Marty’s Corner: Balancing Healthcare Costs and Patient Safety (Takeaways from the ASPEN Meeting)
In January of this year, I attended ASPEN (American Society of Parenteral and Enteral Nutrition) Clinical Nutrition Week. Several sessions dealt with the cost of healthcare and particularly that of malnutrition, including a keynote entitled The Cost of Safety. We’ve all heard these figures before – that, in the USA, our healthcare costs are higher than most countries – 17% of our Gross National Product (2013 data), which is more than 150% of that of many other countries (e.g. Canada’s is 10.7%, the UK’s is 8.8%). We spend $8508 per capita annually on healthcare, as compared to $4522 in Canada and $3405 in the UK and $3000 more than Norway, the second highest spender. The USA also has higher rates of errors – medical, lab, and medication – as compared to other First World countries. Penalties imposed by the Centers for Medicare and Medicaid Services (CMS) for patient readmissions within 30 days, as well as its Value Based Purchasing (VBP) scores, can help control spending and reduce errors. A VBP scoring factor for Safety (e.g. number of infections after surgery) was recently added, with a 20% weight in determining a site’s score.
Another session I attended was entitled, “Your Survival: Communicating and Effectively Working with the C-Suite.” One of the speakers on this panel noted how several initiatives as part of health care reform are focusing on the positive impact of nutrition status on a patient’s health and outcomes. Adequate nutrition screening and follow-up are key components that can also reduce costs. Putting greater emphasis on screening, assessment, and intervention fits well with the Department of Health and Human Services’ movement away from traditional fee-for-service payments towards alternative payment models (like medical homes) and population-based payment. CMS is also paying attention to the incidence of malnutrition in long-term care facilities and issued a Proposed Rule this past July aimed at reforming requirements for those facilities. This includes permission for the physician to delegate to the dietitian the authority to assign a therapeutic diet, which we’ve seen in acute-care facilities this past year (as permitted by laws in the state).
Other sessions I attended dealt with specific topics such as body composition or energy requirements of critically ill neonates. A resounding theme throughout the conference, though, was how provision of adequate nutrition at every stage of care can result in better patient outcomes. These improved outcomes may not only help the USA eventually lower its healthcare spending per capita, but can also help hospitals maximize their net revenue.
Article by: Marty Yadrick, MBI, MS, RDN, FAND - Director of Nutrition Informatics and former President of the Academy of Nutrition and Dietetics; Fusion, 2nd Quarter, 2016