Malnutrition is a preventable condition that NEXDINE Hospitality recognizes as an opportunity to partner with acute care providers to implement effective Medical Nutrition Therapy and capture increased reimbursement for the facility.
We strive to impact malnutrition statistics and increase patient care with our clinicians leading the initiative within the hospital’s interdisciplinary team.
Statistics of Malnutrition
Malnutrition affects 20–50% of patients who are at risk of becoming or are malnourished.
Malnutrition is typically only diagnosed in 8% of hospitalized patients, leaving many potentially undiagnosed and untreated.
Up to 31% of malnourished patients and 38% of well-nourished patients experience nutritional decline during their hospital stays.
Malnutrition Poses a Significant Burden to Patients and Hospitals
5x maximum likelihood of in-hospital death compared to the general patient population.
56% higher likelihood of 30-day readmissions, with septicemia as the leading diagnosis upon readmission.
34% higher costs for a malnourished patient hospital stay compared to non-malnourished patients.
Addressing Malnutrition Can Improve Patient Outcomes and Lower Costs
27% reduction in 30-day readmission rates for a multi-hospital ACO that optimized its malnutrition care.
24% relative reduction in readmission risk for malnourished patients with a nutrition care plan vs those patients without a care plan.
$4.8M in cost savings generated by a 4-hospital system that implemented a nutrition-focused quality improvement program.
Gap in Malnutrition Coding
Data on malnutrition discharges from the 2018 Healthcare Cost and Utilization Project (HCUP) the most recent nationally representative data were examined and compared with earlier HCUP findings. Based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, 8.9% of all US non-maternal, non-neonatal hospital discharges in 2018 had a coded diagnosis of malnutrition (CDM). From this 2018 data, those with a CDM were older, had longer lengths of stay, and incurred higher costs, as compared with those without a CDM. Higher readmission rates and higher inpatient mortality were also observed in this group. If malnutrition is 20-50% of all patients are considered malnourished, then there is a huge gap in coding and capturing that reimbursement based on the 8.9% per the HCUP study.
Bridging That Gap
Therefore, professionals responsible for the nutrition care of hospitalized patients should understand the prevalence of malnutrition, how to identify and communicate a diagnosis of malnutrition in the medical record, and the sophisticated payment systems used to reimburse hospitals for patient care accurately and consistently. Insight into healthcare payment systems and the requirements for clarity, consistency, and accuracy can improve identification, coding, and billing for malnutrition. Hospitals receive reimbursement for services based on anticipated costs for diagnosis-based groups, and documenting the presence of comorbidity, such as malnutrition, can increase the payment for a diagnosis. It is important to accurately document not only the supporting criteria used to diagnose malnutrition but also the interventions used to address it during a patient’s stay.
Medicare Coding and Reimbursement
Medicare Part A pays for hospital inpatient stays under the Hospital Inpatient Prospective Payment System using predetermined rates for hospital discharges.
Under this system, payment rates vary based on severity-adjusted diagnosis-related groups (MS-DRGs) that are used to describe all types of patients. Patients within each category are similar clinically and are expected to use the same level of hospital resources. Certain diagnoses are designated as a major complication/comorbidity (MCC) or complication/co-morbidity (CC) and may result in a higher Medicare payment to account for more intense levels of care and/or longer lengths of stay.
Hospitals are allowed to bill for the treatment of malnutrition based on the severity of the condition (mild, moderate, or severe) and may qualify for increased reimbursement from Medicare. To do so, not only must the medical diagnosis be determined by the physician, but also a plan of care must be implemented during the hospitalization.
ICD-10-CM Codes for Malnutrition
The following ICD-10-CM codes for malnutrition have been designated as either a major complication/comorbidity (MCC) or complication/co-morbidity (CC) under the MS-DRG system:
Implementation: The Malnutrition Quality Improvement Initiative Toolkit
We had NEXDINE Hospitality has a standardized process to support our partners in malnutrition coding and impact their reimbursement rates. We follow the Malnutrition Quality Improvement Initiative (MQii) Toolkit. This was designed in an effort to support hospitals seeking to implement malnutrition QI initiatives. The Toolkit has been implemented, studied, and updated for optimization of content, adaptability, and usability over several cycles of improvement from 2016-2017 at more than 50 hospital centers in the United States. Hi
The MQii Toolkit provides interdisciplinary care teams (including registered dietitian nutritionists, nurses, physicians, pharmacists, patient advocates, and quality leaders) The MQii Toolkit provides interdisciplinary care teams (including registered dietitian nutritionists, nurses, physicians, pharmacists, patient advocates, and quality leaders) guidance for malnutrition screening, nutrition assessment, malnutrition diagnosis, care plan development, monitoring and evaluation, and discharge planning. These resources enable clinicians to identify care gaps and lead QI efforts at their hospitals, regardless of prior experience with QI processes.
In 2009, A.S.P.E.N. and the European Society for Clinical Nutrition and Metabolism (ESPEN) convened an International Consensus Guideline Committee to develop an etiology-based approach to the diagnosis of adult malnutrition in clinical settings which has then been endorsed by the Academy of Nutrition and Dietetics.
The NEXDINE Hospitality Approach
From a clinical perspective, our Registered Dietitian Nutritionists follow the below diagram onsite with the interdisciplinary team.
Implementing a complete malnutrition program requires several steps which NEXDINE Hospitality has the expertise and tools to support. This includes proper training and practice for Registered Dietitian Nutritionists including Nutrition Focused Physical Assessment and order writing toolkits. In addition, the resources tracking and reporting tools capture revenue and impact the hospital’s CMI. Undertaking the process in a step-by-step approach, including the right leadership stakeholders, and enlisting the assistance of the NEXDINE Hospitality’s Registered Dietitian Nutritionist as subject matter expert to drive the process.
Rebecca McCullough, MS RD CDP, SVP of Nutrition, Health & Wellness, NEXDINE Hospitality
Guenter, P, Abdelhadi, R, Anthony, P, et al. Malnutrition diagnoses and associated outcomes in hospitalized patients: United States, 2018. Nutrition in Clinical Practice. 2021; 36: 957– 969. https://doi.org/10.1002/ncp.10771
National Center for Health Statistics. ICD-10 CM Official Guidelines for Coding and Reporting FY 2021. https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf
White J, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36: 275-283.