Nutrition care activities and DRGs

The recent passage and implementation of the prospective payment system (PPS) for Medicare inpatient services have had a strong impact on dietitians practicing in southern Florida. Because several local hospitals service regions in which 90% of the population is 65 years old or older, the annual revenues from Medicare have been reduced. The hospitals still have to meet basic overhead costs and profit margins. This has resulted in the elimination of several dietetic positions. Therefore, dietitians need to establish a cost-benefit justification for the nutrition care and support of patients. This study is the initial phase of a plan to define the nutrition care services the dietitian provides and to identify the most frequently occurring diagnosis related grouping (DRG) categories. For 3 weeks, 31 dietitians maintained logs that detailed dietetic intervention and treatment for each of the 3,827 patients seen. The nutrition care activities reported most frequently by dietitians were basic services, hospital visit and reassessment, initial consultation, and screening to rule out malnutrition. The mean time spent in all nutrition care activities ranged from 13 to 33 minutes. The most frequently occurring DRGs were those for diabetes, heart failure, circulatory disorders, specific cerebrovascular accident, and transient ischemic attacks. Overall, the type of nutrition care activities and the time spent in those activities were significantly different among the hospitals studied. The differences reflect the philosophies of each facility. The types of DRG categories observed reflect the age of the population served.