Addressing Barriers to Medical Nutrition Therapy

By Anne Hogan

According to the CDC, Chronic Kidney Disease (CKD) affects 15% of adults, mostly over the age of 65 (2022). While CKD does not have a cure, one of the best ways to slow the disease progression is to receive Medical Nutrition Therapy (MNT) from a Registered Dietitian Nutritionist (RDN) (NIDDK, 2022).

MNT is effective for CKD patients who can work with an RDN as part of their care team (Cupisti et al., 2020). However, while MNT is effective, utilization can be diminished by confusion over insurance coverage and a lack of communication between patients and providers.

Insurance Coverage of MNT

One of the challenges to providing MNT services for CKD is billing health insurance to cover the cost. While a CKD patient may have health insurance, patients and providers do not always know which insurance policies cover MNT, or how to file claims for different policies (Jimenez et al.). This confusion around health insurance coverage and billing is a barrier to care.

Medicare, along with other private insurance policies, will cover MNT for CKD patients (NIDDK, 2022). However, the responsibility for awareness of MNT coverage and the understanding of how to file claims falls to the patients and providers. Therefore, improving knowledge of insurance must be addressed at both the administrative and individual levels.

 Patient-Provider Communication

A second challenge identified by Jimenez et al. was that patients and providers have different opinions on whether patients were able to make the lifestyle changes needed to manage CKD. Additionally, patients and providers disagreed over whether patients could easily attend another medical appointment.  Physicians and RDNs were less confident than patients that patients had the transportation and time to attend an additional appointment. This suggests a general lack of understanding between patients and their providers regarding individual abilities and preferences.

To meet patient needs and improve their ability to follow a diet plan, Jimenez et al. argue for increasing the practice of patient-centered, coordinated care as well as the use of telehealth appointments to improve MNT accessibility (2020). As in every practice, effective communication between patients and providers must be established to achieve the best results.

Summary

MNT is an effective method for improving the quality of life for CKD patients by slowing the disease progression. While cost and feasibility are barriers to MNT, these can be overcome by improving patient and provider understanding of individual insurance policies and by utilizing an interdisciplinary, patient-centered approach to care.

References

Centers for Disease Control and Prevention (CDC), (2022). Chronic Kidney Disease in the United States, 2021. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved February 27, 2023 from https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html#:~:text=CKD%20Is%20Common%20Among%20US%20Adults&text=More%20than%201%20in%207,are%20estimated%20to%20have%20CKD.&text=As%20many%20as%209%20in,not%20know%20they%20have%20CKD

Cupisti, A., Gallieni, M., Avesani, C.M., D’Alessandro, C., Carrero, J.J., Piccoli, G.B. (November 12, 2020). Medical nutritional therapy for patients with chronic kidney disease not on dialysis: The low protein diet as a medication. Journal of Clinical Medicine, 9(11), 3644. DOI: 10.3390/jcm9113644

Jimenez, E.Y., Kelly, K., Schofield, M., Steiber, A., Abram, J.K., Kramer, H. (November 10, 2020). Medical nutrition therapy access in CKD: A cross-sectional survey of patients and providers. Kidney Medicine, 3(1), 31-41. DOI: https://doi.org/10.1016/j.xkme.2020.09.005

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), (2022). Diet & Nutrition for Adults with Advanced Chronic Kidney Disease. National Institutes of Health (NIH). Retrieved March 2, 2023 from https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition/nutrition-advanced-chronic-kidney-disease-adults#:~:text=Medical%20nutrition%20therapy%20(MNT)%20is,improve%20your%20quality%20of%20life.

Anne Hogan is a Graduate Student in Food Science and Human Nutrition at the University of Illinois at Urbana Champaign