Better patient nutrition may mean fewer Medicare readmissions

New research suggests that healthcare organizations can lower their readmission rates and improve patient care simply by using oral nutritional supplements as part of an overall patient care protocol.

The study, presented in late October at the Society for Medical Decision Making meeting in Baltimore, relied on an 11-year data analysis of hospitalized Medicare patients aged 65 and over with any diagnosis, and those carrying a diagnosis of acute myocardial infarction, congestive heart failure or pneumonia. The matched sample for all Medicare patients aged 65 and over for any primary diagnosis was 667,684 hospital stays. For purposes of the study, oral nutritional supplements given to patients were defined as dietary food, often in liquid form, that provide calories, protein and nutrients for added nutrition and energy in the diet.

The analysis demonstrated that use of nutritional supplements were associated with an 8.4 percent reduction in 30-day readmissions for patients with any diagnosis, a 10.1 percent reduction among patients with congestive heart failure, and a 12 percent reduction for acute myocardial infarction patients. The research was conducted by teams at the University of Southern California, Stanford University, The Harris School at The University of Chicago and Precision Health Economics.

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“Malnutrition is a really big problem among patients, and particularly with the Affordable Care Act and the readmission penalties – it’s something we can focus on that can decrease these readmissions,” said Kelly Tappenden, Ph.D., R.D., FASPEN,  Alliance to Advance Patient Nutrition representative from the Academy of Nutrition and Dietetics. “One in three patients enters the hospital malnourished. Patients do not do as well with malnutrition. They have increased chances of complications, infections and lengths of stays.”

The study also discovered a 16 percent, or 1.65 days, reduction in length of stay among all the studied patients, and 15.8 percent in cost savings per episode, equivalent to $3,079.

These cost savings are even more important when considering that, effective on Oct. 1, the ACA increased hospital penalties based on readmissions for three conditions: acute myocardial infarction, congestive heart failure and pneumonia, with an estimated $227 million in fines expected to be levied by Medicare this year, said Tappenden.

The Centers for Medicare & Medicaid Services is also looking at expanding readmission penalties to include other diagnoses such as chronic obstructive pulmonary disease (COPD), and knee and hip replacements.

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Tappenden explained that while the facts about nutritional supplement use are public knowledge, nutrition is often overlooked and undervalued at hospitals. Even more disturbing, she said that although the Joint Commission mandates a nutritional screening of patients within 24 hours of admissions, such a procedure is not always completed or followed up on.

“The therapeutic value of nutrition is often underappreciated by many clinicians, which is why we’re trying to improve awareness with data on how to reduce costs so they can start paying attention more and put into place these procedures,” Tappenden said.

The Alliance to Advance Patient Nutrition suggests that hospitals make nutrition and nutritional screenings a part of the entire care team's responsibilities. Tappenden says attention to detail will likely improve Medicare readmission rates by decreasing malnutrition.

“Talk about nutrition, make sure it’s not overlooked, and screen 100 percent of the patients,” she said. “Engage evidence-based care that we know will make a difference. Hospital administrators also need to take a role – share the quality and economic gains at the hospital against the relatively low investment in nutritional programs. Administrators are really important for communication. Ensure that this isn’t left on the table.”