A vision of the future for physician practice in nutrition.

One obstacle that may discourage physician trainees from pursuing a career in clinical nutrition is the perception that such physician practice does not generate sufficient income. A review of the history of Medicare and the current payment system for healthcare services by the U.S. government is essential to understand which members and what services provided by a nutrition support team (NST) will be reimbursed. Patients who require nutrition therapy tend to have multiple comorbidities, which should allow for a higher level of billing under evaluation and management codes. Despite the fact that an intact NST improves outcome and helps ensure patient safety, such teams may not be able to function independently and remain financially sustainable. Hospital administration should be mandated to support an institutional nutrition service. Strategies to define malnutrition and identify measures of quality nutrition care should help demonstrate the value and promote the importance of a functioning NST.