CMS Final Rule on Therapeutic Diet Orders

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           The new rule from the Centers of Medicare and Medicaid Services (CMS) took effect on July 11, 2014. The new rule issued by CMS will allow qualified RDNs and qualified food and nutrition practitioners working in hospitals the ability to order therapeutic diet orders independent from a physician’s supervision. It also provides RDNs the privilege to order nutrition related laboratory tests for monitoring therapeutic diet orders with or without supervision of a physician.

            Ordering privileges for nutrition related laboratory tests are determined by hospitals in accordance with state laws and other requirements of CMS. The rule increases flexibility for health care practitioners to improve care, save on costs, and provide a more patient centered care experience.
            This rule was enabled with the help of the Academy of Nutrition and Dietetics (A.N.D.), whom showed CMS substantial evidence that the current practice of the physician ordering the therapeutic diet resulted in wasted time and resources and delayed appropriated nutrition services. A.N.D. also highlighted the increased occurrence of hazardous complications that have resulted from the inappropriate diet orders written by other health practitioners.
            Work still remains since the rule defers to hospitals to determine regulatory flexibility in regards to the ordering of nutrition diet orders. CMS also does not have a definition for the term therapeutic diet in terms of the hospital setting. A.N.D. does have a definition for this term and are working on definitions for nutrition supplements and dietary supplements in the hopes to have these definitions adopted by CMS.
            This is just one small battle won for RDNs in the fight to have the ability to order therapeutic diet orders and nutrition related laboratory tests without physician supervision in a hospital. The rule still needs to be modified so that it protects RDNs more, since it is still deferred to the hospital to determine this decision.
Boyce, B. (2014). CMS final rule on therapeutic diet orders means new opportunities for RDNs. Journal of the Academy of Nutrition and Dietetics, 114(9), 1326-1328. doi: http://dx.doi.org/10.1016/j.jand.2014.07.002
-MG

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