1. CMS Rule on Therapeutic Diet Orders

2.  Centers for Medicare and Medicaid Services (CMS) final rule allows RDNs privilege to:  Order patient diets without requiring the supervision or approval of a physician or other practitioner; and  Order laboratory tests to monitor effectiveness of dietary plans and orders  Effective as of July 11 th, 2014  Why is this important?  Provide patients better health care  Save hospitals time and money

3. What can we do?  Tip #1: Utilize the Academy’s online resource tools  Implementation Steps- Ordering Privileges for the RDN  Hospital Regulation- Ordering Privileges for the RDN  http://www.eatrightpro.org/resource/advocacy/quality-health- care/consumer-protection-and-licensure/learn-about-the-cms-rule-on- therapeutic-diet-orders http://www.eatrightpro.org/resource/advocacy/quality-health- care/consumer-protection-and-licensure/learn-about-the-cms-rule-on- therapeutic-diet-orders  Tip #2: Contact another RD/RDN with success implementing final rule

4. Things to know  Iowa has no regulatory barriers to asking for hospital privileges to order  Check the hospital’s medical staff rules, regulations, and bylaws or other facility-specific procedures  In order to obtain privileges, a hospital must have:  Regulatory flexibility to appoint an RD/RDN(s) to the medical staff and grant specific nutrition ordering privileges, or  Can authorize the ordering privileges without appointment to the medical staff

5. First steps  Steps in determining how hospital & medical staff decide privileges:  Ask how hospital and medical staff prefer to proceed  Whether they want to allow an RD/RDN(s) to order therapeutic diets independent of the physician (no physician co-signature)  The process for granting ordering privileges  What patient population, if not all patients, to allow privileges  Specify scope of care services to be granted  When the RD/RDN(s) must defer to and consult with medical staff  Evaluate any changes that need to be made in the RD/RDN(s) job description  Liability insurance

6. Potential Costs and Benefits  Estimated economic impact of $459 million to hospitals reoccurring annually  Based on savings from lower average hourly cost of RD/RDN compared to physician’s/APRN’s/PA’s

7. Questions? References Practice Tips: Hospital Regulation- Ordering Privileges for the RDN. Academy of Nutrition and Dietetics website. http://www.eatrightpro.org/~/media/eatrightpro%20files/advocacy/practice-tips-hospital-regulation-ordering- privileges-for-the-rdn.ashx Published July 16, 2014. Accessed February 17, 2015. http://www.eatrightpro.org/~/media/eatrightpro%20files/advocacy/practice-tips-hospital-regulation-ordering- privileges-for-the-rdn.ashx Practice Tips: Implementation Steps- Ordering Privileges for the RDN. Academy of Nutrition and Dietetics website. http://www.eatrightpro.org/~/media/eatrightpro%20files/advocacy/practice-tips-implementation- steps-ordering-privileges-for-the-rdn.ashx Published July 16, 2014. Accessed February 17, 2015.http://www.eatrightpro.org/~/media/eatrightpro%20files/advocacy/practice-tips-implementation- steps-ordering-privileges-for-the-rdn.ashx