Nutrition and diet, two keys to patient health, have a place in primary care

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March is National Nutrition Month and it brings World Obesity Day and Obesity Care Week, all efforts to raise and maintain awareness of the importance of food choices to improve health and avoid disease.

The Academy of Nutrition and Dietetics (AND) is the world’s largest association of food and nutrition professionals, representing about 112,000 credentialed nutrition and dietetics practitioners and students.

“The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy,” said Academy President Lauri Wright, PhD, RDN, LDN, FAND. “So, really embracing the power that nutrition has in preventing and treating disease.”

Lauri Wright, PhD, RDN, LDN, FAND
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Wright is an associate professor and director of nutrition programs at the University of South Florida. She spoke with Medical Economics about the latest trends of nutritional counseling and primary care. This transcript has been edited for length and clarity.

Medical Economics: What are some of the most common misconceptions primary care physicians might have about the role of nutrition in overall health?

Lauri Wright, PhD, RDN, LDN, FAND: I really believe that most physicians know how important nutrition is in preventing and treating disease. Not necessarily misconceptions, but challenges that there are, number one, having access to a dietitian. Physicians don't have the time to go through all of the labs and the physical exam and provide nutrition information or education to their clients, so they need to be able to have a dietitian to refer to and so having access to that consultant dietitian. Number two, the reimbursement for dietitian services and that's a big challenge for many of our patients. Right now, there are there are several acts that are before Congress that will increase that access to care to receive nutritional counseling, but right now, under Medicare, dietitians are only reimbursed for diabetes and dialysis. You would just assume that something so basic would be covered. For someone with heart disease, the insurance companies will reimburse for open heart surgery, but they won't reimburse to see a registered dietitian nutritionist. It's puzzling and I don't think many primary care physicians may know that, that the reimbursement is limited. So, you have some patients that can afford that out of pocket. And it really is a low-cost, high-value service, but there are many of our seniors on Medicare or our patients that are on Medicaid that simply cannot afford to pay for that service. And in my mind, that's what keeps perpetuating many of the health disparities that exist in our country today.

Medical Economics: Do you anticipate more registered dieticians will become part of health care teams as primary care physicians integrate and transition into value-based care practice models?

Lauri Wright, PhD, RDN, LDN, FAND: I do think that. Those types of models embrace the interprofessional and when you have the whole team together, obviously we can better treat. But it also enhances the reimbursement factor. At our university health care system, when we have the power of the whole system, we are able to get more reimbursement for dietitian services through the various providers than a dietitian on their own. So, I think that that model will enhance the reimbursement and the services that can be provided.

Medical Economics: For some primary care physicians not currently working with a dietitian, how can they effectively integrate nutritional counseling into their practice to improve patient outcomes?

Lauri Wright, PhD, RDN, LDN, FAND: Really starting with just some awareness. In their busy schedule, it really is difficult for them to work that in. And so being aware of some individual dietitians that you could refer to. Kind of starting with, we're talking about, you have high cholesterol and you have a family history of heart disease, so would you be interested in some lifestyle interventions, changes to treat this, rather than just using meds alone? I think when the doctor asked that question and then is able to have a referral system or maybe they have a consultant dietitian that comes once a week to their office, then a physician is kind of screening the patient's interest to participate in that lifestyle intervention. And then when the physician gives that approval, when they (patients) say OK, well, we actually have a dietitian that comes once a week or twice a month that we can refer you to see, would you be interested in doing that? It's like produce prescription programs. It seems that when the doctor says you need to eat more fruits and vegetables, I'm writing a prescription for you, there are many people that are very rules-follower – my physician wrote a prescription for me for more produce, I'm going to do that. So, I think when we get the physicians’ encouragement or approval for them to go see a dietitian and then actually having a consultant in place, or they know of a consultant that they can refer to, it helps increase that patient's likelihood that they will engage in nutrition counseling.