Is prospective payment inhibiting the use of nutrition support services? Discussion and research implications

Much concern has been generated about the impact of the diagnosis-related group (DRG) prospective payment system on a variety of medical treatments. In particular, high technology medical or surgical applications, such as enteral and parenteral nutrition support, are often perceived as cost-increasing rather than cost-reducing. The threat to the use of nutrition support services relates to the non-existence of an effective reimbursement scheme for recovery of labor costs for the services. High overhead and relatively expensive hard- and software may price nutrition services out of the health care system if an appropriate reimbursement plan is not developed. To address the obvious lack of provision for reimbursement of nutrition support services under the DRG system, several cost-benefit issues related to the provision of nutrition support must be addressed. Empirical data are necessary to determine the clinical significance of these procedures relative to severity and duration of illness and subsequent associated length-of-stay issues; and the cost-benefit justification of nutrition support for acute and chronically ill patients. The purpose of this discussion is not to propose such a system of reimbursement but rather to present a framework for the development and justification of a revised DRG reimbursement plan to cover adequately the cost of providing enteral and parenteral nutrition support services.