IAND Members Only - Delegate Report
Iowa Academy of Nutrition and Dietetics
REPORT OF DELEGATE
JANICE A. FISHER, PHD, RD, LD, CDE, BC-ADM, FAADE
AUGUST 27, 2010
Goal 1. Enhance and Promote the Value of Membership
Fall 2010 HOD Meeting
The Fall 2010 House of Delegates Meeting will be conducted November 4 and 5 at the Westin Boston Waterfront in Boston, Massachusetts. All registered members are welcome to join delegates in discussing two mega issues facing the profession: Health Reform — Next Steps and Multidisciplinary Membership Category.
A competitive analysis of the dietetic service market has determined that in order for dietitians to remain at the forefront of the provision of services, we must embrace new strategies. This includes working collaboratively with other practitioners, such as those who may have previously been perceived as a threat. The proposed Multidisciplinary category would address this concept, with very specific criteria needed to become a non-voting, non-elected office member of this new ADA group.
Other professionals are accessing academic and professionally developed nutrition related information. ADA can capitalize on this opportunity to be that source for credible, science-based information by creating a membership category for these like minded collaborators.
Considerations
- Practice versus membership: Membership provides a forum for sharing ideas and should not be confused with the practice of a profession.
- Because of rapid technological advances, virtually no information is inaccessible. Whether practical or academic, no body of information—including dietetics knowledge—is beyond reach of the consumer and allied professionals.
- Benchmarking shows that a majority of our sister organizations offer some form of membership to their like-minded colleagues.
Some Potential Pros
- Opportunity for ADA members to influence food and nutrition markets and provide greater visibility with new consumer types (untapped markets).
Increased demand and utilization of services provided by RDs and DTRs via enhanced awareness of our unique role in food, nutrition, and health. - Enhanced support for ADA’s public policy efforts.
- Showcases expertise of ADA members.
- Increases diversity of perspective by having members from other disciplines.
- Embraces differences and supports finding common ground to accomplish shared goals.
- Assists in building bridges between ADA members and our like-minded collaborators.
- Increases research grants and participation in research projects.
- Enhances ADA member knowledge base and skills in niche and specialty practice areas.
- Builds goodwill with other organizations.
Some Potential Cons
- Risk is unknown.
- Potential for inconsistency in values.
- Shift in marketing of profession.
- Encroachment/perceived approval of practice.
- Dilution of resources.
- May alienate some of our current members.
- Dilutes our special niche.
- Some may use their ADA membership to inappropriately promote programs, products, and services.
- Setting the Multidisciplinary category educational qualification minimum at the Associate degree level may be seen as “diluting” ADA membership.
Criteria for Proposed Membership Category
- Minimum of an Associate degree granted by a U.S. regionally accredited college or university or foreign equivalent and the appropriate degree and/or training, certification, or license in one of the following professions:
- Certified Health Education Specialist (CHES)
- Certified Midwife (CM or CNM)
- Certified Professional—Food Safety (CP-FS)
- Dental Hygienist (BS-DH or RDH)
- Dentist (DDS)
- Pharmacist (RPh or PharmD)
- Physical or Occupational Therapist (PT/OT)
- Physician (MD or DO)
- Physician Assistant (PA)
- Registered Environmental Health Specialist/Registered Sanitarian (REHS/RS)
- Registered Nurse (RN)
- School Nutrition Specialist (SNS)
- Speech-Language Pathologist (CCC-SLP)
OR
A minimum of an Associate degree in Culinary Arts from a U.S. regionally accredited college or university or U.S. culinary association.
OR
Is a Certified Culinary Professional (certification from the American Culinary Foundation or the International Association of Culinary Professionals).
OR
Is a certified sports medicine practitioner (certification from the American College of Sports Medicine)
OR
Is a certified dietary manager, (certification from the Dietary Managers Association).
Discussion Activity – Talk with Your Delegate
Consider the following questions:
Quadrant 4: What are the advantages of keeping the membership categories as they are currently (no change)? |
Quadrant 2: What are the advantages to adding a multidisciplinary membership category? |
Quadrant 1: What are the disadvantages of not adding a multidisciplinary membership category (no change)? |
Quadrant 3: What are the disadvantages to adding a multidisciplinary membership category? |
Mega Issue Question and Expected Outcomes
What is the role of the RD and DTR in the implementation of health care reform on the state level?
Meeting participants will:
• Understand how health care reform impacts the public and themselves professionally.
• Identify the challenges and opportunities for RDs resulting from health care reform legislation.
• Identify what members must do to take advantage of these opportunities, and what must ADA do to ensure members have the necessary resources for success?
• The Affordable Care Act’s inclusion of nutrition does not equate to the specific inclusion of RDs or DTRs, and it remains unclear at this time whether the provision of these services will be from RDs or from other health professionals;
• The Affordable Care Act merely authorizes the creation of the new programs and policies. The Affordable Care Act does not appropriate (i.e., actually fund) the monies necessary to carry out most of the new programs; and
• Our competitors are engaged in aggressive advocacy efforts that—in the absence of a countervailing RD presence—may result in RDs being undervalued and omitted from state programs and delivery of services
Key NutritionRelated Provisions in the Affordable Care Act
Select Provision Senate H.R. 3590 Patient Protection & Affordable Care Act
with amendments from House H.R. 4872 Reconciliation Act of 2010
Health Aging.PreventiveServices for adults 5564
The Affordable Care Act establishes a grant program for state and local health departments and Indian tribes for: public health interventions, community preventive screenings, and referral and treatment for chronic diseases for individuals between 55 and 64 years old. Intervention activities include improving nutrition and increasing physical activity.
Wellness/Prevention for Employees
The Affordable Care Act allows the Department of Health and Human Services and the Department of Labor to set discounts up to 50 percent of insurance premiums if the wellness program is determined beneficial for the employee.
SchoolBased Health Clinics
The Affordable Care Act establishes grants to launch schoolbased clinics. Optional services include nutrition counseling, but providers are not specifically listed.
Prevention Task Forces, etc.
The Affordable Care Act established a Preventive Services Task Force and a Community Preventive Services Task Force. The Affordable Care Act establishes a Prevention and Public Health Investment Fund– funding is set at $2.4 billion for 2010 and increases up to $4.6 billion by 2019.
Medicare Preventive Services
The Affordable Care Act adjusts current law to allow the Centers for Medicare and Medicaid Services (CMS) to determine whether and how to expand existing and establish new preventive services. MNT beyond renal and diabetes is specifically included in the list of services that CMS may potentially expand. The Affordable Care Act eliminates costsharing (copayments and deductibles) for preventive services, making preventive care free for Medicare recipients. The Affordable Care Act provides for an annual
wellness visit that includes personalized prevention plan services with a health care assessment. Along with physicians and nurses, registered dietitians are listed as screening and counseling providers, and CMS must establish appropriate reimbursement policies and rules for referral. Specifically, CMS must determine when a referral is warranted and how many counseling sessions a patient can receive.
Medicaid
The Affordable Care Act establishes a fiveyear grant program to encourage Medicaid beneficiaries to adopt more healthy lifestyles, specifically related to weight reduction, cholesterol reduction, prevention of the onset of diabetes, and diabetes selfmanagements. CMS will set the parameters for awarding grants. The Affordable Care Act includes coverage for those preventive services recommended by the United States Preventive Services Task Force (USPSTF). Because USPSTF currently recommends “intensive
nutrition behavioral counseling” for adults with hyperlipidemia and “other dietrelated chronic diseases,” CMS must determine (1) what constitutes “dietrelated chronic diseases” for purposes of coverage and (2) who may provide the intensive counseling. USPSTF recommends referral to an RD after physician treatment. Costsharing (copayments and deductibles) for these preventive services are also eliminated.
Home Health
The statute provides for a demonstration program for direct, homebased patient care. CMS will set the parameters, and although RDs are listed as possible providers, this is merely a recommendation, not a requirement. Because the pilot program may later be broadly adopted with potentially significant impact for the profession, ADA can assist those working in home health who want to show the benefits of having an RD provide nutrition services. Those interested should follow carefully the rules for the program and application procedures when they are proposed in the coming months for more details and to determine their eligibility for the program.
Medical Homes
MEDICAID: The Affordable Care Act allows for medical home waivers for statecoordinated programs focusing on (1) diabetes treatment and prevention and (2) treating cardiovascular disease and those considered overweight. Nutritionists are listed among providers, thus allowing for the inclusion of registered dietitians, although Congress did not identify them specifically. Instead, given their different licensing requirements and scope of practice, Congress deferred to individual states to decide whether RDs or others should be permitted to provide these services.
COMMUNITY SETTING
The Affordable Care Act establishes the medical home in public health programs
and recommends the dietitian be included as a qualified provider and part of the medical home team, but CMS is given the authority to make the final determination. Reconciliation Act of 2010
NutritionLabeling of Menu items at Chain Restaurants
The Affordable Care Act requires chain restaurants with at least 20 outlets to post calories on menus, menu boards (including drivethrus), and food display tags, with additional information (fat, saturated fat, carbohydrates, sodium, protein and fiber) available in writing upon consumer request. The Affordable Care Act requires national uniformity so that there is consistency in information provided, and states and localities will not be able to require that chains provide additional nutrient information on menus. Calorie labeling must also be affixed to vending machines.
Child Obesity Demonstration Project
The Affordable Care Act fully funds $25 million (until 2014) for a demonstration project aimed at reducing childhood obesity in communitybased settings and schools through educational, counseling, and training activities.
Discussion Questions for Delegates
Delegates will be collecting data and reporting on the following questions.
• For Affiliate Delegates: What has been done to date (since Fall 2009 HOD Meeting) related to health reform in your state?
• For all delegates and meeting participants: Describe working relationships and interactions of delegates with the Public Policy Coordinators (PPC), State Regulatory Specialists (SRS), State Policy Representatives (SPR) and Affiliate Public Policy Panels (PPP). Is the delegate included in the PPP in your affiliate?
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