Nutrition therapy for patients with CKD may be limited due to cost concerns
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Despite finding patients and providers have “positive perceptions” of nutrition therapy in chronic kidney disease, researchers suggest the broad implementation of such programs may be limited due to cost-related factors.
More specifically, Elizabeth Yakes Jimenez, PhD, RDN, LD, director of the nutrition research network at the Academy of Nutrition and Dietetics in Chicago, and colleagues identified cost to the patient, insurance coverage and service reimbursement as potential feasibility concerns.
“Nutrition management can slow the progression of chronic kidney disease (CKD) and help manage complications of CKD, but few individuals with CKD receive medical nutrition therapy before initiating dialysis,” the researchers wrote. “This study aimed to identify knowledge, attitudes, experiences, and practices regarding medical nutrition therapy and barriers and facilitators to medical nutrition therapy access for individuals with CKD stage G1-G5, from the perspective of patients and providers.”
Researchers recruited participants through email using National Kidney Foundation and Academy of Nutrition and Dietetics databases, as well as the NKF 2019 Spring Clinical Meetings mobile app. A total of 348 patients, 66 registered dietitian nutritionists and 30 medical providers completed the anonymous surveys.
Survey results revealed that while most participants viewed nutrition therapy positively and agreed that lifestyle changes can reduce CKD-related complications, researchers determined patients were “more optimistic” than providers regarding their capability in making these lifestyle changes (44% of patients “strongly agreed” with the statement vs. 29% of registered dietician nutritionists and 13% of medical providers).
Further findings indicated almost half of medical providers and one-third of registered dietitian nutritionists agreed that nutrition handouts and/or handheld device applications can help patients make lifestyle changes, with patients expressing a preference for handouts compared with applications.
“The vast majority of participants agreed that medical nutrition therapy is important in preventing the progression of CKD stage G1-G5 and most agreed that patients are interested in being referred to a registered dietitian nutritionist for medical nutrition therapy,” the researchers wrote, noting that although participants have positive views on nutrition therapy in theory, “all three groups had concerns about the feasibility of medical nutrition therapy access.”
Regarding potential barriers, researchers found less than half of medical providers, registered dietitian nutritionists and patients agreed that patients can easily afford to see a registered dietitian nutritionist.
Further, most medical providers and patients were unaware of Medicare coverage for medical nutrition therapy, and providers expressed concerns over billing, coding and reimbursement for services.
“Issues that practices reported encountering include billing for medical nutrition therapy and not getting paid, being paid a very low rate for medical nutrition therapy, and being unable to bill for medical nutrition therapy services the same day as a medical provider office visit,” Yakes Jimenez and colleagues explained, concluding that opportunities exist to design and test interventions that can improve therapy access, including a focus on telenutrition.
“Telenutrition services provided by a registered dietitian nutritionist for patients with CKD may address time and transportation issues, and have improved health outcomes and patient satisfaction for individuals with other chronic conditions,” the researchers wrote. “Rapid changes in telehealth implementation and coverage during the COVID-19 pandemic may offer opportunities to more permanently expand remote access to medical nutrition therapy for CKD through legislative and regulatory changes.”
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