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Getting paid for nutrition services: a model to improve reimbursement and efficiency in a variety of private practice settings
SUNDAY, OCTOBER 3
ORIGINAL CONTRIBUTIONS: MEDICAL NUTRITION THERAPY TITLE: USE OF PROGRAM OUTCOMES TO MARKET A DIABETES SELF MANAGEMENT PROGRAM AUTHOR(S): C.S. Chima, MS, RD; N.F. Dziak, MS, RD; P.A. Cardwell, MS, RD; S.H. Snow, MS, RD; C.A. Schmidt, RN; The MetroHealth System, Cleveland, OH LEARNING OUTCOME: To identify one system for tracking outcomes of participants in a Diabetes Self Management Program (DSMP) and relate how these outcomes may be used to increase program referrals. TEXT: Outcomes are key in evaluating the effectiveness of care, meeting accreditation requirements, and marketing DSMPs to physicians, patients, and third party payors. In our program, a baseline A1C is requested on referral. At the patient’s first visit, assessment data is entered directly into an online database form, including baseline demographics, lab data, medical, and social history. Quarterly, updated weight and lab data is downloaded from the electronic outpatient system for patients in the program. To date, approximately 300 patients have been entered onto the program roster. Mean body mass index (BMI) of patients referred is 36.4⫹-9.0, range 18.4 to 69.5. More than 75% of patients referred are classified as obese based on BMI at baseline. Of all patients who had pre and post program A1Cs, median baseline A1C was 9.3%, and the median last available A1C was 7.3%, p⬍.001, n⫽133 (patients ranged from 90 days to more than 3 years out from program entry.) Of those patients, 39% had most recent A1C’s less than 7%; 23% had A1Cs ⬎7 and ⱕ8%, and 37% had A1Cs ⬎ 8%. These outcomes reflect program interventions and medication changes as indicated. As a result of these outcomes, we secured approval to implement an alert in the outpatient charting system triggered by a diagnosis of diabetes and an A1C⬎8.5%. Internal Medicine physicians receive a message recommending they consider a referral to the DSME. Since implementation of the prompt, referrals to the program have increased 40%. The prompt will be expanded to Family Practice patients this year. FUNDING DISCLOSURE: No grant funding
TITLE: TAKING THE SHOW ON THE ROAD; MEDICAL NUTRITION THERAPY MEDICARE REIMBURSEMENT. GETTING PAID FOR WHAT YOU DO AUTHOR(S): S.I. Zwick-Hamilton, MS, RD, LD, CDE; Harborside Healthcare, Beachwood, OH; K. Palmer, RD, LD, CDE; Food Solutions Inc., Lakewood, OH LEARNING OUTCOME: Assess the understanding of the importance of becoming a Medicare provider. TEXT: Due to decreasing census in healthcare facilities and cuts in Medicare payment, dietetic professionals appear to have a renewed interest in Medical Nutrition Therapy Medicare reimbursement. An Ohio Dietetic Association sponsored seminar was held in 2004 to assess local interest in Medicare reimbursement. With an increased interest in revenue generating departments, many dietetic professionals have sought access to more information on the revenue generating process. The seminar included sessions on accurate billing, the history of Medicare reimbursement, the application process, troubleshooting and an expert panel question and answer period. Incentives, such as complimentary lunch, chair massages, beauty consultations, and multidistrict involvement tripled attendance. Sixty individuals, the majority being in practice greater than 5 years, attended and appeared satisfied with the information as demonstrated by program evaluations, questions asked and verbal feedback. A seven-question survey was administered and completed by 28 participants. One hundred percent of respondents answered yes to the question: Following this seminar, do you understand the importance of becoming a Medicare provider. Only twenty percent of the respondents were currently Medicare providers. Five percent were pending for Medicare provider approval. Local seminars taking a how to trouble shooting approach generate renewed interest concerning the importance of becoming a Medicare Provider. Attendees identified their individual fiscal and political benefits and barriers to reimbursement. The seminar identified who are providers and those who want to be involved in networking to help get legislation passed to improve reimbursement. FUNDING DISCLOSURE: Ohio Dietetic Association budget for Reimbursement and Coverage Committee
TITLE: GETTING PAID FOR NUTRITION SERVICES: A MODEL TO IMPROVE REIMBURSEMENT AND EFFICIENCY IN A VARIETY OF PRIVATE PRACTICE SETTINGS AUTHOR(S): M. Davis, MS, RD, LDN, FADA, CDE; Live Nutrition, Brewster, MA LEARNING OUTCOME: To increase the scope and efficiency of billing, reimbursement and revenue possibilities for Registered Dietitians in private practice by utilization of a model of practice management techniques, information technologies and client education. TEXT: Registered Dietitians are increasingly employed in a variety of non-traditional and non-salaried positions in a variety of practice settings. Independent practitioners and consultants bill clients and third party payers to seek reimbursement for services but often meet with frustration during the billing process. Despite Medicare Medical Nutrition Therapy coverage and growing recognition of Dietitians as the nutrition experts by the general public and the medical community, they must seek more efficient ways of keeping their practices viable in a climate of declining or insufficient third party reimbursement rates. In order to be compensated for providing expert MNT as well as preventive nutrition care, efficient modalities for practice management can be adopted by solo practitioners as well as larger practices, thereby decreasing frustration with the reimbursement process, increasing job satisfaction, promoting greater focus on direct client care. The program presents a model of how Dietitians can implement a strategic business plan that improves reimbursement through a combination of 1) adoption of practice management techniques, 2) utilization of hardware and software to network and integrate consultation and billing processes, 3) implementation of electronic medical record documentation to meet specific MNT and practice needs, 4) an education program to target the client’s role and responsibility in the reimbursement process, and 5) use of a website to facilitate practice operations. FUNDING DISCLOSURE: Lytec Corporation (pending)
A-12 / August 2004 Suppl 2—Abstracts Volume 104 Number 8
ORIGINAL CONTRIBUTIONS: MEDICAL NUTRITION THERAPY TITLE: USE OF PROGRAM OUTCOMES TO MARKET A DIABETES SELF MANAGEMENT PROGRAM AUTHOR(S): C.S. Chima, MS, RD; N.F. Dziak, MS, RD; P.A. Cardwell, MS, RD; S.H. Snow, MS, RD; C.A. Schmidt, RN; The MetroHealth System, Cleveland, OH LEARNING OUTCOME: To identify one system for tracking outcomes of participants in a Diabetes Self Management Program (DSMP) and relate how these outcomes may be used to increase program referrals. TEXT: Outcomes are key in evaluating the effectiveness of care, meeting accreditation requirements, and marketing DSMPs to physicians, patients, and third party payors. In our program, a baseline A1C is requested on referral. At the patient’s first visit, assessment data is entered directly into an online database form, including baseline demographics, lab data, medical, and social history. Quarterly, updated weight and lab data is downloaded from the electronic outpatient system for patients in the program. To date, approximately 300 patients have been entered onto the program roster. Mean body mass index (BMI) of patients referred is 36.4⫹-9.0, range 18.4 to 69.5. More than 75% of patients referred are classified as obese based on BMI at baseline. Of all patients who had pre and post program A1Cs, median baseline A1C was 9.3%, and the median last available A1C was 7.3%, p⬍.001, n⫽133 (patients ranged from 90 days to more than 3 years out from program entry.) Of those patients, 39% had most recent A1C’s less than 7%; 23% had A1Cs ⬎7 and ⱕ8%, and 37% had A1Cs ⬎ 8%. These outcomes reflect program interventions and medication changes as indicated. As a result of these outcomes, we secured approval to implement an alert in the outpatient charting system triggered by a diagnosis of diabetes and an A1C⬎8.5%. Internal Medicine physicians receive a message recommending they consider a referral to the DSME. Since implementation of the prompt, referrals to the program have increased 40%. The prompt will be expanded to Family Practice patients this year. FUNDING DISCLOSURE: No grant funding
TITLE: TAKING THE SHOW ON THE ROAD; MEDICAL NUTRITION THERAPY MEDICARE REIMBURSEMENT. GETTING PAID FOR WHAT YOU DO AUTHOR(S): S.I. Zwick-Hamilton, MS, RD, LD, CDE; Harborside Healthcare, Beachwood, OH; K. Palmer, RD, LD, CDE; Food Solutions Inc., Lakewood, OH LEARNING OUTCOME: Assess the understanding of the importance of becoming a Medicare provider. TEXT: Due to decreasing census in healthcare facilities and cuts in Medicare payment, dietetic professionals appear to have a renewed interest in Medical Nutrition Therapy Medicare reimbursement. An Ohio Dietetic Association sponsored seminar was held in 2004 to assess local interest in Medicare reimbursement. With an increased interest in revenue generating departments, many dietetic professionals have sought access to more information on the revenue generating process. The seminar included sessions on accurate billing, the history of Medicare reimbursement, the application process, troubleshooting and an expert panel question and answer period. Incentives, such as complimentary lunch, chair massages, beauty consultations, and multidistrict involvement tripled attendance. Sixty individuals, the majority being in practice greater than 5 years, attended and appeared satisfied with the information as demonstrated by program evaluations, questions asked and verbal feedback. A seven-question survey was administered and completed by 28 participants. One hundred percent of respondents answered yes to the question: Following this seminar, do you understand the importance of becoming a Medicare provider. Only twenty percent of the respondents were currently Medicare providers. Five percent were pending for Medicare provider approval. Local seminars taking a how to trouble shooting approach generate renewed interest concerning the importance of becoming a Medicare Provider. Attendees identified their individual fiscal and political benefits and barriers to reimbursement. The seminar identified who are providers and those who want to be involved in networking to help get legislation passed to improve reimbursement. FUNDING DISCLOSURE: Ohio Dietetic Association budget for Reimbursement and Coverage Committee
TITLE: GETTING PAID FOR NUTRITION SERVICES: A MODEL TO IMPROVE REIMBURSEMENT AND EFFICIENCY IN A VARIETY OF PRIVATE PRACTICE SETTINGS AUTHOR(S): M. Davis, MS, RD, LDN, FADA, CDE; Live Nutrition, Brewster, MA LEARNING OUTCOME: To increase the scope and efficiency of billing, reimbursement and revenue possibilities for Registered Dietitians in private practice by utilization of a model of practice management techniques, information technologies and client education. TEXT: Registered Dietitians are increasingly employed in a variety of non-traditional and non-salaried positions in a variety of practice settings. Independent practitioners and consultants bill clients and third party payers to seek reimbursement for services but often meet with frustration during the billing process. Despite Medicare Medical Nutrition Therapy coverage and growing recognition of Dietitians as the nutrition experts by the general public and the medical community, they must seek more efficient ways of keeping their practices viable in a climate of declining or insufficient third party reimbursement rates. In order to be compensated for providing expert MNT as well as preventive nutrition care, efficient modalities for practice management can be adopted by solo practitioners as well as larger practices, thereby decreasing frustration with the reimbursement process, increasing job satisfaction, promoting greater focus on direct client care. The program presents a model of how Dietitians can implement a strategic business plan that improves reimbursement through a combination of 1) adoption of practice management techniques, 2) utilization of hardware and software to network and integrate consultation and billing processes, 3) implementation of electronic medical record documentation to meet specific MNT and practice needs, 4) an education program to target the client’s role and responsibility in the reimbursement process, and 5) use of a website to facilitate practice operations. FUNDING DISCLOSURE: Lytec Corporation (pending)
A-12 / August 2004 Suppl 2—Abstracts Volume 104 Number 8