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The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
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SPOTLIGHT: EXPANDED OPPORTUNITIES FOR THE USE OF MNT
On May 22, US Representatives Eliot Engel (D-NY) and Pete King (R-NY) introduced the Medical Nutrition Therapy Act of 2020 (HR 6971). This bipartisan bill would amend the Social Security Act to expand the availability of medical nutrition therapy (MNT) services under Medicare Part B. While Medicare currently only covers MNT for patients with diabetes, non-dialysis kidney disease, and 36 months following a kidney transplant, this amendment would expand applicable conditions to include others such as cancer, obesity, dyslipidemia, malnutrition, and any disease related to unintentional weight loss. The bill would also authorize nurse practitioners, physician assistants, clinical nurse specialists, and psychologists to refer their patients for MNT. The bill has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means for further consideration. You can read more about the bill on the Academy’s advocacy website and attend its upcoming webinar on July 7. You can also read more about current Medicare coverage for MNT on Medicare.gov and the Academy’s payment website.
While the current version of the bill would not cover most inpatient dietitian services (except for some working in specialty units), the proposed bill would expand opportunities for dietitians practicing in a wide variety of other settings to be reimbursed for their services, which could increase Medicare patients’ access to important interventions provided by dietitians. Increased coverage of these services may enable inpatient dietitians to feel more comfortable referring patients to dietitians as they are discharged and transition across care settings, and may support improved care coordination between dietitians and physicians in both inpatient and outpatient settings. We know that many of you are interested in expanding the role of nutrition in ERAS programs in your site(s), and the expanded access to dietitians before and after surgery if this bill is signed into law could lead to improvement in patients’ surgical outcomes. Additionally, many of you focus in specific areas such as oncology and eating disorders, which are also areas in which expanded access to dietitians could lead to improved health outcomes. Should you be interested in more information on this bill or would like to engage on this opportunity, please reach out to the Academy’s Policy Initiatives and Advocacy team at [email protected].
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As the pandemic continues to spread, the MQii Leadership Team is compiling resources about responding to COVID-19 for Learning Collaborative members. Here are a few resources and updates that may be of use to you during this time:
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WHAT'S AROUND THE CORNER?
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Please check the MQii Learning Collaborative Calendar to see a schedule of upcoming events with corresponding registration links, including 2020 MQii Learning Collaborative Expert Webinars.
Coffee Break: “How to Use Your MQii Performance Report to Improve/Expand Care Within Your Hospital” | Wednesday, July 29, 2020, at 1:00 PM ET
This conversation will provide an opportunity for Learning Collaborative members to discuss how collection and analysis of patient data can be used to improve or expand nutrition care for patients within your hospital. This will be particularly important as facilities begin to understand the impact of the current pandemic on patients’ nutritional status and nutrition care delivery.
Please register for the Coffee Break in advance here.
Coffee Break: “Best Practices for Malnutrition Care Amidst Changing Roles of Dietitians” | Tuesday, August 11, 2020, at 2:00 PM ET
This conversation will provide an opportunity for Learning Collaborative members to discuss how the COVID-19 pandemic has forced dietitians in many settings across the country to adjust their practices and roles to meet patients’ needs, and how these might be continued to improve patient care going forward.
Please register for the Coffee Break in advance here.
POSTPONED Expert Webinar: “Interactions Between Malnutrition and Gastrointestinal Disease”
The expert webinar, “Interactions Between Malnutrition and Gastrointestinal Disease,” was originally scheduled for June 10 but will be postponed until the fall due to time constraints and clinical needs posed by the COVID-19 pandemic. During this future webinar, participants will learn about:
- The connections between gastrointestinal (GI) diseases, diet, and nutritional status
- How GI diseases affect physiology and present in nutritional assessments
- Suggestions for providing optimal interdisciplinary care to meet nutritional needs for patients with GI diseases
The webinar will feature Gerry Mullin, MD, MS, Johns Hopkins Medicine, and Laura Matarese, PhD, RDN, LDN, CNSC, FADA, FASPEN, FAND, East Carolina University. Attendees will be eligible to receive a one-hour CPEU credit for their participation.
We will announce the rescheduled date in the upcoming Dish and on our website once available so that you can register in advance.
For all of our expert webinars and Coffee Breaks, we encourage you to send any questions for the speakers in advance to [email protected].
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In case you missed it:
If you missed previous MQii Learning Collaborative expert webinars, you can access webinar recordings and slides on the MQii Member Portal. You will also find other member-only content, including the calendar of upcoming events, pre-recorded educational webinars, and archived Dish newsletters, on this site. As a reminder, the login information is: Username: MQii Password: MQiiLC2018!
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Consider opportunities to share your MQii project and findings!
The following table outlines an upcoming meeting that may be of interest to Learning Collaborative members in the coming months. We encourage you to look at the event websites, review submission criteria, and consider sharing your research with various audiences. While many 2020 conferences have either been cancelled, rescheduled, or moved to a virtual setting, we encourage you to still participate when possible. Please reach out with any questions or for assistance in pulling submission materials together.
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NUTRITION RESEARCH
Articles Highlight Links Between Malnutrition, Protein Intake, and Fall Risk
A recent article by Smith et al. evaluated an intervention called Stepping Up Your Nutrition, designed for older adults at high risk of falls. Titled, “A Brief Intervention for Malnutrition among Older Adults: Stepping Up Your Nutrition,” the article offers an example of a workshop-centered intervention that can serve the additional purpose of identifying malnutrition risk among community-dwelling older adults and link them to needed services. This 2.5-hour workshop consists of education, self-assessments, and activities to teach participants about how nutrition and muscle strength impact risk of falls, how lifestyle factors build muscle, and how to take action to reduce their risk. The authors also concluded that further efforts are necessary to expand the delivery infrastructure of this promising intervention. This study offers an innovative example of an intervention that can both provide needed education and be used to detect and treat previously undetected malnutrition in community settings across the country.
Additionally, Paul et al. recently published a study titled, “Association between Very Low Dietary Protein Intake and Subsequent Falls in Community-Dwelling Older Adults in the United States,” analyzing the important connection between diet and health risk based on retrospective survey data. The authors found that very low protein intake may be a risk factor for predicting future falls in older adults with a history of falls. They also concluded that their findings reinforce the importance of screening for low protein intake among those with a history of falls to prioritize referrals for nutrition interventions. Such screenings in outpatient settings can help to protect older adults and reduce the risk of falls as well as declining nutritional status and various associated diseases.
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LEARNING COLLABORATIVE PARTICIPANT RESOURCES
NFPE “Tip of the Month”
Presence of Malnutrition Clinical Characteristics and Outcomes
In a retrospective chart review conducted at a Veterans Affairs (VA) tertiary care facility, data were gathered on veterans with documented malnutrition. The most frequent malnutrition clinical characteristics indicated under the severe, acute illness, or injury-related malnutrition were: inadequate energy intake (85%), weight loss (85%), and muscle loss (75%). The most prevalent malnutrition clinical characteristics indicated under the severe, chronic illness-related malnutrition were: muscle loss (93.8%) and fat loss (87.7%). Overall, the data showed that the 4 most identified characteristics for patients identified with malnutrition were: muscle loss (84.7%), fat loss (79.7%), weight loss (77.8%), and inadequate energy intake (68.3%). Analysis of the number of malnutrition clinical characteristics (between 2 and 6) per patient showed that 4 of the characteristics were most often identified (at 42.6%) for all degrees and categories of malnutrition.
The authors also compared the malnourished group of veterans to a non-malnourished control group and found that the malnourished group was more likely to be readmitted within 30 days (31% vs 12%); die within 90 days of discharge (32% vs 8%); and have a hospital length of stay >7 days (41% vs 14%).
Mirroring MQii recommendations and steps addressed by the malnutrition eCQMs, the authors concluded that factors including interdisciplinary early nutrition screenings, malnutrition identification using standardized guidelines, prompt intervention, ongoing inpatient monitoring, and post-discharge follow-up can improve patient outcomes.
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NEXT STEPS
- Visit the COVID-19 page on our website for more resources
- Attend the upcoming July Coffee Break if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition quality improvement programs
- Share your progress or reach out with any questions to your MQii Point of Contact. Please also let us know about any transitions in leadership, requested topics for future events, or additional events of interest to share with other members
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