Malnutrition -- Novitas Webinar on Targeted Probe & Educate

There was a recent webinar by Novitas regarding their TPE for malnutrition.

Did anyone else have the chance to listen in?
I believe that the webinar was recorded.

One of my take away impressions is that they were looking for more than the simple documentation of the diagnosis by the physician -- they were expecting something more written personally by the physician. What exactly wasn't crystal clear.

Additionally, though they did cite the ASPEN criteria, they seemed to at a minimum be accepting other clinical criteria, if not actually looking for criteria in addition to ASPEN.
They seemed to indicate that the ASPEN criteria had a high sensitivity (to identify malnutrition), but a not very strong specificity (to identify the severity).
One supposes that might have driven their rather HIGH (roughly >95%) partial denial of the TPE cases.  In total, they had looked at roughly 40 organizations in 2 regions, with 20 to 40 cases for each organization completed in round one. Partial denial seems to me only translates as denying the severity but not the existence of the documented malnutrition.


  • (posted a bit early)
    I found the presentation very thought provoking. Also very concerning -- both based on the initial results and based on some of the information and hints regarding how they were evaluating the clinical validity of the diagnosis.

    Anyone else saw the webinar?
    Any other thoughts and take aways?
    Am I off on some of my thoughts above?

  • I did not see the webinar but I have seen a lack of documentation regarding treatment and the malnutrition's impact (or interaction) on other concurrent diagnoses being lacking in many of the cases of the denials.  There was some times very clear diagnostic criteria for reporting, but not enough to establish the hospital expended MCC level resources actually managing the problem (which might even be a fair concern). 

    The 5 criteria are Evaluation by MD (there is your "personal notes" by the MD about the clinical significance), diagnostic testing (not much you can add here for malnutrition) Treatment (I already mentioned that is often some what absent other than the nutritionists pushing ensure/calories and or doing counseling which often seems to not be enough) Nursing services (won't often be evident for malnutrition) or increased length of stay (also wont often be evident for malnutrition).

    Providers often consider the treatment for the underlying medical problems (infections, cancers, GI problems etc.) to in fact BE the "treatment" which should also help correct the malnutrition and therein (I think) lies the problem with malnutrition documentation.  

    Many things are just assumed and never written in the record.  
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