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Partners in Prevention: RDNs Moving Into the Medical Home

Connie Liakos, MS, RDN, CSSD, LDPediatric & Sports Dietitianhttp://nutritionforkids.com

@nutritionkids

Overview

• Definition of Medical Home• Role of RDNs in Primary Care• Overcoming Barriers• Marketing• Case examples from a pediatric practice

What is a “Medical Home”?• Also Known as a PCPCH or PCMH

Patient Centered Primary Care Home orPatient Centered Medical Home

• A model of primary care

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More on Medical Homes

• National Center for Quality Assurance (NCQA) awards recognition based on 5tier levels

• In Idaho, find information at Idaho Office of Healthcare Policy Initiatives -http://ship.idaho.gov/PCMH/tabid/3068/Default.aspx

• In Oregon, find information at http://www.oregon.gov/oha/pcpch

Medical Home Teams

Excerpt from After Visit Summary

Patient Instructions:Referral Information-You have been referred to the Pediatric Associates of the Northwest dietitian. Please call us if you have not heard from our office within 3 business days about referral specifics.

Please contact us at 503-227-0671 if you have any questions or concerns. Electronically signed by: PILAR H BUERK MD Date: March 9, 2016Your Medical Home Team includes: Pilar Buerk MD, Geri Luxenberg RN, Lynn Hanks CMA, Kira FalzoneYour Medical Home Team also includes Behavioral Health and Nutrition specialists.

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• Free to Academy members• Health Care Delivery Models• Clinical Quality Measures• Resources

• https://www.cdrnet.org/news/rdns-toolkit

Role of RDNs in Primary CareMy Story

http://portlandpediatric.com

• Tier 4 Medical Home, Physician owned practice• Two locations (NW Portland & Tigard)• 18 total providers - 12 pediatricians,

4 psychologists, 1 nurse practitioner, 1 RDN + 2 lactation consultants

http://portlandpediatric.com

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Role of RDNs in Primary Care

• Medical Nutrition Therapy (MNT) – Not just for obesity, diabetes & renal- In Oregon, consult Oregon Health Plan prioritized list*

• Screen and recommend referrals to RDNs with specialized skills (e.g. eating disorders, CDE, feeding clinic)

• Resident nutrition expert

* https://www.oregon.gov/oha/HPA/DSI-HERC/Pages/Prioritized-List.aspx

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Role of RDNs in Primary Care

• Sports Nutrition• Nutrition Education• Resource

Development• Staff Wellness

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“87% of all pediatric office visits are provided in private solo or group practice, with the remainder provided in health centers, clinics, HMOs and other settings. 79% of all pediatric office visits are provided in physician or physician-group owned settings.”Source: American Academy of Pediatrics, Profile of Pediatric Visits, Updated April 2010, https://www.aap.org/en-us/professional-resources/practice-support/financing-and-payment/Billing-and-Payment/Documents/Profile_Pediatric_Visits.pdf, Accessed 3/2016

RDNs Need to be in Primary Care!

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Barriers to RDNs in Primary Care

• Financial considerations• Novel – out of “comfort zone”• Space considerations• Perceived patient resistance• Physicians not comfortable talking to

patients about weight issues• Resistance to giving up control/delegating

to others

Financial Considerations

2012 2013 2014 2015

Revenue from Nutrition Visits

• Registered Dietitian• NPI Number• State Licensed• Idaho Practitioner

Application

Becoming Credentialed

Example from Oregon

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http://www.eatrightpro.org/resource/news-center/in-practice/mnt-provider/2016-mnt-provider

“RDNs already working within medical clinics and physician practices are well-positioned to promote their services to physicians and patients.”

Checking Benefits Helps!

Checking Benefits Helps!Even when insurance doesn’t cover!

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Know Your Codes

https://www.nutritioncaremanual.org/vault/2440/web/files/ICD-10-CM%20Codes%20for%20RDNs.pdf

Barriers to RDNs in Primary Care

• Financial considerations• Novel – out of “comfort zone”• Space considerations• Perceived patient resistance• Physicians not comfortable talking to

patients about weight issues• Resistance to giving up control/delegating

to others

Marketing RDN Services

• Marketing RDN services to practices• Internal marketing to providers• Nutrition services to patients • Dietitian FAQ• Website promotion

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Case Examples

• Class Content• Patient Examples

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FAQ

Baby-led Weaning

Organic vs. conventional foods

Arsenic in rice

Mercury in fish

General food safety

Food allergies/intolerances

Your Baby’s Development

Brain Development

• During the last trimester, the brain grows approximately 260%, with an average weight of approximately 400 grams at birth.

• The brain continues to grow 175% during the first year of life and another 18% during the second year.

• While significant changes occur in neural pathway adaptation and wiring during childhood, adolescence, and early adulthood, the brain grows only another 21% in size from the age of 2 until adulthood.

• Key nutrients important for brain development: Protein, Long-Chain Polyunsaturated Fatty Acids (e.g. DHA), Iron, Zinc, Iodine, Choline, Copper

15 year-old girl with elevated BMI

“I feel more body confident”

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18 year-old boy with severe obesity

“I just worked on the stuff we talked about”

9 year-old boy with wt. loss/ADHD

15 year-old wrestler

Body fat 6.6%

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15 year-old wrestler

Infant Falling Off Growth Curve

4 year-old falling off growth curve

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Elevated Lipids in 10 year-old girlDATE Total Cholesterol LDL HDL Triglycerides

11/24/15 188 mg/dl 133 mg/dl 44 mg/dl 51 mg/dl

7/22/15 223 mg/dl 151 mg/dl 37 mg/dl 173 mg/dl

Mystery Patient – your thoughts?

ThankYou!

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Questions/Sharing