CMS Rule on Therapeutic Diet

Orders

CMS Rule on Therapeutic Diet Orders Centers for Medicare and Medicaid Services (CMS) final rule

allows RDNs privilege to: Order patient diets without requiring the supervision or approval

of a physician or other practitioner; and

Order laboratory tests to monitor effectiveness of dietary plans and orders

Effective as of July 11th, 2014

Why is this important? Provide patients better health care

Save hospitals time and money

What can we do?

Tip #1: Utilize the Academy’s online resource tools Implementation Steps- Ordering Privileges for the RDN

Hospital Regulation- Ordering Privileges for the RDN

http://www.eatrightpro.org/resource/advocacy/quality-health-care/consumer-protection-and-licensure/learn-about-the-cms-rule-on-therapeutic-diet-orders

Tip #2: Contact another RD/RDN with success implementing final rule

Things to know

Iowa has no regulatory barriers to asking for hospital privileges to order

Check the hospital’s medical staff rules, regulations, and bylaws or other facility-specific procedures

In order to obtain privileges, a hospital must have: Regulatory flexibility to appoint an RD/RDN(s) to the

medical staff and grant specific nutrition ordering privileges, or

Can authorize the ordering privileges without appointment to the medical staff

First steps

Steps in determining how hospital & medical staff decide privileges: Ask how hospital and medical staff prefer to proceed

Whether they want to allow an RD/RDN(s) to order therapeutic diets independent of the physician (no physician co-signature)

The process for granting ordering privileges

What patient population, if not all patients, to allow privileges

Specify scope of care services to be granted

When the RD/RDN(s) must defer to and consult with medical staff

Evaluate any changes that need to be made in the RD/RDN(s) job description

Liability insurance

Potential Costs and Benefits

Estimated economic impact of $459 million to hospitals reoccurring annually

Based on savings from lower average hourly cost of RD/RDN compared to physician’s/APRN’s/PA’s

Questions?

References

Practice Tips: Hospital Regulation- Ordering Privileges for the RDN. Academy of Nutrition and Dietetics website. http://www.eatrightpro.org/~/media/eatrightpro%20files/advocacy/practice-tips-hospital-regulation-ordering-privileges-for-the-rdn.ashx Published July 16, 2014. Accessed February 17, 2015.

Practice Tips: Implementation Steps- Ordering Privileges for the RDN. Academy of Nutrition and Dietetics website. http://www.eatrightpro.org/~/media/eatrightpro%20files/advocacy/practice-tips-implementation-steps-ordering-privileges-for-the-rdn.ashx Published July 16, 2014. Accessed February 17, 2015.