Medical Nutrition Therapy for Adults in Health Resources & Services Administration-Funded Health Centers: A Call to Action.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 450 words

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Abstract :

Abstract Vulnerable adult populations' access to cost-effective medical nutrition therapy (MNT) for improving outcomes in chronic disease is poor or unquantifiable in most Health Resources & Services Association (HRSA)-funded health centers. Nearly 50% of the patients served at Federally Qualified Health Centers are enrolled in Medicaid; the lack of benefits and coverage for MNT is a barrier to care. Because the delivery of MNT provided by registered dietitian nutritionists is largely uncompensated, health centers are less likely to offer these evidence-based services and strengthen team-based care. The expected outcomes of MNT for adults with diabetes, obesity, hypertension, and other conditions align with the intent of several clinical quality measures of the Uniform Data System and quality improvement goals of multiple stakeholders. HRSA should designate MNT as an expanded service in primary care, require reporting of MNT and registered dietitian nutritionists in utilization and staffing data, and evaluate outcomes. Modification to the Centers for Medicare & Medicaid Services Prospective Payment System rules are needed to put patients over paperwork: HRSA health centers should be compensated for MNT provided on the same day as other qualifying visits. Facilitating the routine delivery of care by qualified providers will require coordinated action by multiple stakeholders. State Medicaid programs, Medicaid Managed Care Organizations, and other payers should expand benefits and coverage of MNT for chronic conditions, factor the cost of providing MNT into adequate and predictable payment streams and payment models, and consider these actions as part of an overall strategy for achieving value-based care. Author Affiliation: (1) California State University Sacramento, Family and Consumer Sciences Department, Sacramento, CA (2) White Salmon, WA (3) Santa Barbara, CA (4) Salud Medical Clinic, Woodburn, OR (5) Nutrition Services Integration, Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL (6) Legislative and Government Affairs, Academy of Nutrition and Dietetics, Washington, DC (7) Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago IL (8) Miami Beach, FL * Address correspondence to: Michelle Kuppich, RD, Nutrition Services Coverage, Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606. (footnote) STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors. (footnote) FUNDING/SUPPORT There is no funding to disclose. (footnote) AUTHOR CONTRIBUTIONS N. Braunstein, M. Guerrero, S. Liles wrote and revised drafts with the support of Academy staff member M. Kuppich. All authors reviewed and commented on subsequent drafts of the manuscript. Byline: Nadine Braunstein, PhD, RD, LDN, FAND (1), Michele Guerrero, RD (2), Susan Liles, MS, RD (3), Antonio Germann, MD, MPH (4), Michelle Kuppich, RD [mkuppich@eatright.org] (5,*), Hannah Martin, MPH, RDN (6), Marsha Schofield, MS, RD, LD, FAND (7), Krista Yoder Latortue, MBA, RD, LDN, FAND (8)

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Gale Document Number: GALE|A676152122