Changes in billing for nutrition support services and dietetics staff resources between 1984 and 1986

Changes in hospital funding resulting from the Prospective Payment System have been recognized as a major force in hospitals in the 1980s. The Dietitians in Nutrition Support (DNS) Practice Group examined these changes using a survey sent to 1,000 clinical nutrition managers at American Hospital Association (AHA) hospitals. The goals of the survey were (a) to evaluate changes in billing for nutrition services and (b) to evaluate changes in resources available to dietetics staff members. Although income from nutrition services to inpatients had increased only 18% since 1984, 45% of respondents reported an increase in payment for outpatient services. Prior to 1984, larger hospitals reported screening for malnutrition more often than smaller hospitals, and the responsibility for screening was handled more often by dietetic technicians than by RDs. Larger hospitals also reported establishment of a home nutrition support company more often than smaller hospitals. Computer and academic course costs were paid more frequently by nonprofit and tertiary hospitals. Although the number of hospitals billing for nutrition services to patients was small, most reported receiving payment. We conclude that charges for nutrition services by dietitians to outpatients have increased, and that most dietitians who bill for services receive payment. Academic and technological resources for RDs have increased in general, though smaller primary-care and for-profit hospitals report such supports less consistently than larger, tertiary-care, and not-for-profit hospitals.