Medicare criteria for home parenteral nutrition may need updating

Last Updated: 2017-03-01

By Rob Goodier

NEW YORK (Reuters Health) - Patients who meet clinical-guideline criteria for home parenteral nutrition often don’t qualify for it under Medicare, a recent study found.

The discrepancy suggests that Medicare criteria for malnutrition may need to be updated, to bring the U.S. federal insurance program for the elderly and disabled in line with current recommendations, researchers said in a presentation February 19 during Clinical Nutrition Week 2017 in Orlando, Florida.

“My recommendations to physicians are to clearly and specifically document in the medical record why their patient's gut cannot be used or relied solely on to maintain their weight and strength; the expected length of need for the home parenteral nutrition; and to request that a nutrition assessment be completed if not already done,” the study’s lead author, Natalie Tu, of Affiliation Option Care in Farmington Hills, Michigan, told Reuters Health by email.

Tu and colleagues reviewed data on 142 patients who were receiving parenteral nutrition at home. The most common indications were cancer, bowel strictures, fistulas, and short bowel syndrome.

Forty-nine patients, or 34.5%, qualified for Medicare coverage while 56 did not. The rest did not complete the qualification process.

In comparison, nearly twice as many patients - 67.6% - qualified under the home parenteral nutrition guidelines of the American Society for Parenteral and Enteral Nutrition (ASPEN), the association that sponsors Clinical Nutrition Week.

Of the 56 patients who did not meet Medicare criteria, 31, or 55.4%, did meet ASPEN guidelines.

“These 31 patients were denied a potentially life-saving therapy,” Tu says. “It is less expensive to provide this therapy in the home than in the hospital, and it can prevent hospital readmissions due to malnutrition and/or dehydration, which would save Medicare dollars in the long run.”

The researchers also looked at three Medicare Situations for which patients tried to qualify: E (severe malabsorption), F (Severe motility disturbance, and G/H (other and failed tube trial). They found that 23 patients did not qualify for those Medicare criteria, but 14 of the 23, representing 60.6 percent, did meet ASPEN criteria.

Medicare may need to consider updating its criteria to more closely match current standards of practice for home parenteral nutrition and malnutrition diagnosis, the researchers concluded in their presentation.

SOURCE: http://bit.ly/2lrguRj

Clinical Nutrition Week 2017.