Practice paper of the academy of nutrition and dietetics: principles of productivity in food and nutrition services: applications in the 21st century health care reform era.

Food and nutrition services, along with the health care organizations they serve, are becoming increasingly complex. These complexities are driven by sometimes conflicting (if not polarizing) human, department, organization, and environment factors and will require that managers shift how they think about and approach productivity in the context of the greater good of the organization and, perhaps, even society. Traditional, single-factor approaches to productivity measurements, while still valuable in the context of departmental trend analysis, are of limited value when assessing departmental performance in the context of an organization's goals and values. As health care continues to change and new models of care are introduced, food and nutrition services managers will need to consider innovative approaches to improve productivity that are consistent with their individual health care organization's vision and mission. Use of process improvement tools such as Lean and Six Sigma as strategies for evaluating and improving food and nutrition services efficiency should be considered.

Medical nutrition therapy provided to adult hematopoietic stem cell transplantation patients.

This study explored the current medical nutrition therapy (MNT) provided to adult patients undergoing hematopoietic stem cell transplantation (HSCT) and examined the current and desired role of registered dietitians (RDs) in providing MNT. A total of 60 RDs (57% response rate) responded to an electronic questionnaire. Descriptive statistics and χ(2) analyses (SPSS; version 18) were used. Results revealed the primary form of diet was oral, and for patients on nutrition support, parenteral nutrition (PN) was used more frequently (16%-31%) than enteral nutrition (EN) (5%-9%; P ≤ .05). Nutrition support decisions were based on patients' individualized needs rather than established protocol or policies. Mucositis was the most common reason for implementing PN (31%), and intubation or being in the intensive care unit was the most common reason for implementing EN (28%). The RDs had varying degrees of autonomy in order writing and were most often recommending MNT to the physician or writing the MNT order with a physician cosignature. Many RDs reported desiring higher autonomy than what they were currently practicing (P < .05). Those who held a certified specialist in oncology (CSO) or certified nutrition support dietitian/clinician (CNCD/C) certification were significantly more likely to have and desire greater autonomy in order writing than those without specialty credentials (P ≤ .05). No difference was found in current practice or desired autonomy based on the years of experience or educational degree.

Registered dietitians' coding practices and patterns of code use.

Coding, coverage, and reimbursement are vital to the clinical segment of our profession. The objective of this study was to assess understanding and use of the medical nutrition therapy (MNT) procedure codes. Its design was a targeted, cross-sectional, Internet survey. Participants were registered dietitians (RDs) preselected based on Medicare Part B provider status, randomly selected RDs from the American Dietetic Association database based on clinical practice designation, and self-selected RDs. Parameters assessed were knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use/compensation, need for additional codes for existing/emerging services, and practice demographics. Results suggest that MNT is being reimbursed for a variety of diseases and conditions. Many RDs working in clinic settings are undereducated about code use of any kind, reporting that code selection frequently is determined not by the RD providing the service, but by "someone else." Self-employed RDs are less likely to rely on others to administrate paperwork required for reimbursement, including selection of procedure codes for billable nutrition services. Self-employed RDs are more likely to be reimbursed by private or commercial payers and RDs working in clinic settings are more likely to be reimbursed by Medicare; however, the proportion of Medicare providers in both groups is high. RDs must be knowledgeable and accountable for both the business and clinical side of their nutrition practices; using correct codes and following payers' claims processing policies and procedures. This survey and analysis is a first step in understanding the complex web of relationships between clinical practice, MNT code use, and reimbursement.

A survey of perceived benefit and differences in therapy provided by credentialed and noncredentialed nutrition support dietitians.

BACKGROUND: Benefits of the certified nutrition support dietitian (CNSD) credential to clinicians, their patients, and healthcare administrators have not been defined. A study was designed to measure the difference in cost of therapy provided by credentialed and noncredentialed nutrition support dietitians and to measure the perceived value of the credential to those who hold it. METHODS: Using a modified Delphi technique, a questionnaire was developed to obtain demographic information, responses to statements of perceived benefit of the credential, and costs of therapy selected for patients in common clinical scenarios. RESULTS: Of the 691 questionnaires mailed, 314 (45%) were returned. For 8 of 10 statements of perceived benefit, mean response scores indicated agreement. Respondents did not agree that salary increases resulted from credentialing. There was no difference between groups in the type of monitoring selected or in the time to complete an initial assessment. Cost of therapy was significantly higher for credentialed versus noncredentialed dietitians (dollar 915.67 +/- dollar 241.73 versus dollar 851.78 +/- dollar 243.44; p = .035), although the survey was not designed to show that the most appropriate care was least expensive. CONCLUSIONS: The CNSD credential is of perceived benefit to practitioners except in obtaining salary increases. Credentialed dietitians selected more expensive therapy than noncredentialed dietitians, which would benefit healthcare administrators only if reduction of other costs resulted. More complex models are needed to fully assess the benefit of credentialed nutrition support dietitians to patients and healthcare administrators.