Improving Malnutrition Outcomes in Post-Acute and Long-Term Care: Best Practices and Their Influence on Payment

Malnutrition is a significant public health problem that influences older adults at disproportionate rates. It is estimated that up to 50% of older adults across care settings are either at risk of becoming malnourished or are malnourished.¹ Despite this prevalence, malnutrition is understudied and often undermonitored in skilled nursing facilities (SNFs). In 2019, the Centers for Medicare & Medicaid Services issued the Patient Driven Payment Model as a new reimbursement model for patients entering SNFs as Medicare Part A stays. For the first time ever, SNFs had an opportunity to capture reimbursement for malnutrition, which prompted an increase in the study and monitoring of malnutrition in this setting. To successfully capture reimbursement for malnutrition, it is imperative that licensed interdisciplinary professionals-registered dietitian nutritionists (RDNs), physicians, nurses, social workers, and therapists-work together to identify and treat malnutrition. RDNs play a vital role in ensuring that the Nutrition Care Process is followed, including screening with a validated tool and communicating the malnutrition risk level with the licensed practitioner and interprofessional teams to implement interventions for addressing the malnutrition risk and to capture reimbursement. The objective of this article is to provide recommendations on best practices for RDNs to use in diagnosing and addressing malnutrition in SNFs and the valuable role they play in SNF reimbursement opportunities. It also aims to serve as guidance on how to start the implementation of a process to improve malnutrition reimbursement and/or tracking it within any SNF.