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Shaping the Marketplace for Medical Nutrition Therapy—Advocating for Coverage
practice applications
PUBLIC POLICY NEWS
Shaping the Marketplace for Medical Nutrition Therapy—Advocating for Coverage
A
s a nation we are spending more on health care than ever. We are spending at a pace that leaders in both the public and private sector have deemed unsustainable. With health care costs now more than 15% of our national economy, government and private insurance are on the hunt for innovative cost-containment strategies. As a result, disease management, pay-for-performance, and outcomes data are buzzwords we hear being associated with the future of the marketplace. With care that increasingly is multidisciplinary, high-quality, and costeffective comes a unique opportunity for registered dietitians (RDs). Medical nutrition therapy (MNT) can serve as a means to contain costs yet provide high-quality, evidence-based care. According to a study by the Institute of Medicine (1), “Expanded coverage for nutrition therapy is likely to generate economically significant benefits to beneficiaries and, in the short term, to the Medicare program itself through reduced healthcare expenditures.” The challenge now for RDs is to bring that message to coverage decision makers. The work of RDs is critical to millions of Americans, including many who have limited access to nutrition services due to inadequate health insurance. Therefore, it is vital that RDs be at the table, today and in years to come, advocating for the expansion MNT coverage. The implications for the profession and the public are enormous.
This article was written by Tori Katz, MSJ, communications manager for the Nutrition Services Coverage Team at ADA in Chicago, IL. doi: 10.1016/j.jada.2006.05.265
WHY IS ADVOCACY SO IMPORTANT? Jane Garvey, former deputy administrator at the Federal Highway Administration, said, “The future is not someplace we are going to, but a place we are creating. The paths to it are not found, they are made.” This theory holds true for the future of the dietetics profession. In order to influence coverage, payment decisions, and continue to provide service in the marketplace, RDs must demonstrate that they are the preferred providers of nutrition services and work to increase visibility and recognition. According the Institute of Medicine (1), “With regard to the selection of health care professionals to provide nutrition therapy, the registered dietitian is currently the single identifiable group of health care professionals with standardized education, clinical training, continuing education, and national credentialing requirements necessary to be directly reimbursed as a provider of nutrition therapy.” RDs have to catch up with other health professions for recognition and what many would call “respect.” With respect comes the ability to influence the future of coding, coverage, and health policy issues. For example, the Medicare MNT victory of 2000 opened the door for the American Dietetic Association (ADA) and RDs. ADA now has representation on the American Medical Association coding and payment committees to create coding and payment policies for MNT codes, new education and training codes, and team conference codes. In addition, RD recognition among physician and nonphysician practitioners, the Centers for Medicare & Medicaid Services, Blue Cross Blue Shield, and the American Hospital Association is better than ever. According to an American Academy of Pediatrics (2) policy, “multidisciplinary team management is strongly recommended for youth with type 2
© 2006 by the American Dietetic Association
diabetes mellitus. The team usually is composed of a physician, a registered dietitian, a nurse clinician, a social worker, and the patient and the family.” Despite these accolades, there is still work to be done— especially at the local level. HOW DO RDs ADVOCATE FOR EXPANSION OF THEIR SERVICES? RDs who are successful advocates know the rules of self advocacy and how to apply them to real world opportunities. The process includes these five steps: 1. Know the law—This includes federal, state, and local legislation and the regulations that are promulgated to implement the laws. 2. Develop/use your resources— This includes contacting your elected officials, advocacy organizations, medical directors affiliated with the plan, other health care professionals, and consumers. Establish a dialogue because a single meeting will not create or sustain a relationship. Consider asking people familiar with your work and its value to attest to the importance of dietetics and to help advocate for your cause. Gather outcomes and other important data. 3. Assert yourself—This means coordinating with your state affiliates and ADA, gather financial data on the health plan, and use outcomes data from hospitals or private practitioners’ practices to show the impact of nutrition services. 4. Ask for change—Make specific requests, arrange meetings, and get others on your side. 5. Follow-up—Always follow up and remember to be gracious of their time. Sandy Woodruff, RD, past presi-
Journal of the AMERICAN DIETETIC ASSOCIATION
1027
PUBLIC POLICY NEWS
CHANGE OF ADDRESS Moving? ADA members can fill out and mail the tearout postcard found in the back of the Journal, or update online at ADA’s Online Business Center at www.eatright.org. Log on with your member ID number and Web password and access your member profile to change the address. Nonmember notification should be sent to Journal of the American Dietetic Association, Elsevier, Periodicals Dept, 6277 Sea Harbor Dr, Orlando, FL 328874800 or email at [email protected].
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July 2006 Volume 106 Number 7
dent of the Florida Dietetic Association, knows that people with a shared goal and willingness to advocate can make a difference. When Florida passed legislation to reform its Medicaid system in 2005, Woodruff and her colleagues saw an opportunity to establish RDs as uniquely qualified to provide nutrition services within the state program. They attended Florida Medicaid reform meetings in large cities and rural areas and testified about the role of MNT and RD services in health care. They have been successful in getting the attention of decision makers throughout the state. Currently, Woodruff and her colleagues are advocating for inclusion of MNT wherever possible, including in new Medicaid demonstration projects. HOW CAN ADA HELP RDs TO PROMOTE COVERAGE OF NUTRITION SERVICES? ADA knows just how critical advocacy is to the health of the profession and has a number of resources to assist members in their quest for coverage and payment. In June the Nutrition Services Coverage Team released a revised edition of the MNT Works Kit. The kit was created to assist members’ MNT marketing initiatives, and can be used during meetings and presentations to local third-party payers, employer groups, and hospital finance and billing departments. For the latest edition, the Nutrition Services Coverage Team obtained input from the affiliate and dietetic practice group reimbursement representatives, outlined commonly used codes, and found the latest return on investment data available on MNT. The current version of the MNT Works Kit can be easily downloaded from the MNT section of ADA’s Web site, and as of July members can request a hard copy. In an effort to make communication with third-party payers as seamless as possible, ADA will be developing a PowerPoint presentation for members to deliver to coverage decision makers. The Nutrition Services Coverage Team will also be available to assist members in locating state specific information. To be well-informed advocates, ADA members might also consider contacting their state reimbursement representative. ADA has volunteer
reimbursement representatives in every state for local information about reimbursement from third-party payers. The reps share MNT reimbursement and Medicare information with local members— directing members to additional resources or members involved with MNT coding and coverage. In the “Advocacy and the Profession” section of ADA’s Web site, members can stay up to date on the latest policy news. Members can sign up for On the Pulse, ADA’s policy initiatives and advocacy report; obtain evidencebased data on MNT, obesity, child nutrition, and health aging; and learn about ADA’s Public Policy Workshop 2007, which will be held April 23-25. WHAT ARE THE IMPLICATIONS FOR THE PROFESSION AT LARGE? Many people talk about nutrition, but only a few can talk as knowledgeably about the connections between food, nutrition, and health as RDs. Advocacy at the national, state, local, and personal level will work both for individual RDs and the profession’s advantage. “If your voice is not heard, others will step in and shape current and future coverage and payment issues,” said Jane White, PhD, RD, FADA, a member of ADA’s coding committee. If we are not self-advocates, White said, others will shape how facilities offer nutrition services and by whom. References 1. Committee on Nutrition Services for Medicare Beneficiaries Food and Nutrition Board. The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: Institute of Medicine; 1999. 2. Gahagan S, Silverstein J; American Academy of Pediatrics Committee on Native American Child Health; American Academy of Pediatrics Section on Endocrinology. Prevention and treatment of type 2 diabetes mellitus in children with special emphasis on American Indian and Alaska Native Children. Pediatrics. 2003;112:328-347. Available at: http://www.pediatrics. org/cgi/content/full/112/4/e328. Accessed May 11, 2005.
PUBLIC POLICY NEWS
Shaping the Marketplace for Medical Nutrition Therapy—Advocating for Coverage
A
s a nation we are spending more on health care than ever. We are spending at a pace that leaders in both the public and private sector have deemed unsustainable. With health care costs now more than 15% of our national economy, government and private insurance are on the hunt for innovative cost-containment strategies. As a result, disease management, pay-for-performance, and outcomes data are buzzwords we hear being associated with the future of the marketplace. With care that increasingly is multidisciplinary, high-quality, and costeffective comes a unique opportunity for registered dietitians (RDs). Medical nutrition therapy (MNT) can serve as a means to contain costs yet provide high-quality, evidence-based care. According to a study by the Institute of Medicine (1), “Expanded coverage for nutrition therapy is likely to generate economically significant benefits to beneficiaries and, in the short term, to the Medicare program itself through reduced healthcare expenditures.” The challenge now for RDs is to bring that message to coverage decision makers. The work of RDs is critical to millions of Americans, including many who have limited access to nutrition services due to inadequate health insurance. Therefore, it is vital that RDs be at the table, today and in years to come, advocating for the expansion MNT coverage. The implications for the profession and the public are enormous.
This article was written by Tori Katz, MSJ, communications manager for the Nutrition Services Coverage Team at ADA in Chicago, IL. doi: 10.1016/j.jada.2006.05.265
WHY IS ADVOCACY SO IMPORTANT? Jane Garvey, former deputy administrator at the Federal Highway Administration, said, “The future is not someplace we are going to, but a place we are creating. The paths to it are not found, they are made.” This theory holds true for the future of the dietetics profession. In order to influence coverage, payment decisions, and continue to provide service in the marketplace, RDs must demonstrate that they are the preferred providers of nutrition services and work to increase visibility and recognition. According the Institute of Medicine (1), “With regard to the selection of health care professionals to provide nutrition therapy, the registered dietitian is currently the single identifiable group of health care professionals with standardized education, clinical training, continuing education, and national credentialing requirements necessary to be directly reimbursed as a provider of nutrition therapy.” RDs have to catch up with other health professions for recognition and what many would call “respect.” With respect comes the ability to influence the future of coding, coverage, and health policy issues. For example, the Medicare MNT victory of 2000 opened the door for the American Dietetic Association (ADA) and RDs. ADA now has representation on the American Medical Association coding and payment committees to create coding and payment policies for MNT codes, new education and training codes, and team conference codes. In addition, RD recognition among physician and nonphysician practitioners, the Centers for Medicare & Medicaid Services, Blue Cross Blue Shield, and the American Hospital Association is better than ever. According to an American Academy of Pediatrics (2) policy, “multidisciplinary team management is strongly recommended for youth with type 2
© 2006 by the American Dietetic Association
diabetes mellitus. The team usually is composed of a physician, a registered dietitian, a nurse clinician, a social worker, and the patient and the family.” Despite these accolades, there is still work to be done— especially at the local level. HOW DO RDs ADVOCATE FOR EXPANSION OF THEIR SERVICES? RDs who are successful advocates know the rules of self advocacy and how to apply them to real world opportunities. The process includes these five steps: 1. Know the law—This includes federal, state, and local legislation and the regulations that are promulgated to implement the laws. 2. Develop/use your resources— This includes contacting your elected officials, advocacy organizations, medical directors affiliated with the plan, other health care professionals, and consumers. Establish a dialogue because a single meeting will not create or sustain a relationship. Consider asking people familiar with your work and its value to attest to the importance of dietetics and to help advocate for your cause. Gather outcomes and other important data. 3. Assert yourself—This means coordinating with your state affiliates and ADA, gather financial data on the health plan, and use outcomes data from hospitals or private practitioners’ practices to show the impact of nutrition services. 4. Ask for change—Make specific requests, arrange meetings, and get others on your side. 5. Follow-up—Always follow up and remember to be gracious of their time. Sandy Woodruff, RD, past presi-
Journal of the AMERICAN DIETETIC ASSOCIATION
1027
PUBLIC POLICY NEWS
CHANGE OF ADDRESS Moving? ADA members can fill out and mail the tearout postcard found in the back of the Journal, or update online at ADA’s Online Business Center at www.eatright.org. Log on with your member ID number and Web password and access your member profile to change the address. Nonmember notification should be sent to Journal of the American Dietetic Association, Elsevier, Periodicals Dept, 6277 Sea Harbor Dr, Orlando, FL 328874800 or email at [email protected].
1028
July 2006 Volume 106 Number 7
dent of the Florida Dietetic Association, knows that people with a shared goal and willingness to advocate can make a difference. When Florida passed legislation to reform its Medicaid system in 2005, Woodruff and her colleagues saw an opportunity to establish RDs as uniquely qualified to provide nutrition services within the state program. They attended Florida Medicaid reform meetings in large cities and rural areas and testified about the role of MNT and RD services in health care. They have been successful in getting the attention of decision makers throughout the state. Currently, Woodruff and her colleagues are advocating for inclusion of MNT wherever possible, including in new Medicaid demonstration projects. HOW CAN ADA HELP RDs TO PROMOTE COVERAGE OF NUTRITION SERVICES? ADA knows just how critical advocacy is to the health of the profession and has a number of resources to assist members in their quest for coverage and payment. In June the Nutrition Services Coverage Team released a revised edition of the MNT Works Kit. The kit was created to assist members’ MNT marketing initiatives, and can be used during meetings and presentations to local third-party payers, employer groups, and hospital finance and billing departments. For the latest edition, the Nutrition Services Coverage Team obtained input from the affiliate and dietetic practice group reimbursement representatives, outlined commonly used codes, and found the latest return on investment data available on MNT. The current version of the MNT Works Kit can be easily downloaded from the MNT section of ADA’s Web site, and as of July members can request a hard copy. In an effort to make communication with third-party payers as seamless as possible, ADA will be developing a PowerPoint presentation for members to deliver to coverage decision makers. The Nutrition Services Coverage Team will also be available to assist members in locating state specific information. To be well-informed advocates, ADA members might also consider contacting their state reimbursement representative. ADA has volunteer
reimbursement representatives in every state for local information about reimbursement from third-party payers. The reps share MNT reimbursement and Medicare information with local members— directing members to additional resources or members involved with MNT coding and coverage. In the “Advocacy and the Profession” section of ADA’s Web site, members can stay up to date on the latest policy news. Members can sign up for On the Pulse, ADA’s policy initiatives and advocacy report; obtain evidencebased data on MNT, obesity, child nutrition, and health aging; and learn about ADA’s Public Policy Workshop 2007, which will be held April 23-25. WHAT ARE THE IMPLICATIONS FOR THE PROFESSION AT LARGE? Many people talk about nutrition, but only a few can talk as knowledgeably about the connections between food, nutrition, and health as RDs. Advocacy at the national, state, local, and personal level will work both for individual RDs and the profession’s advantage. “If your voice is not heard, others will step in and shape current and future coverage and payment issues,” said Jane White, PhD, RD, FADA, a member of ADA’s coding committee. If we are not self-advocates, White said, others will shape how facilities offer nutrition services and by whom. References 1. Committee on Nutrition Services for Medicare Beneficiaries Food and Nutrition Board. The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: Institute of Medicine; 1999. 2. Gahagan S, Silverstein J; American Academy of Pediatrics Committee on Native American Child Health; American Academy of Pediatrics Section on Endocrinology. Prevention and treatment of type 2 diabetes mellitus in children with special emphasis on American Indian and Alaska Native Children. Pediatrics. 2003;112:328-347. Available at: http://www.pediatrics. org/cgi/content/full/112/4/e328. Accessed May 11, 2005.