Successful strategies for reimbursement of outpatient nutrition services.

During the 1970s, there was little need for nutrition services in hospitals to be profitable. The health care market was growing and professional nutrition services were included in the overhead of hospital operations. The primary focus of all health professionals during this time was on the planning and provision of services; the need for marketing or innovation was not a concern (1). By the late 1970s, however, the federal government and third-party payers began to look at cost-containment strategies. And, during the 1980s, escalating health care costs created competition for health care dollars.

In an attempt to control escalating health care costs, the federal government instituted the Prospective Payment System by diagnosis related groups for Medicare patients in 1983 (2). Because of declining Medicare reimbursement, dietitians were forced to quantify the value of their services, investigate methods to increase their profitability, and communicate in business terms to insurance companies and other third-party payers (3-5). In essence, dietitians have become accountable for justifying the costs of their services (6).

Nevertheless, third-party reimbursement for nutrition services continues to be denied despite the accumulation of data on the cost-effectiveness of these services (7,8). In this article we describe how dietitians at one institution, The Ohio State University Hospitals, successfully proposed, negotiated, and implemented a reimbursement plan for outpatient …