itive change—such as improvement in the patient’s clinical or functional status, demonstrable financial benefits, or a shortened time period for treatment or care— that is a direct result of the MNT provided. The implementation of the Nutrition Care Process (NCP) and creation of the standardized NCPT have greatly enhanced the ability of RDNs to capture outcomes in data directly related to the care they provide.63


Documentation should show whether the nutrition diagnosis was re-


solved, note changes in the signs and symptoms identified in the PES (problem, etiology, and signs and symptoms) statement, and detail improvement in overall nutrition-related health outcomes such as weight, blood pressure, lipid levels, or reduced medication requirements.60 Documenting MNT outcomes is essential for the following reasons:


› Managed care demands positive outcomes. Insurance will reimburse only those health care services that are proven to produce positive outcomes in a cost-


effective manner.


› Consumers and referring providers also demand outcomes information. Patients expect to see results and may ask about the program’s track record before they


schedule and come to an appointment or other service. › Outcomes are the basis for standardized MNT protocols.


› Positive outcomes demonstrate the effectiveness of RDNs to physicians, which in turn generates referrals that can produce revenue for your facility.


› Emerging reimbursement models, such as medical homes and bundled services, will also put outcomes data under enhanced scrutiny to ensure programs are


cost-effective and benefit patients. CNMs should have a plan in place to collect outcomes data at the initial patient


visit and then at regularly timed intervals thereafter and should be prepared to report and market positive outcomes to insurers, hospital administrators, and physi- cians as well as the community, colleagues, and prospective patients. With continued advancements of the EHR, there is ample opportunity to collaborate with informatics specialists to develop reports and automated methods for collecting and reporting outcomes. In addition, resources such as MNT Providing Return on Investment64


and


the Academy of Nutrition and Dietetics Evidence Analysis Library (www . andeal . org) may be helpful in identifying key outcomes of interest.


Summary


The CNM’s range of responsibilities is extensive and may include both inpatient and outpatient nutrition services. CNMs, especially those new to their position, should seek the guidance of leaders within and outside their department, other CNMs in their hospital system, and CNMs at other hospitals. A network of individuals who can share real-world experiences, as well as advice based on those experiences, is priceless. The Academy of Nutrition and Dietetics has abundant resources of value to the CNM, including the Clinical Nutrition Management Dietetic Practice Group, the Quality Management Committee, and extensive information related to payment and leadership. CNM is a challenging and fulfilling role for RDN leaders, and one that impacts patient care as well as patient and organizational outcomes.


CHAPTER 4: Clinical Nutrition Management 99


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