points as part of its 2025 proposed skilled nursing pay rule.
The Academy of Nutrition and Dietetics says it “strongly opposes the elimination of malnutrition and at-risk for malnutrition” from NTA classification.
“Malnutrition is a prevalent health issue among the Medicare population, with approximately 50% of older adults affected,” Academy leaders wrote in a formal comment letter to CMS.
“Timely identification and evidence-based treatment of malnutrition are vital across the healthcare continuum, preventing adverse outcomes during care transitions,” they added. “Multidisciplinary collaboration, with RDNs [registered dietitian nutritionists] at the forefront, ensures comprehensive malnutrition assessment, personalized treatment, and care continuity, ultimately enhancing patient outcomes and optimizing healthcare resource utilization.”
Janet McKeee, owner of Florida-based Nutritious Lifestyles, estimates between one-third and 60% of patients referred to skilled nursing from a hospital are malnourished. And having ICD-10 coding for malnourishment and risk of malnourishment doesn’t just trigger additional payments, McKee told McKnight’s Long-Term Care News Thursday.
“It gives us a chance to quickly identify that and develop a treatment plan,” she said, noting that her dietitians work with nurses, certified dietary managers, speech pathologists and other members of the interdisciplinary team to intervene after an assessment. “It’s essential we do that early in the admission. The MDS point system really allows us the tools we need.”
Providing a pay boost to cover appropriate services can head off worse outcomes that are often more expensive to treat. Early intervention in the form of supplemented nutrition or strategies that increase caloric intake can help head off additional weight loss, development of pressure ulcers and increased weakness that can diminish a resident’s ability to participate in therapy or complete activities of daily living, McKee warned.
Wide-ranging interventions
Christie Titmus, vice president of clinical operations at Healthcare Services Group, leads a team of dietitians providing nutrition services in skilled nursing facilities across the US.
She calls the additional funding — an average of $5 daily for a single NTA point — facilities currently receive “a critical piece” in the residents’ well being and health outcomes.
A resident properly screened for and diagnosed with malnutrition may need enteral nutrition (tube feeding), additional wound care treatments or IV antibiotics. Nursing homes may need to provide them with additional high calorie foods or supplements to increase nutritive intake and monitor weight and lab work more frequently than for typical patients.
And diagnosed residents also could be included in restorative dining programs that provide greater feeding assistance and supervision due to decreased feeding ability, Titmus said.
“The residents who are at the most risk often need more assistance at meals,” she told McKnight’s. “This may include needing more time to eat a meal, or encouragement and supervision at meal times. Many need to be fed their meals which takes time and nursing staff to do. The best food or supplement interventions are ineffective if the residents are not consuming them. Not to mention the additional time required by the interdisciplinary team to properly monitor and reassess these residents.”
McKee encouraged CMS to reconsider how it views the NTAs related to malnourishment.
“Having that coding is just like having a notification that gets the whole team involved,” she said. “I really hope they don’t take this opportunity away because … even losing five pounds for a person who is 100 pounds … we want to know if she’s lost that weight so our team can pay special attention to her.”
