Does malnutrition influence hospital reimbursement? A call for malnutrition diagnosis and coding

Fernandes, A.C.O.; Pessoa, Ana; Vigário, M.A.; Jager‐Wittenaar, Harriët; Pinho, João Pedro

doi:10.1016/j.nut.2020.110750

Cited by 9 publications

(12 citation statements)

References 36 publications

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“…The findings of this study also have economic implications. Since hospital reimbursement depends on the hospitalization costs and case mix index, the identification of patients at risk followed by nutritional assessment, documenting and coding of malnutrition would increase potential hospital reimbursement [15,[37][38][39], which would help further investment in nutritional care. In fact, the economic situation has been shown to influence the fight against malnutrition, including education and treatment [40].…”

Section: Discussionmentioning

confidence: 99%

High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study

Marinho

Pessoa²,

Lopes

et al. 2020

European Journal of Internal Medicine

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Section: Discussionmentioning

confidence: 99%

High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study

Marinho

Pessoa²,

Lopes

et al. 2020

European Journal of Internal Medicine

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“…Studies have shown that diagnosing, documenting and coding undernutrition can increase hospital reimbursement, since hospital reimbursement relies on the case-mix index. 20,[27][28][29] Increased hospital reimbursement could facilitate further investment in nutritional care and help compensating the costs associated with undernutrition. 29,30 Future studies should investigate the cost associated with coding undernutrition, as this could be an incentive to screen, evaluate, and treat malnourished patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study

Marinho

Pessoa²,

Lopes

et al. 2021

Acta Med Port

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Introduction: Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians’ impression of nutritional risk and evaluation by Nutritional Risk Screening 2002.Material and Methods: A cross-sectional multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Data on demographics, previous hospital admissions, primary diagnosis, and Charlson comorbidity index score were collected. Nutritional risk at admission was assessed using Nutritional Risk Screening 2002. Agreement between physicians’ impression of nutritional risk and Nutritional Risk Screening 2002 was tested by Cohen’s kappa.Results: The study included 729 participants (mean age 74 ± 14.6 years, 51% male). The main reason for admission was respiratory disease. Mean Charlson comorbidity index score was 5.8 ± 2.8. Prevalence of nutritional risk was 51%. Nutritional risk was associated with admission during the previous year (odds ratio = 1.65, 95% confidence interval: 1.22 - 2.24), solid tumour with metastasis (odds ratio = 4.73, 95% confidence interval: 2.06 - 10.87), any tumour without metastasis (odds ratio = 2.04, 95% confidence interval:1.24 - 3.34), kidney disease (odds ratio = 1.83, 95% confidence interval: 1.21 - 2.75), peptic ulcer (odds ratio = 2.17, 95% confidence interval: 1.10 - 4.25), heart failure (odds ratio = 1.51, 95% confidence interval: 1.11 - 2.04), dementia (odds ratio = 3.02, 95% confidence interval: 1.96 - 4.64), and cerebrovascular disease (odds ratio = 1.62, 95% confidence interval: 1.12 - 2.35). Agreement between physicians’ evaluation of nutritional status and Nutritional Risk Screening 2002 was weak (Cohen’s kappa = 0.415, p < 0.001).Discussion: Prevalence of nutritional risk in the Internal Medicine population is very high. Admission during the previous year and multiple comorbidities increase the odds of being at-risk. Subjective physician evaluation is not appropriate for nutritional screening.Conclusion: The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.

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“…Public hospitals in Singapore receive funding from the government based on case mix (diagnosis-related groups), and coding of malnutrition will impact case-mix funding favorably for this group of patients, 24 as well as increase hospital revenue. 25 A significant number of patients lost to follow-up died or were readmitted to the hospital likely because of the severity or progression of the disease. A high proportion of patients with oncological histories and on palliative care contributed to this high rate.…”

Section: Discussionmentioning

confidence: 99%

“…A national guideline on diagnosing and treating malnutrition should be considered and used as a diagnostic criterion for MediFund support. Public hospitals in Singapore receive funding from the government based on case mix (diagnosis‐related groups), and coding of malnutrition will impact case‐mix funding favorably for this group of patients, 24 as well as increase hospital revenue 25 …”

Section: Discussionmentioning

confidence: 99%

Medical Nutrition Reimbursement in Singapore: Who Are the Patients Receiving MediFund Assistance? An Audit of Clinical Outcomes and Issues Pertaining to Reimbursement in a Public Hospital in Singapore

Wong

Goh

et al. 2020

J Parenter Enteral Nutr

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Background: Financial reimbursement (MediFund) of medical nutrition products (MNPs) was recently implemented in some of the public hospitals in Singapore for patients with financial difficulties. This study aimed to investigate the sustainability of this policy and the benefits conferred. Methods: We performed a 1-year retrospective audit of patients in a tertiary hospital who received MediFund. Demographics, presupport and postsupport clinical outcomes, and cost of support were determined and analyzed. Results: A total of 129 patients received MediFund for MNPs. The median length of financial support was 115 days (interquartile range, 37-269). Overall, body mass index increased after nutrition support (20.9 ± 5.1 vs 20.4 ± 5.3; P = .012). There was a significant decrease in the number of malnourished patients (final, 55.1% vs initial, 86.8%; P < .001) and a significant increase in 7-point subjective global assessment scores (final, 4.9 ± 1.3 vs initial, 4.1 ± 1.3; P < .001) after MNP support. MNP adherence was high for 88.5% of patients who returned for follow-up appointments. Patients who defaulted follow-up appointments were more likely to have 30-day readmission (50% vs 19.5%; P < .001) and had higher mortality rates (35.7% vs 10.3%; P < .001). Total reimbursement of S $108,960 was provided to subsidize MNPs over 1 year. Conclusion: Supporting patients with financial difficulties led to an improvement in their nutrition status. Regular dietitian reviews of patients and monitoring compliance to consumption of MNPs are essential to ensure patients benefit from the support.

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Does malnutrition influence hospital reimbursement? A call for malnutrition diagnosis and coding

Cited by 9 publications

References 36 publications

High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study

High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study

Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study

Medical Nutrition Reimbursement in Singapore: Who Are the Patients Receiving MediFund Assistance? An Audit of Clinical Outcomes and Issues Pertaining to Reimbursement in a Public Hospital in Singapore

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