Malnutrition a major factor in readmissions; make compliant CDI and coding capture your priority

By Brian Murphy

 

File this under reason 1,227 to diligently work to capture malnutrition.

 

Medscape recently covered a study published in Aging Clinical and Experimental Research. The study followed 319 patients aged 65+, hospitalized for the first time with COPD in Southwest China. Median age was 76 days and patients averaged five comorbidities.

 

The punchline: The 180-day readmission rate was far higher in patients diagnosed with malnutrition than those without (30.38% vs. 10.56%). Which makes it imperative to capture severe and other forms of this diagnosis–not just for direct reimbursement, but for your organization’s performance in the CMS Hospital Readmissions Reduction Program (HRRP).

 

As a reminder COPD is one of the six conditions/procedures included in the 30-day risk-standardized unplanned readmission measures in the HRRP. In fiscal year 2024, approximately 75% of eligible U.S. hospitals received a penalty under the HRRP. Most penalties were modest (0.43% of total Medicare revenues) but HRRP penalties top out at 3%–significant in an era of small margins.

 

Takeaway messages from the study per Medscape:

 

1. Early intervention on nutrition for patients with COPD may help to avoid these worsened outcomes.

 

1. As clinicians target specific subgroups for more aggressive measures to treat severe exacerbations and reduce readmissions, older adults with COPD are a good group on which to focus. Nutritional intervention “can increase lean body mass in malnourished COPD patients, enhance their respiratory muscle function, and improve their overall health status,” the study said.

 

A couple nuances here.

 

First, patients in the study were diagnosed using Global Leadership Initiative on Malnutrition (GLIM) criteria. GLIM is less commonly used in the United States than AAIM criteria—updated Academy of Nutrition and Dietetics (Academy)/American Society for Parenteral and Enteral Nutrition (ASPEN), according to Ashley Strickland, adult clinical dietitian supervisor and an surgical/trauma intensive care dietitian at ECU Health, whom I recently hosted on Off the Record.

 

AAIM has now also been fully validated, per a study published in the Journal of the Academy of Nutrition and Dietetics. Unfortunately auditors often use GLIM and AAIM interchangeably, whichever results in a more favorable denial rationale.

 

Second, the HRRP is 30-days risk standardized, and these patients were evaluated over 180 days. Plus of course the study was conducted in China.

 

Still worth considering, however.

 

Compliant capture of severe and other forms of malnutrition is a huge topic, far beyond what I can squeeze into a 500-word LinkedIn post. I recommend you check out the recent podcast I did with Strickland below.

 

Hospitals that effectively address malnutrition as part of their discharge planning and follow-up care can reduce readmissions and improve their HRRP performance. But it starts with good documentation and coded data.

 

References

 

• Medscape, Malnutrition Contributes to Hospital Readmission in Older COPD Patients

 

• Off the Record podcast with Ashley Strickland

 

• CMS Hospital Readmissions Reduction Program