Jessie M. Pavlinac

Academy of Nutrition and Dietetics and National Kidney Foundation: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nephrology Nutrition

Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition.

American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care

The American Dietetic Association (ADA) Renal Dietitians Practice Group (RPG) and the National Kidney Foundation Council on Renal Nutrition (NKF CRN), under the guidance of the ADA Quality Management Committee and Scope of Dietetics Practice Framework Sub-Committee, have developed the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care (Supplementary Figures 1, 2, and 3 are available only online at www.jrnjournal.org). The SOP and SOPP documents are based upon the 2008 Revised Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians (RDs)(1), which are part of ADAs Scope of Dietetics Practice Framework(2). The 2008 Revised SOP in Nutrition Care and SOPP, along with the Code of Ethics(3), guide the practice and performance of RDs in all settings.

American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for Registered Dietitians (generalist, specialty, and advanced) in nephrology care.

The Joint Standards Task Force of the American Dietetic Association Renal Dietitians Dietetic Practice Group and the National Kidney Foundation Council on Renal Nutrition: Deborah Brommage, MS, RD, CSR, CDN; Maria Karalis, MBA, RD, LDN; and Cathi Martin, RD, CSR, LDN: Co-chairs; Maureen McCarthy, MPH, RD, CSR, LD; Deborah Benner, MA, RD, CSR; Catherine M. Goeddeke-Merickel, MS, RD, LD; Karen Wiesen, MS, RD, LD; Laura Byham-Gray, PhD, RD; Jennie Lang House, RD, CSR, LD; Jessie Pavlinac, MS, RD, CSR, LD; Linda McCann, RD, CSR, LD

Current Coding Practices and Patterns of Code Use of Registered Dietitian Nutritionists: The Academy of Nutrition and Dietetics 2013 Coding Survey

Coding, coverage, and reimbursement for nutrition services are vital to the dietetics profession, particularly to registered dietitian nutritionists (RDNs) who provide clinical care. The objective of this study was to assess RDN understanding and use of the medical nutrition therapy (MNT) procedure codes in the delivery of nutrition services. Its design was an Internet survey of all RDNs listed in the Academy of Nutrition and Dietetics (Academy)/Commission on Dietetics Registration database as of September 2013 who resided in the United States and were not retired. Prior coding and coverage surveys provided a basis for survey development. Parameters assessed included knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use, payer reimbursement patterns, complexity of the patient population served, time spent in the delivery of initial and subsequent care, and practice demographics and management. Results show that a majority of respondents were employed by another and provided outpatient MNT services on a part-time basis. MNT codes were used for the provision of individual services, with minimal use of the MNT codes for group services and subsequent care. The typical patient carries two or more diagnoses. The majority of RDNs uses internal billing departments and support staff in their practices. The payer mix is predominantly Medicare and private/commercial insurance. Managers and manager/providers were more likely than providers to carry malpractice insurance. Results point to the need for further education regarding the full spectrum of Current Procedural Terminology codes available for RDN use and the business side of ambulatory MNT practice, including the need to carry malpractice insurance. This survey is part of continuing Academy efforts to understand the complex web of relationships among clinical practice, coverage, MNT code use, and reimbursement so as to further support nutrition services codes revision and/or expansion.

Know and Use ADA's Evidence-Based Practice Resources

hese statements, published in the September 2001 Journal, heralded ADA’s commitment to vidence-based practice and emphaized the need for all practitioners to nderstand evidence analysis and se evidence-based guidelines in our ork with patients and clients. Possily the most visible demonstration of DA’s commitment is the developent and growth of a free benefit of embership (available to nonmemers via subscription), the Evidence nalysis Library (EAL), http://www. daevidencelibrary.com. Since the EAL’s debut in late 2004, ell over 7 million page views have een recorded and more than 3,600 nurition articles have been abstracted. hirteen guidelines have been pubished on some of the most crucial pracice issues we face: Diabetes Type 1 nd 2, Disorders of Lipid Metabolism, dult Weight Management, Critical llness, Pediatric Weight Management, ncology, Hypertension, Heart Failre, Chronic Obstructive Pulmonary isease, Gestational Diabetes, Celiac isease, Spinal Cord Injury, and Uninended Weight Loss. More are in the ipeline, including Chronic Kidney Disase, HIV, and Vegetarian Nutrition. I ave the opportunity to see the guideine development process in action as a ember of the Chronic Kidney Disease orkgroup. The EAL also offers answers to pracice-based questions; systematic reiews; educator modules for teaching he evidence analysis process; Poweroint slides of EAL practice guidelines nd projects; companion materials uch as toolkits, available for purchase n downloadable and print versions, for e

Competent, Proficient, Advanced Practice/Expert—Where Are You in Your Career Development?

E ALL START our careers as renal dietitians as competent practitioners—some of us more recently than others. The competent dietitian recognizes patients at nutrition risk, gathers pertinent nutrition assessment information, interprets that data, diagnoses/determines the nutrition problem, and formulates a plan of care. Critical-thinking skills continue to develop, and our ability to ‘‘sift’’ through all of the data and find the relevant datacontinuestoimprovewithexperience.Asacompetent practitioner, focusing on the data versus the patient is not uncommon. As we progress in our careers, we become proficient and have enhanced critical-thinking skills. Our knowledge and experience can be transferred and easily used in solving a clinical puzzle in a different patient. We get moreorganized in our reasoning and more able to recognize patterns in our patients. We get better at diagnosing/determining the actual nutrition problem. An example would be a patient with hyperkalemia who has diabetic ketoacidosis. The problem is not increased intake of potassium, but a shifting of hydrogen ions from the blood into the cells and potassium leaving the cells and entering the blood. Advanced practice or expert renal dietitians have the highest nutrition assessment and diagnosis skills. Critical thinking and problem-solving are instinctive, and at this level the registered dietitian is able to quickly determine relevant data and diagnose the problem on the basis of the evidence. The advanced practice renal dietitian can also anticipate likely future problems. The dietitian, performing at the expert level, critiques the literature, applies clinical research to improve patient outcomes, and identifies the gaps in the research/literature. As a professional, it is important to self-identify where you are inyourcareer development and to layout your lifelong learning plan to continue to progress in your level of practice and provide safe and high-quality patient care. A workgroupcomposedofmembersoftheCouncilonRenal Nutrition and the Academy of Nutrition and Dietetics Renal Practice Group are revising the 2009 Standards of Practice (SOP) and Standards of Professional Performance (SOPP) in nephrology care. The SOP/SOPP can help with self-assessment and guide that learning plan. The 2014 revision, scheduled to be published in the Journal of Renal Nutrition in the fall, uses the new language of competent, proficient, and advanced practice/expert. 1-3 This resource will assist you in developing an individual professional growth plan and can serve as a tool in programmatic development. I encourage you to look for the article next fall.

Healthcare reform: implications for renal dietitians.

Journal of Renal Nutrition, Vol 23, N OVER THE LAST 40 years, the financing and programmatic changes in the Medicare end-stage renal disease (ESRD) program have affected the renal dietitian’s practice and the care of the patients we serve. The Affordable Care Act (ACA) will affect the ESRD program and funding for primary and specialty care (including medical nutrition therapy) for our patients before with chronic kidney disease Stage 1 to 4. One of the underpinnings of the ACA is the Institute for Healthcare Improvement Triple Aim Initiative http://www.ihi.org/offerings/Initiatives/TripleAim/Pages/ MeasuresResults.aspx, which aims to Improve the health of the population served, Improve the experience of the individual, and Provide affordability as measured by the total cost of care.