NN&I - January 2012

Nutrition Update Referrals needed to impact survival Peggy Harum RD LD Recent research led by Yelena Slinin MD and colleagues of the VA Medical Center in Minneapolis1 has shown that the survival of patients on dialysis in the first year of treatment can be improved significantly if a dietitian is involved more than 12 months before the start of treatment Predialysis care by a dietitian was associated in the study with lower total cholesterol levels and normal albumin levels at the onset of dialysis In general hemodialysis patients who had the advantage of dietary counseling were more likely to maintain appropriate nutrition Medicare has been paying for medical nutrition therapy for patients within six months of a kidney transplant and for those with a glomerular filtration rate of 15 to 50 since 2002 But only 105 of the patients beginning dialysis since 2005 received dietary counsel before commencing ESRD therapy Why is this Medicare covered service rarely used Obtaining a provider number is easy Primary care physicians need to know that dietary therapy in chronic kidney disease is effective In addition to slowing progression medical nutrition therapy can mitigate and in some cases improve complications of CKD said Eileen Newman MS RD associate director of the National Kidney Disease Education Program National Institute of Diabetes and Digestive and Kidney Diseases Everyone patients and providers benefits if patients with kidney disease receive effective instruction on dietary interventions Medicare makes it easy for renal dietitians to get their National Provider Identifier NPI number This number allows them to offer medical nutrition therapy to CKD patients The dietitian can use the offices of a nephrologist to counsel CKD patients and the office can then bill Medicare using the dietitians NPI number to reimburse for these services but getting the referrals not so much While working in North Carolina as a renal dietitian I obtained my NPI number in 2009 I offered MNT services to five nephrologists who provided care for patients at our clinic but did not receive any referrals despite the fact that Medicare covered it Renal dietitians are a very altruistic group we want to help patients But referrals are needed Perhaps as renal dietitians we need to do a better job of educating our medical directors as to the value of our pre dialysis counseling Have we earned the respect of our nephrologists to merit this referral There is a financial benefit for all involved Now we just need to motivate the doctors to allow us to provide this needed service A recognized value Before Medicare funded the MNT services I received hundreds of referrals while working as a renal dietitian in the Miami area for more than 30 years My counseling helped people with CKD prevent the progression of their disease Now that the data shows we can help reduce mortality in that first crucial year on dialysis referrals to the renal dietitian when patients are at CKD stage 3 5 can make a difference References 1 Slinin Y Guo H Gilbertson D Mau LW Ensrud K Collins A Ishani A Prehemodialysis care by dietitians and first year mortality after initiation of hemodialysis Am J Kidney Dis 58 4 583 590 October 2011 Ms Harum is a renal dietitian with Texas Renal Ventures in Ft Worth and is a member of NN Is Editorial Advisory Board Getting the word out The Renal Practice Group of the American Dietetics Association recognizes the need for further education of its members They have collaborated with the National Kidney Disease Education Program and the National Institute of Diabetes and Digestive and Kidney Diseases in developing a program of five education modules This program is dedicated to preparing ADA member renal dietitians to educate patients with chronic kidney disease Stages 3 through 5 For more information go to www renalnutrition org There are also many educational programs available for renal dietitians to teach CKD patients such as Kidney School www kidneyschool org The National Kidney Foundation also has excellent resources menus and diet plans if the renal dietitian needs materials to teach their patients There is a 10 minute video in English or Spanish on the subject and you can find it at www rd411 com Nephrology News Issues January 2012 Subscribe to our free eNewsletter at www NephrologyNews com 18