New therapeutic diet ordering privileges

The Centers for Medicare and Medicaid Services (CMS) approve final rule authorizing ordering of therapeutic diets in hospitals. Previously the CMS rule gave dietitians authority to provide nutrition services for patients based on physician orders. This process often caused a delay in nutrition management. In this case dietitians were not able to “provide [patients with] timely, cost-effective and evidenced-based nutrition services” (Rumsey, 2014) including vitamin prescriptions, certain diets or nutrition support. Under the new rule (effective May of this year), the registered dietitian nutritionist (RDN) or qualified nutrition professional may write the diet without direct approval from the physician. The final rule also provides clarification that privileges related to writing diet orders and ordering labs pertinent to nutritional status must be granted. Dietitians will only gain diet ordering privileges as determined by medical staff recommendations. Clinical authority for ordering therapeutic diets are granted only to certain qualified nutrition professionals and other nonphysician providers. Basic goal of the new CMS therapeutic diet order ruling is to reduce future health care costs, maximize medical staff opportunities (in accordance to state laws and scope or practice) and improve inpatient outcomes (Schaeffer, 2014).

As mentioned above, those qualified nutrition professionals who are privileged may independently write diet prescriptions that have been recommended by medical staff and approved by the hospital and state. Dietitians may also be privileged to order nutrition related labs test, monitor patient toleralace and sign prescriptions for vitamin supplements without the supervision of the physician, physician assistant, or nurse practitioner. Independent ordering of diets allow dietitians to finally do what they have been trained while allowing physicians and other health practitioners more time to care and treat patients (Rumsey, 2014; Schaeffer, 2014). While there are some benefits to this final ruling, some RDs and non-RD nutritional professionals have expressed concern regarding which credentials make a nutrition professional qualified to provide nutrition care (Schaeffer, 2014). In a statement, director of nutrition for Cancer Treatment Centers of America Nhu Huynh, RD, CSO, CNSC notes that the open-ended language in the ruling may impact patient safety and care (Schaeffer, 2014). Legislative actions at the state level are making regulatory adjustments concerning RD licensure and scope of practice.   

Rumsey, A. (2014). The new CMS therapeutic diet order ruling: What does it mean for you? [Web]. Retrieved from: http://www.foodandnutrition.org/Stone-Soup/May-2014/The-New-CMS-Therapeutic-Diet-Order-Ruling-What-Does-It-Mean-For-You/

Schaeffer, J. (2014). Therapeutic diet ordering privileges: What the CMS final rule says, to whom it applies, and what RDs and other nutrition professionals think about it. Today’s Dietitian, 16 (10): 48. Retrieved from: http://www.todaysdietitian.com/newarchives/100614p48.shtml 

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