Feasibility and financial impact of preoperative malnutrition screening and diagnosis

Background

Malnutrition is a common and underdiagnosed comorbidity in surgical patients. It negatively impacts wound healing, maintenance of muscle mass, survival rate, length of stay, and subsequent hospitalization costs in post-operative patients. Early diagnosis and treatment of malnutrition can potentially mitigate these complications. Our study looked at the feasibility of screening for malnutrition in a preoperative clinic, with subsequent dietician evaluation of patients with positive screens. We also examined the effect of diagnosis on reimbursement associated with these patients who incur increased hospital costs.

Methods

This prospective observational study included all surgical patients seen in the preoperative clinic at a large academic hospital in 2022. Patients were screened for malnutrition as part of the preoperative nursing assessment. Based on malnutrition score or surgical procedure, patients were referred to an in-clinic dietitian for preoperative evaluation and treatment. We tracked the number of patients screened, evaluated, and diagnosed with moderate or severe malnutrition. A financial analysis was undertaken to determine the reimbursement benefit of the diagnosis and documentation of malnutrition in the preoperative setting. Standard Medicare reimbursement coding rates were used to calculate the This may be Funding Agency. Please check.financial impact.

Results

17,464 patients were screened for malnutrition by preoperative clinic nurses during the study period. Among these patients, 1,366 underwent in-person or virtual evaluation by the dietitian based on screening results or surgical procedure. 309 patients were identified with moderate or severe malnutrition by a registered dietitian. In the financial analysis, documentation of moderate or severe malnutrition in 25 Medicare patients resulted in $441,635.37 in additional hospital reimbursement. Additionally, there were 6 Medicare patients where malnutrition was documented but not captured by the coding department, resulting in a missed opportunity of $86,273.61.

Conclusions

Preoperative malnutrition is common and underdiagnosed. Preoperative malnutrition screening and intervention is feasible using a simple preoperative workflow. Improved documentation of malnutrition may also have positive financial implications for health systems, making this a cost-effective intervention program.