- Email: [email protected]
Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality – Letter to the Editor
Clinical Nutrition 32 (2013) 488
Contents lists available at SciVerse ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Letter to the Editor
Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality – Letter to the Editor Dear Editor, I have just read with a great interest the article by Su Lin Lim et al.1 I would like to congratulate the Authors for such a thorough analysis of the impact of malnutrition on treatment outcome and health-care costs. It is of utmost importance nowadays to show the way to improve the outcome and reduce costs using clinical nutrition, particularly having in mind cost of disease-related malnutrition (over 14.6 billion Euros annually).2 There are, however, few points in the article that I would like to comment. Firstly, I would like to suggest that Authors use another screening tool instead of Subjective Global Assessment (SGA), chiefly due to its subjectivity. Nutrition Risk Screening 2002 (NRS 2002) or Malnutrition Universal Screening Tool (MUST) would be more accurate as they represent objective scales. Secondly, it would be better to characterize patients not with DRG, but clinical diagnoses (using ICD-10 classification). DRG may be misleading; for example a patient suffering from advanced neoplastic disease, admitted for dehydration may be coded on discharge with E86 (DRG) or C97 and classified to appropriate (K26 and F46) group using DRG. Thirdly, the use of DRG system to estimate profits and losses for the health system can be hazardous, because the financier, either public or private, is always interested only in reduction of expenses, sometimes even disregarding treatment outcome if costs are contained. Thanks to its basic feature, which is the payment for the group described by the disease treated (coded with ICD-10) or disease and procedure performed (coded with ICD-10), DRG represents one of the tools enabling that goal, unfortunately. It is so because insurance company may reimburse just for one and one only treatment described by DRG. In some countries, insurance company does not pay for patient’s readmission in 14 days after discharge if the DRG of that readmission was the same as the one from previous discharge. It helps to save money in the system, and switch real costs to hospitals. In one of our research, performed in the groups of home patients, DRG led to underestimation of real costs.3
Therefore, I think we should call the expenses caused by malnutrition as hospital expenditures and try to focus the attention of health managers on that problem, because the proper and quick treatment of disease-related malnutrition can help them to save money eventually. Last but not least: it would be beneficial to analyze the clinical course of malnourished patients and try to establish whether they received proper nutritional intervention in case the malnutrition was diagnosed and learn whether the screening on admission was not performed ineffectively. Conflict of interest Author hereby declares that the article is original, is not under consideration for publication anywhere else and has not been previously published. Moreover, author declares no potential or actual personal, political or financial interest in the material, information or techniques described in the paper. References 1. Lim SL, Ong KCB, Chan HC, Loke WC, Fergusson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2012;31:345–50. 2. Elia M, Stratton RJ. Calculating the cost disease-related malnutrition in the UK in 2007 (public expenditure only). In: Elia, Russell, editors. Comating malnutrition: recommendations for actions. A report from the advisory group on malnutrition led by BAPEN 2009. p. 39–45. 3. Klek S, Szybinski P, Sierzega M, Szczepanek K, Sumlet M, Kupiec M, et al. Commercial enteral formulas and nutrition support teams improve the outcome of home enteral tube feeding. J Parenter Enteral Nutr 2011;35:380–5.
Stanislaw Klek* Stanley Dudrick Memorial Hospital, 15 Tyniecka Street, 30-050 Skawina, Poland * Tel.: þ48 604293566; fax: þ48 124446846. E-mail address: [email protected]
0261-5614/$ – see front matter Ó 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. http://dx.doi.org/10.1016/j.clnu.2012.12.013
23 August 2012
Contents lists available at SciVerse ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Letter to the Editor
Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality – Letter to the Editor Dear Editor, I have just read with a great interest the article by Su Lin Lim et al.1 I would like to congratulate the Authors for such a thorough analysis of the impact of malnutrition on treatment outcome and health-care costs. It is of utmost importance nowadays to show the way to improve the outcome and reduce costs using clinical nutrition, particularly having in mind cost of disease-related malnutrition (over 14.6 billion Euros annually).2 There are, however, few points in the article that I would like to comment. Firstly, I would like to suggest that Authors use another screening tool instead of Subjective Global Assessment (SGA), chiefly due to its subjectivity. Nutrition Risk Screening 2002 (NRS 2002) or Malnutrition Universal Screening Tool (MUST) would be more accurate as they represent objective scales. Secondly, it would be better to characterize patients not with DRG, but clinical diagnoses (using ICD-10 classification). DRG may be misleading; for example a patient suffering from advanced neoplastic disease, admitted for dehydration may be coded on discharge with E86 (DRG) or C97 and classified to appropriate (K26 and F46) group using DRG. Thirdly, the use of DRG system to estimate profits and losses for the health system can be hazardous, because the financier, either public or private, is always interested only in reduction of expenses, sometimes even disregarding treatment outcome if costs are contained. Thanks to its basic feature, which is the payment for the group described by the disease treated (coded with ICD-10) or disease and procedure performed (coded with ICD-10), DRG represents one of the tools enabling that goal, unfortunately. It is so because insurance company may reimburse just for one and one only treatment described by DRG. In some countries, insurance company does not pay for patient’s readmission in 14 days after discharge if the DRG of that readmission was the same as the one from previous discharge. It helps to save money in the system, and switch real costs to hospitals. In one of our research, performed in the groups of home patients, DRG led to underestimation of real costs.3
Therefore, I think we should call the expenses caused by malnutrition as hospital expenditures and try to focus the attention of health managers on that problem, because the proper and quick treatment of disease-related malnutrition can help them to save money eventually. Last but not least: it would be beneficial to analyze the clinical course of malnourished patients and try to establish whether they received proper nutritional intervention in case the malnutrition was diagnosed and learn whether the screening on admission was not performed ineffectively. Conflict of interest Author hereby declares that the article is original, is not under consideration for publication anywhere else and has not been previously published. Moreover, author declares no potential or actual personal, political or financial interest in the material, information or techniques described in the paper. References 1. Lim SL, Ong KCB, Chan HC, Loke WC, Fergusson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2012;31:345–50. 2. Elia M, Stratton RJ. Calculating the cost disease-related malnutrition in the UK in 2007 (public expenditure only). In: Elia, Russell, editors. Comating malnutrition: recommendations for actions. A report from the advisory group on malnutrition led by BAPEN 2009. p. 39–45. 3. Klek S, Szybinski P, Sierzega M, Szczepanek K, Sumlet M, Kupiec M, et al. Commercial enteral formulas and nutrition support teams improve the outcome of home enteral tube feeding. J Parenter Enteral Nutr 2011;35:380–5.
Stanislaw Klek* Stanley Dudrick Memorial Hospital, 15 Tyniecka Street, 30-050 Skawina, Poland * Tel.: þ48 604293566; fax: þ48 124446846. E-mail address: [email protected]
0261-5614/$ – see front matter Ó 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. http://dx.doi.org/10.1016/j.clnu.2012.12.013
23 August 2012