New Opportunity to Better Integrate Nutrition into Clinical Preventive Care

March is National Nutrition Month and a good time to consider how nutrition can be better integrated into clinical preventive care for older adults. One opportunity is a new health equity Improvement Activity for food insecurity and nutrition risk identification and treatment. This Improvement Activity (IA) was recently approved by the Centers for Medicare & Medicaid Services (CMS) for 2022 reporting in their Merit-based Incentive Payment System (MIPS).

Office-based physicians and clinicians who participate in MIPS can now choose this new IA to help enhance clinical practice and better patient outcomes. Here are the facts to know:

What Is MIPS?

It has been more than five years since eligible office-based physicians and clinicians caring for Medicare patients moved from a traditional fee-for-service to a value-based payment model as mandated by the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA). This value-based system, known as the Quality Payment Program, includes MIPS and provides incentives for improved clinician performance based on quality, costs, promoting interoperability and improvement activities. The goal is to incentivize high quality, accessible and cost-efficient care, particularly for expensive chronic diseases like diabetes and heart disease. Integrating quality nutrition care into the MIPS framework can help to better address chronic diseases and support active aging.

What Are MIPS Improvement Activities?

MIPS IAs are designed to support practice improvement goals and to have a high impact on healthcare quality. They are focused on improving clinical processes, enhancing care delivery, and increasing access to care. Clinicians choose IAs appropriate to their practice, allowing them to focus on their specific patient population, while implementing the processes needed to deliver optimal care.

‘It is estimated that every day, 15,000 hospitalized patients with malnutrition are not diagnosed.’

Unlike quality measures, IAs are not compared against benchmarks or results from other clinicians. Instead, the focus is on implementing planned activities that will lead to better care delivery and improved performance for individual clinical practices. More than 100 IAs are available to select for 2022, including the new food insecurity and nutrition risk IA (see pages 2353–54 of the Final Rule).

How Does Nutrition Fit?

The structure of MIPS encourages clinicians to focus more broadly on preventive care areas like nutrition. Better nutrition care also can help clinicians improve their performance on required quality metrics, such as those related to falls risk, diabetes control and hospital readmissions. Food insecurity and nutrition risk (often called malnutrition, which can include undernutrition, overnutrition, lack of adequate protein, calories and/or other nutrients) are interconnected conditions that worsened during the pandemic. Malnutrition can lead to a number of poor health outcomes including increased morbidity and mortality, increased length of hospital stay and rehospitalizations, increased healthcare costs and increased disability. Food insecurity and malnutrition are also related to health equity as poor diet and lack of access to healthy foods can contribute to health disparities.

Unfortunately, malnutrition is frequently not identified or treated; it is estimated that every day, 15,000 hospitalized patients with malnutrition are not diagnosed. These patients may be discharged without any identification or treatment of their malnutrition, so follow-up by office-based clinicians is critical to determine risk for food insecurity and malnutrition and provide recommendations for intervention.

Where Do Clinicians Start?

CMS identified in its final rule (pp. 2353–54) specific actions to implement the food insecurity and nutrition risk IA, including using the Malnutrition Quality Improvement Initiative (MQii) and standardized screening tools. The MQii offers a number of resources for MIPS participants and has outlined helpful screening and intervention workflows (see Figure below).

Figure: Food Insecurity and Nutrition Risk Screening Workflows



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In addition, the MQii offers further information about the new food insecurity and malnutrition risk IA and links to validated screening tools for food insecurity and nutrition risk screening. As clinicians develop implementation plans for the food insecurity and nutrition risk IA, working with a multidisciplinary team, including a registered dietitian nutritionist, can help identify optimal documentation, workflows, tools and community referral pathways and resources.

More than 1 million clinicians caring for Medicare patients around the country are reported to use MIPS, including physicians, physician assistants, nurse practitioners, physical and occupational therapists, clinical psychologists, speech-language pathologists, audiologists, registered dietitian nutritionists and clinical social workers. Helping prevent and treat chronic diseases remain top priorities for these providers as they continue to work to improve care quality and lower costs. Implementing the food insecurity and nutrition risk IA can help clinicians improve chronic disease outcomes through better preventive care and support health equity for older adults.

Beth Besecker, MD, MBA, SSGB, is director of Medical Affairs Adult Nutrition–U.S. for the Abbott Nutrition Division of Abbott in Columbus, Ohio