Patient-Driven Payment Model’s Non-Therapy Ancillary

This past spring, CMS proposed removing some conditions from the Patient-Driven Payment Model’s Non-Therapy Ancillary category. McKnight’s reported that nursing homes receive an NTA add-on for those with patients coded for a specific diagnosis. Patients who are at risk for both Malnutrition and are at risk get one point toward increased pay of the PDPM. Dietitians urge the Centers for Medicare & Medicaid not to remove the critical coding that helps identify patients at risk for Malnutrition. This specific coding helps relieve the cost of assessment and treatment.

The Academy of Nutrition and Dietetics says it “strongly opposes the elimination of malnutrition and at-risk for malnutrition.” Academy leaders wrote to CMS noting that Malnutrition is a “prevalent health issue among the Medicare population,” and 50% of older adults are affected. Identifying Malnutrition will allow adverse outcomes to be treated during care transitions. Collaboration with RDNs includes comprehensive malnutrition assessment, personalized treatment, and care continuity. These all increase healthy patient outcomes and “optimize healthcare resource utilization.”

Owner of Florida-based Nutritious Lifestyle, estimates that between one third and 60% of patients who are brought to skilled nursing facilities from hospitals are malnourished. The ICD-10 coding for malnourishment and risk of malnourishment provides the opportunity to quickly develop a treatment plan for the patient. 

Incorporating a pay boost for appropriate services will cause more expensive issues later on, compared to assessing issues early on. Early interventions include, higher caloric intake will prevent weight loss, pressure ulcers, and increased weakness. The issues previously stated, prevent residents from engaging in therapy or daily activities. 

Christie Titmus, VP of clinical operations at Healthcare Services Group, is the leader of a group of dietitians who provide nutrition services to skilled nursing facilities across the US. Additional funding of $5 per day for a single NTA point is “a critical piece” to make sure residents are supported through their health. 

Residents who are diagnosed and properly screened for Malnutrition might need enteral nutrition, additional wound care treatments, or IV antibiotics. They may even need additional high-calorie foods/supplements that increase their nutrition intake, constant weight monitoring, and lab work more often than typical residents. 

According to Titmus, diagnosed residents could be included in restorative dining programs that ultimately provide greater assistance and supervision during feeding. Titmus told McKnights, “The residents who are at the most risk often need more assistance at meals.” This could include additional time to eat a meal as well as encouragement/supervision at mealtime. Many need nursing staff to feed them their meals; therefore, if the residents are not eating their meals, the food/supplement interventions are ineffective.

Titmus says, “Having that coding is just like having a notification that gets the whole team involved,” she said. “I really hope they don’t take this opportunity away because … even losing five pounds for a person who is 100 pounds … we want to know if she’s lost that weight so our team can pay special attention to her.”