More and more, hospitals and health systems are beginning to address root causes of disease in their communities. In 2002, the Affordable Care Act (ACA) began penalizing hospitals with high readmission rates. In fact, hospitals face a three percent cut in Medicare payment for having higher readmission rates for certain measures. Failing to lower patient readmission rates not only leads to strong financial penalties, but also to fewer or potentially lost referrals, and higher costs to deliver care. Not surprisingly, resources, programs, and initiatives have emerged over the last decade—many focusing on nutrition.
A study published in the American Journal of Clinical Nutrition showed that malnourished patients are two times more likely than well-nourished patients to be readmitted to the hospital. In malnourished patients, 25% required readmission to acute-care hospitals compared with 11% of the well-nourished group. In a 2010 study, being underweight ranked as the number-one, nutrition-related reason for readmission, followed by having a chronic disease, having depressive symptoms, and being obese. It is important to note that being malnourished means either an individual has an over- or underconsumption imbalance, so someone who is obese can be malnourished.
Given the statistics, what exactly is the solution to lowering hospital readmissions? Food certainly plays into the equation, as there’s nothing more fundamental to population health than food and other social determinants of health. In a report by the U.S. Department of Agriculture entitled "Household Food Security in the United States in 2011," nearly 15 percent of U.S. households were “food insecure” in 2011 – hungry, or uncertain about their food supply. The U.S. government defines food insecurity as a condition where people must skip meals, cut back on the quality or quantity of what they eat, or rely on emergency sources for food.
Not surprisingly, post-discharge meals have proven a big deterrent to hospital readmissions. In a CMS pilot study, post-discharge meals were shown to reduce hospital readmissions by 39%. Post-discharge meals ensure patients continue to receive proper nutrition once they leave the hospital. This is especially key for patients suffering from a chronic condition, which puts them at risk for malnutrition. Patients with chronic conditions like diabetes or heart disease may require a diet low in sugar, fat, sodium or cholesterol. Post-discharge meals are equally important to individuals who simply cannot prepare meals for themselves or whose caretakers don’t know how to fulfill their nutritional needs, as well as those who are food insecure.
In a study published in Health Affairs (April 2018) entitled “Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries,” lack of access to nutritious food for people who are dually eligible for both Medicare and Medicaid is a problem that likely leads to higher readmission rates.
Home-delivered meals—both that were tailored to medical needs and meals that were not—were found to help curtail the use of some costly health services for this patient population. The study focused on 133 participants who received medically tailored meals and 624 participants who received non-tailored food, and compared them against unmatched controls. Participants in both programs were associated with lower emergency department (ED) visits, inpatient admissions and uses of emergency transportation.
There is still much work to be done to bridge the continuum of care from hospital to home or living facility. One thing is for certain, however. Through food, we can drive change.
Catherine Macpherson is a registered dietitian nutritionist and an expert in care transitions and chronic care program development and measurement. For questions about incorporating meals into care programs for your members or patients, contact Catherine at 844-280-2134 or Catherine.firstname.lastname@example.org.