Clavier Nutrition Avec Doigt

Beginning a new year is such a hopeful time as there’s the sense of being given a fresh start every January 1st.   And with that comes time to set new goals and resolutions for the upcoming year.  What better way to plan for 2020 than to reflect on a few of the major changes that have impacted Food and Nutrition Services in long term care in 2019.

  1. IDDSI (International Dysphagia Diet Standardization Initiative) launched May 1st, 2019. The aim of IDDSI when founded in 2013 was: “Achieve global diet terminology, creating common terminology and common understanding across international borders, across the lifespan, across all professions, and across all stakeholders to help the care of people with difficulty swallowing (dysphagia).”

IDDSI diet framework consists of eight levels (0-7) and includes both foods and liquids on a single continuum. Levels are identified by numbers, text labels, and color codes with drinks being measured from Levels 0-4, while foods are measured from Levels 3-7.  There liquid consistencies are expanded in comparison to the National Dysphagia Diet levels which includes nectar, honey, and pudding thick and within the IDDSI framework includes thin, slightly thick, mildly thick, moderately thick, and extremely thick.

While implementing IDDSI is not mandatory, it will help to streamline diets across the continuum of care.  The IDDSI website provides useful materials including guides for testing for food and liquid testing in addition to patient and caregiver informational materials.

  1. PDPM (Patient Driven Payment Model) started October 1, 2019. CMS replaced the current SNF PPS Resource Utilization Group (RUGs) payment model with the new per-diem payment model PDPM.  As part of the IDT, dietitians and dietary managers can play a critical role in helping achieve maximum reimbursement from CMS.   One nutrition component under section K includes determining whether a swallowing difficulty is present.  Dietitians can assess whether a patient may benefit from a mechanically-altered diet or have a swallowing disorder and refer that patient to the SLP for evaluation.  Any identified swallowing problem or patient requiring a mechanically altered diet should be coded appropriately on the MDS Section K.

Key Non-Therapy Ancillary (NTA) include:

Comorbidity MDS Point Value
Parenteral Nutrition (High) K0510A2, K0710A2 7
Parenteral Nutrition (low) K0510A2, K0710A2, K0710B2 3
Feeding Tube K0510B2 1
Malnutrition (Or Risk of) I5600 1
Morbid Obesity I8000 1

CMS recognizes these conditions and services under PDPM and provides an opportunity for increased reimbursement.  It is designed for the facility to increase the use of appropriate services, such as medical nutrition therapy by a dietitian.  For the first time, the nutrition care and interventions registered dietitians have always provided will help bring revenue into the facility.

  1. On November 28th, 2019 nursing homes were expected to follow Phase 3 of Requirements of Participation set forth by CMS. While the interpretive guidelines have yet to be released, the main focus is on Quality Improvement practices and implementation.    CMS issued a memo “We will be releasing the guidance in the second quarter of calendar year 2020, along with information on training and implementing related changes to The Long Term Care Survey Process (LTCSP).  While the regulations will be effective, our ability to survey for compliance with these requirements will be limited until the Interpretive Guidance is released.”

Now is the time to reflect and plan how these changes will be implemented if you haven’t already started.    Whether it be implementing the new IDDSI terminology, executing new procedures to capture all the various diagnosis/comorbidities that are available under PDPM on the MDS, or establishing new QAPI programs Nutrition Care Systems RD’s are here to help.

Let’s all aim for a healthy and prosperous 2020.