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Sign-On Letter for Therapeutic Diet Order Proposed Rule

To gain support for CMS' rule on therapeutic diet orders, the Academy asked its members to have their fellow non-RD practitioners (physicians, advanced practice nurses, physician assistants), hospital executives and health systems administrators to sign a letter of support (below).

Download the "Letter to non-RD practitioners, hospitals and health system administrators" and the "Letter of support" »

FAQs - CMS proposed rule related to therapeutic diet orders »

Learn more about the proposed rule related to therapeutic diet orders »


Letter to non-RD practitioners, hospitals and health system administrators:

February 15, 2013

Dear Sir or Madam:

The Academy of Nutrition and Dietetics (the “Academy”) is seeking support from hospital associations, medical associations, physician and non-physician providers, and health systems administrators for the provisions in the February 7, 2013 proposed rule changeMedicare and Medicaid Programs; Part II—Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction (CMS–3267–P)that will permit privileged registered dietitians (RDs) to order and modify patient diets and order necessary laboratory tests to monitor the effectiveness of dietary plans and orders. As CMS concluded, the proposed change would “[s]ave hospitals significant resources by permitting registered dietitians to order patient diets independently, which they are trained to do, without requiring the supervision or approval of a physician or other practitioner. This frees up time for physicians and other practitioners to care for patients.”

The Academy is asking interested non-RD providers, associations, and entities to sign-on to the below letter in support of the rule change that is expected to ease burdens on non-RD providers and is estimated to save up to $528 million annually. To ensure these cost savings are achieved and hospitals nationwide are permitted to privilege qualified registered dietitians, the letter asks CMS to clarify its definition of “qualified dietitian” to comport with that in 42 CFR 482.94(e) (“a qualified dietitian is an individual who meets practice requirements in the State in which he or she practices and is a registered dietitian with the Commission on Dietetic Registration”).

To confirm your interest in signing on, please email Pepin Tuma at govaffairs@eatright.org confirming your name, title, affiliation and business address prior to March 8, 2013.We will append the sign-on letter to the Academy’s formal comments listing your name, city, and state. Thank you so much for your consideration and support of this important initiative.

Sincerely,

Pepin Signature

Pepin Andrew Tuma, Esq.
Director, Regulatory Affairs


Letter of Support:

April 8, 2013

Marilyn Tavenner, MS RN, Acting Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-9965-P
P.O. Box 8010,
Baltimore, MD 21244-8010

Re: Medicare and Medicaid Programs; Part II—Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction (CMS–3267–P)

Dear Ms. Tavenner:

We, the undersigned hospital associations, medical associations, physician and non-physician providers, and health systems administrators, appreciate the opportunity to comment in support of the provisions in the February 7, 2013 proposed rule “Medicare and Medicaid Programs; Part II—Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction (CMS–3267–P)” that will permit privileged registered dietitians (RDs) to order and modify patient diets and order necessary laboratory tests to monitor the effectiveness of dietary plans and orders.  Our experience working in and administering hospitals comports with the proposed rule’s conclusion that “[t]he addition of ordering privileges enhances the ability that RDs already have to provide timely, cost-effective, and evidence-based nutrition services as the recognized nutrition experts on a hospital interdisciplinary team and saves valuable time in the care and treatment of patients, time that is ;now often wasted as RDs must seek out physicians, APRNs, and PAs to write or co-sign dietary orders.”  

As the proposed rule makes clear, even the conservative estimates of the potential cost savings associated with this regulatory change are substantial; less conservative assumptions could realize annual savings of even more than $528 million. We agree with the Centers for Medicare and Medicaid Services (CMS) that “[w]ithout the proposed regulatory changes allowing [hospitals] to grant appropriate ordering privileges to RDs, hospitals would not be able to effectively realize the improved patient outcomes and overall cost savings that we believe would be possible with such changes.” These cost savings will only be realized if standards and qualifications for qualified dietitians are maintained.  Some state licensure laws set minimum qualifications for nutrition professionals substantially below that necessary to achieve the cost savings anticipated under this rule, making it imperative that CMS clarify that the definition of “qualified dietitian” in §482.28 is consistent with that in §482.94(e), the only definition for “qualified dietitian” specified in the Conditions of Participation for Hospitals (42 CFR 482 et seq.)

We are confident that the proposed rule guarantees appropriate medical staff oversight of dietetic practice and RD-ordering of patient diets and will allow hospitals in all fifty states to privileging of registered dietitians in all fifty states. Thank you for your continued efforts to reduce outmoded and unnecessarily burdensome rules; we sincerely appreciate CMS’ efforts to provide us with the regulatory flexibility we need to provide quality and cost-effective care and to ensure the privileging process matches the right providers to the job.

Signed,