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The Affordable Care Act: Are we REALLY Willing to Pay for Prevention
Patricia Davidson, RD, DCN, Clifford M. Sales, MD. The Cardiovascular Care Group, Westfield, NJ, USA.
OBJECTIVES: There is indisputable evidence that nutrition plays a major role in the management of vascular disease processes. Monitoring nutritional parameters are necessary for improving health outcomes in those with diabetes mellitus and renal insufficiency. Hemodialysis can be delayed with correct nutritional management for, at a minimum, six months if delivered in a comprehensive manner. However, for this therapy to be effective, it must make economic sense for health care providers to do so. METHODS: Review of the income statement for the year ending May 31, 2013 was performed for nutritional services provided to patients diagnosed with chronic kidney disease. The setting was a ten physician vascular surgical practice where a Registered Dietician (RD) was employed on a full-time basis. Variable costs include the salary of the Registered Dietician, educational, licensing and billing costs. Fixed costs were not included. RESULTS: There were 466 access-related procedures (CPT 36818-36830) performed from June 1, 2012 to May 31, 2013.. During that same time period, Medical Nutritional Therapy services were performed in our practice: CPT 97802 (n=679), CPT 97803 (n=1618) and CPT 98961 (n=50) for a total of 2347 procedures. Reimbursement for these procedures, occupying the full-time of one registered dietician, totaled $94,107. Assuming an annual salary of $60,000 plus 20% of salary for benefits, 6% of collections for billing costs and $3,500 for annual educational, licensing and malpractice costs, the profit, prior to costs for rent and staff, was $12,960. The cost of placing one patient on hemodialysis for one year has been estimated at $87,561 per patient per year. CONCLUSIONS: The cost of employing an experienced Registered Dietician closely parallels the income that professional can generate. This equation balances only after the RD can build up a substantial patient base. Therefore, the lead-in period (time to build) is performed at a loss to the institution with the potential benefit only marginal. The savings of keeping a single patient off of hemodialysis for one extra year far outweighs the costs of employing a clinically seasoned RD. It would appear that the current health care system is unwilling to really pay for the prevention it espouses.
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