Insurance covers CKD nutrition therapy, but many medical providers and dieticians unaware
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Although most insurance providers, including Medicare and private insurers, cover medical nutrition therapy for individuals with chronic kidney disease, few patients ever meet with a registered dietician.
Holly Kramer, MD, MPH, of Loyola University Chicago, attributes low use of the therapy to a lack of awareness on the part of medical providers and registered dieticians.
“Medical nutrition therapy has been shown to delay the need for dialysis in clinical trials and, of course, has been very successful in helping people manage diabetes; we need to have that same energy for medical nutrition therapy for kidney disease,” Kramer said during her presentation at the virtual National Kidney Foundation Spring Clinical Meetings, adding that Medicare currently provides full coverage with no copay for patients who have a GFR between 13 mL/min/1.73 m2 and 50 mL/min/1.73 m2 (most private insurance companies, as well as Medicaid, follow this same model, she said).
Despite full coverage, Kramer cited evidence from 2017 which showed less than 1% of beneficiaries with CKD who were eligible for medical nutrition therapy had received it during that past year.
Furthermore, she said, data show use of the therapy was just as dismal in recent years as it was before the Affordable Care Act was passed (when medical nutrition therapy still had a 20% copay). After her hypothesis that utilization would increase with coverage failed to manifest, Kramer and colleagues administered online surveys to patients, medical providers and registered dietician nutritionists (RDN) to gain further insight into the matter.
Although more than 91% of participants agreed that “lifestyle changes can reduce complications in CKD and other chronic diseases,” – with most expressing that medical nutrition therapy in particular is important in preventing CKD progression – only about half of the patients had ever been seen by an RDN and only half had been referred.
The most telling portion of the survey results, according to Kramer, were differences between the three groups of respondents regarding affordability and coverage of medical nutrition therapy.
For general affordability, 27% of patients said they “weren’t sure” if they could afford it, whereas 27% and 30% of RDNs and medical providers, respectively, said they disagreed that patients would be able to afford therapy.
Further, 40% of medical providers and 48% of RDNs disagreed or strongly disagreed that there is adequate insurance coverage for medical nutrition therapy for patients with CKD, with most patients and medical providers expressing uncertainty regarding specifics of coverage (RDNs demonstrated greater awareness on specifics).
“The main reason for patients with CKD not meeting with a dietician is due to a lack of awareness that patients can afford to get nutrition therapy,” Kramer said. “We need to educate providers and patients about the importance of medical nutrition therapy and the fact that there is coverage for this. Most patients want to see a dietician, especially if recommended by a provider.”
She also indicated there is a need for more research that points to the benefits of medical nutrition therapy for patients with kidney disease, as well as the expansion of telehealth so the therapy can be delivered in a more accessible way.
“I think we’re in an era when we’re going to change kidney care and improve outcomes over the next decade,” Kramer said.
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Kramer H. Advancing American kidney health initiatives opportunities to improve outcomes. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
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