title: Home Nutrition Support: Ethics and Reimbursement.
abstract: Ethical dilemmas challenge providers on both sides of the hospital and clinic doors. In addition to establishing the nutrition care plan and guiding the client into the home setting with safe and effective parenteral or enteral nutrition therapy, procuring home nutrition support involves meeting documentation requirements and verifying that clients meet reimbursement criteria for home therapy based on third-party payer criteria. Providers have entered a realm for which training has been scarce and they face moral and ethical dilemmas involving serving as patient advocates, possibly stretching the truth to fit the clinical documentation to criteria vs maintaining professional integrity. Nutrition research and evidence-based practice have outpaced modifications to policies including Medicare's national and local coverage determinations, the bulk of which have not seen revisions in 32 years. This review elucidates clinical dilemmas and urges a political call to action to advocate for changes in current, outdated requirements for reimbursement. Given the current healthcare environment and trend toward expedited hospital stays, patients may be better served (and nourished) with revised guidelines.
authors.affiliation: University of Texas Center for Health Sciences, Neurology and Executive Health, San Antonio, Texas American Medical Direct Infusion, Nutrition Support, San Antonio, Texas kmartinrd@gmail.com.
authors.forename: Karen
authors.initials: K
authors.lastname: Martin
authors.affiliation: Nutrition Support, Sanford USD Medical Center, Sioux Falls, South Dakota.
authors.forename: Carol
authors.initials: C
authors.lastname: McGinnis
mesh_terms: D006699:Home Care Services / Q000191:economics / Q000941:ethics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000941:ethics*; D018529:Nutritional Support / Q000191:economics / Q000941:ethics* / Q000379:methods*
keywords: enteral nutrition; home care; home nutritional support; medical ethics; parenteral nutrition; public policy; reimbursement