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The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
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SPOTLIGHT: JUNE MNT PROVIDER FEATURES QCDR RESOURCES
The latest issue of the Academy of Nutrition and Dietetics’ MNT Provider features information on the new malnutrition quality measures for Merit-based Incentive Payment System (MIPS) reporting via Qualified Clinical Data Registries (QCDRs). This reporting system for malnutrition measures offers an excellent opportunity to both improve quality of care for malnourished patients and further highlight the important role of the registered dietitian in doing so. Academy members can watch the Academy’s free series of four, 15-minute webinars about QCDRs for further information. The MQii also plans to offer an expert webinar focused on QCDRs for Learning Collaborative members later in 2020; we will promote this via the Dish and on our website when further information is available.
Further, the Academy recently submitted a comment letter to urge the Centers for Medicare and Medicaid Services (CMS) to include the Global Malnutrition Composite Score Measure (which is based on the malnutrition electronic clinical quality measures) in the 2020/2021 Measures Under Consideration List. Including this composite measure would be an important step to advance malnutrition care and impact related outcomes such as reducing hospital readmissions, length-of-stay, and overall healthcare costs.
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COVID-19 CORNER
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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NUTRITION POLICY UPDATE
Following the May introduction of the Medical Nutrition Therapy Act of 2020, the Academy is asking that dietitians share stories highlighting the impact of MNT in treating and preventing diseases/conditions that would be covered under the MNT Act of 2020. These could include stories highlighting the effectiveness of MNT services for older adults at a time they were unable to see a patient due to lack of Medicare coverage for a certain disease or condition. Meanwhile, the Academy continues to work to advance this bill and is currently helping develop a companion Senate bill. If you would like to learn more, Academy members can view the recording of the July 7th webinar or corresponding slides. Should you be interested in more information on this bill or would like to engage in this opportunity, please reach out to the Academy’s Policy Initiatives and Advocacy team at [email protected].
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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 | Tuesday, August 11, 2020, at 2:00 PM ET (postponed from July 29th)
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 | Monday, August 24, 2020, at 3:00 PM ET (postponed from August 11th)
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.
Canceled Expert Webinar: Interactions Between Malnutrition and Gastrointestinal Disease
While we had planned to postpone the expert webinar, “Interactions Between Malnutrition and Gastrointestinal Disease,” until the fall due to time constraints and clinical needs imposed on our speakers by the COVID-19 pandemic, continuing constraints on the speakers have led us to cancel this webinar. We are planning 3 additional webinars in the remainder of 2020 and will announce in the Dish and on our website when they are scheduled 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 conferences 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 the various audiences. While many 2020 conferences have either been cancelled, rescheduled, or moved to a virtual setting, we encourage you to still participate in these when possible. Please reach out with any questions or for assistance in pulling submission materials together.
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MALNUTRITION IN THE NEWS
An audit recently reported by the Office of the Inspector General (OIG) identified that hospitals overbilled Medicare $914,128 by incorrectly assigning severe malnutrition diagnosis codes (E41 and E44) to inpatient hospital claims in fiscal years 2016 and 2017. Notably, the estimated overpayments identified in this audit represent less than 0.5% of the overall payments made for inpatient services during these two years. Adding severe malnutrition diagnoses results in a higher Medicare payment and previous audits have concluded that incorrect diagnoses have led to overbilling, as well. In response to these findings, OIG recommended that CMS notify the pertinent providers so that they can identify, report, and return any overpayments within the mandatory 60-day period.
The Academy serves on ASPEN's Malnutrition Coding and Reimbursement Task Force, which is actively working on a strategy to help the US Department of Health and Human Services, OIG, and CMS to understand the best practices for diagnosing, documenting, and coding malnutrition. Many MQii sites have asked for support addressing questions regarding appropriate documentation for coding and billing of malnutrition services. MQii sites are encouraged to review the Academy/ASPEN Consensus Statement: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition and A Step-By-Step Guide to Implementing a Malnutrition Coding Program for Adult Inpatients. Recommendations include partnering with physicians to review dietitians’ malnutrition assessment results and clear, thorough documentation of the findings and rationale for malnutrition diagnoses as well as the associated care plan. The malnutrition eCQMs offer helpful steps to ensure appropriate evaluation, care, and documentation of patients’ nutritional status. MQii sites should continue working with interdisciplinary teams to ensure evidence-based identification and documentation of malnutrition.
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MALNUTRITION RESEARCH
Articles Highlight Links Between Malnutrition, Food Intake, and Poor Health
A recent study by Sandoval-Insausti et al. found that consumption of ultra-processed foods is strongly associated with frailty risk in older adults. In their article titled, “Ultra-processed Food Consumption and Incident Frailty: A Prospective Cohort Study of Older Adults,” the authors describe their prospective cohort study with 1,822 adults age 60 and older. After a 3.5-year follow-up, 132 participants were identified as frail. Based on participants’ dietary histories, the authors measured the adjusted risks of frailty across increasing quartiles of the percentage of total energy intake from ultra-processed foods (such as pastries, packaged juices, etc.). The strong association led the authors to conclude that substituting unprocessed or minimally processed foods is important for preventing age-related frailty. As appropriate, including this dietary recommendation in counseling and education for older patients who are malnourished or at risk of malnutrition can be an important step to optimize their health.
Additionally, Bilgen et al. recently published a study titled, “Insufficient Calorie Intake Worsens Post-Discharge Quality of Life and Increases Readmission Burden in Heart Failure,” evaluating the relationship between calorie intake and outcomes in hospitalized patients with heart failure (HF) following discharge. While it is known that malnutrition worsens outcomes for patients with HF, the subjects in this study population with HF were primarily obese and rarely malnourished; and yet, the authors found that insufficient calorie intake was associated with poorer quality of life following hospital discharge and increased readmission rates. The authors concluded that improving inpatient dietary assessment could be used to better stratify patients by readmission risk and those with highest need for nutritional intervention. As these goals of improving malnutrition assessments and reducing readmissions are important goals for all Learning Collaborative members, this association suggests another potential strategy for quality improvement in malnutrition care.
Finally, Arensberg et al. published an article titled, “Opportunities for Quality Improvement Programs (QIPs) in the Nutrition Support of Patients with Cancer,” describing the important role that QIPs (such as the MQii) can play in improving care processes and helping to meet quality measure performance goals, as well as opportunities to engage in translational research. Such programs can be used to improve the consistency and accuracy of malnutrition screening and interventions in ambulatory cancer care, thereby improving health outcomes. Implementation of a malnutrition-focused QIP in outpatient cancer care presents an important opportunity for Learning Collaborative members to better address patients’ nutritional needs across care settings.
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LEARNING COLLABORATIVE PARTICIPANT RESOURCES
NFPE “Tip of the Month”
The nutrition-focused physical exam (NFPE) provides supportive data spanning from head to toe to identify malnutrition in patients. It is one of the five domains of the Nutrition Care Process (NCP) for a complete nutrition assessment.
- Loss of Subcutaneous Fat—orbital fat pads, buccal fat pads, triceps, ribs/mid-axillary line
- Loss of Muscle Mass—temporalis (temples), pectoralis (clavicle), deltoid (shoulder), interosseous (hand), trapezius/infraspinatus/supraspinatus (scapula), quadriceps (thigh), gastrocnemius (calf)
- Fluid Accumulation—upper and lower extremities, vulvar/scrotal edema, ascites
- Functional Status—reduced handgrip strength via dynamometer
Additional review can be found in Academy of Nutrition and Dietetics’ NFPE Pocket Guide.
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NEXT STEPS
- Visit the COVID-19 page on our website for more resources
- Attend the upcoming upcoming August 11th Coffee Break (rescheduled from July 29th) if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition initiatives
- 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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