Future Dimensions

In Clinical Nutrition Practice

A Message From the Chair

Kathy Allen, MA, RD, CSO
Chair, CNM DPG
2014-2015

Greetings!!
Fall is in the air and the holidays
are on their way! Time is flying by
as we head into the second half of
our membership year. For those
of you who were able to attend
FNCE® this year, I hope you were
able to attend our member reception and take full advantage of
the endless networking opportunities. It was wonderful to see
familiar faces, good friends I have
made throughout the years, make
new acquaintances and meet new
DPG members. I am consistently
amazed at the talent, diversity
and passion to be found within
our organization.
While in Atlanta, we also had one
of our two face-to-face Executive
Committee meetings during
which we had a robust discussion
and review of our Strategic Plan. I

was pleased to find that we have
already made significant strides
in achieving our objectives. Some
recent accomplishments include
the enhancements to our website, creation of the QPI subunit,
development of a member recognition program and incentive
to submit Quality Improvement
projects. Susan DeHoog and Barbara Isaacs-Jordan represented
us well with their premier presentation of the results of our
staffing study.
The 2015 Symposium is also well
under way with an exciting slate
of speakers, vendor booths and
the brand new addition of a
poster session. Be sure to register early and don’t forget to sign
up for a tour of Seattle. I look forward to seeing many of you
there!
In closing, I’d like to express my
deepest appreciation for your
support and confidence in me as
your chair. It is truly an honor
and privilege. Also, many thanks
to the entire Executive Committee for volunteering your valuable time and efforts.
Warmest regards,
Kathy Allen
Chair, CNM DPG

Fall, 2014
Volume 33, No 4

Inside this issue:
CPE (1) Article:
Providing Outpatient Nutrition
2-7
Services Using an
Activity Based
Costing Method
2015 CNM
Symposium
Preview

8

GENIE: Your Nutrition Education
9-10
Wishes Have
Been Granted!
Fall House of
11-12
Delegates Report
CNM DPG
Updates

13-16

Featured
Member

17

CNM Executive
Committee

18

Like us on Facebook!
https://www.facebook.c
om/ClinicalNutritionMan
agementDpg

Future Dimensions in Clinical Nutrition Practice

Fall 2014

Providing Outpatient Nutrition Services Using an
Activity Based Costing Method
Wendy Phillips, MS, RD, CNSC, CLE, Cynthia Moore, MS, RD, CDE, FAND, and Keith Batt, MEd, RRT
Hospitals typically staff Registered Dietitians (RD)
to see patients during their inpatient stay, but
with the changing healthcare environment there
is a growing emphasis on providing nutrition
counseling in the outpatient setting. Many hospitals are determining how best to provide these
services within their current budgeting structures. This article describes an Activity Based
Costing (ABC) accounting method that can be
used to provide these services.1 When using this
method, the nutrition department is paid by the
medical center for time spent by the RDs and ancillary staff providing the outpatient nutrition
services. The medical center receives the reimbursements obtained by billing insurers and patients, which offsets the costs paid to the nutrition department. This system has some features
in common with financial costing used by dietitians in successful private practice.
It is important to calculate the costs involved in
providing MNT services and then compare these
to the expected reimbursement rates from insurance providers and out of pocket/self-pay rates
to determine if the endeavor can be financially
viable. 2 Revenue tracking needs to be ongoing,
and RDs should know how many patients need
to be seen per month in order to bring in enough
revenue to at least cover the cost of salaries and
benefits.
Medical Nutrition Therapy (MNT) visits with an
RD are reimbursable for some diagnoses, and
these covered diagnoses may vary depending on
the insurance provider. Current Procedural Terminology (CPT) codes are used to bill for services
rendered and should provide the basis for developing the ABC method. CPT codes for Medical
Nutrition Therapy are described in Table 1. 3 One
2

CPT
Code
97802

97803

97804

G0270

G0271

Description
Medical Nutrition Therapy; initial
assessment and intervention, individual, face-to-face with the patient,
each 15 minutes
Medical Nutrition Therapy; reassessment and intervention, individual, face-to-face with the patient,
each 15 minutes
Group Medical Nutrition Therapy; (2
or more individuals), each 30 minutes
MNT reassessment (2nd referral) for
change in condition /diagnosis /
treatment, individual (15 minute
units)
MNT reassessment (2nd referral) for
change in condition /diagnosis /
treatment, group (30 minute units)

Table 1. Current Procedural Terminology Codes
for Medical Nutrition Therapy
or more corresponding diagnosis code(s), using
the International Classification of Diseases, 9th
edition (ICD-9) must accompany the CPT code
when submitted to the insurance provider. 1
CPT codes for MNT are in 15 minute increments,
or units, for individual appointments. The length
of the visit is likely to vary based on the patient’s
need, but generally initial visits are 60 to 75 minutes (4 to 5 units of code 97802) and follow-up
visits are generally 45 minutes (3 units of code
97803). Classes can also vary in length, but are
billed in 30 minute increments for CPT code
97804. Since the length of time can vary based
on the patient encounter type, the ABC method

Future Dimensions in Clinical Nutrition Practice

should be developed per unit of measurement of
the specific CPT code.
Costs Associated with the Provision of MNT
Salary and benefits for the RDs and ancillary staff
are the major contributors to the cost of providing services, but there are other contributing
costs that must be considered as well. This section discusses those relevant costs.
RD Salary, Benefits and Management Costs
Salary and benefit costs for the RD needs to be
determined, as well as costs for management associated with the RD. Typically, standardized
benefits ratios are used, with an additional factor
included for management resources, which is referred to as a General and Administrative (G & A)
fee. For example, an RD’s annual salary may be
$52,000. An average benefit cost for many
healthcare companies adds an additional 41.2%
of the RD’s salary. Therefore, the salary and
benefit cost of this RD would be
$52,000 x 1.412 = $73,424/year.
While the G & A fee may vary depending on the
geographic location and care setting, an average
rate often used is 5%. Therefore, the G & A fee in
this scenario would be
$52,000 x 0.05 = $2,600/year.
This G & A fee would then be added to the
$73,424 that is calculated for the RD’s salary and
benefits, making the total annual expense for the
RD $76,024.
RD Specific Costs
Registered dietitians are required to earn 75 continuing education units (CEUs) every five years in
order to maintain registration. In addition, focused trainings, as documented by specialty certifications, help RDs provide better counseling
services for their patients.4 Money should be
budgeted each year to provide educational opportunities, which contributes to the overall expense of providing MNT. Likewise, consideration
should be given to time during the year dedicated to these educational efforts, with the un3

Fall 2014

derstanding that some of this professional education will be done on the RD’s own time, i.e. above
and beyond the normal work day. In our outpatient practice, up to five days per year may be
blocked from each full time RD’s schedule to allow them to attend educational conferences.
This time, therefore, is not revenue generating
and should be accounted for when determining
the costs for providing care.
In addition to essential professional education
time that can be considered “non-productive” or
“non-revenue generating,” RDs accrue paid time
off (PTO) benefits that can be used for vacation
and/or sick leave. This time needs to be accounted for in the same way as professional education time, and may vary depending on the RD’s
length of service with the company.
Many healthcare organizations pay the costs of
registration, licensing, and/or professional certifications, and memberships for their clinical staff,
including registered dietitians. Membership in
the Academy of Nutrition and Dietetics, as well as
annual registration dues through the Commission
on Dietetics Registration should be covered. Dietetic Practice Groups and/or Member Interest
Group membership can assist the RD in providing
excellent patient care, and therefore membership to at least one of these should be paid for
each RD. Some organizations will also pay for a
professional certification every five years, such as
the Certified Diabetes Educator or Certified Specialist in Pediatrics credentials. Additionally, malpractice insurance is almost always paid by the
healthcare organization on behalf of their clinicians, including RDs. All of these expenses contribute to the overall cost of providing MNT in
the outpatient setting.
Client Scheduling / Registration Costs
Registration, scheduling, and billing functions
should be completed by support staff, not the
RD. Dietitians may not find these tasks to be professionally satisfying, which can lead to reduced
employee satisfaction and possibly increased RD

Future Dimensions in Clinical Nutrition Practice

Fall 2014

turnover. Equally important is the fact that most medical record and communicating with other
RDs are not always competent at these tasks,
healthcare providers for care coordination.
especially when it comes to navigating the billing
Therefore, time should be blocked out of the paprocess and negotiating / communicating with
tient care schedule periodically to ensure RDs
insurance providers. If working within a healthhave time to document the patient care encouncare facility, RDs can usually utilize the expertise
ter in a timely manner. This is considered nonrevenue generating time, yet these activities are
of staff members who are specifically dedicated
essential to providing care and seeking reimto handling these functions on behalf of the orbursement. The time dediganization. It may be difficult
to determine exactly how
“RDs can bill for time spent cated towards these activities should be considered in
much time support staff memface-to-face
with
clients,
but
the overall costs for providbers dedicate to the MNT visits, but they are costs that
not for time spent document- ing MNT.
need to be considered when
determining the overall cost of ing in the medical record and For example, if documentcommunicating with
ing the initial visit and colproviding the MNT service.
other healthcare providers…” laborating with other
healthcare providers to coAssessing the time required to
ordinate care generally
receive referrals, follow up
takes 20 minutes for a new client, the RD specific
with potential patients, and send appointment
labor plus benefits cost would be divided by the
and other pertinent letters may help determine
4 or 5 units of MNT for an initial visit to assess
how many minutes are required to schedule and
the specific “cost” per 15 minute unit of an initial
register each new client. This total cost can be
visit. A typical scenario includes the RD spending
divided by the average of 4 or 5 units of MNT,
20 minutes documenting the 1 hour initial MNT
depending on the duration of an initial visit, and
visit, so 20 minutes ÷ 4 units = 5 minutes of docuthen added into the total cost. Generally less
time is required for scheduling, etc., for follow up mentation/care coordination time per 15 minute
increment. For follow up clients, both charting
clients.
and follow up may be of shorter duration, so the
costs should be calculated appropriately.
Patients occasionally do not show up for their
appointments, and without adequate notice anSupply Costs
other patient visit cannot be scheduled in that
time slot. This causes non-revenue generating
It is important to consider all supply costs intime for the RD. An adjustment factor for this
volved with providing MNT services. This can
time, based on the facility’s historical data of “no include food and nutrition specific supplies, ofshow” rates, can be included in the ABC account- fice supplies, equipment, and educational mateing method. These calculations can be complex
rials used in patient care. Equipment costs genand estimated differently depending on the facil- erally include phone bills, printer/fax/copier
ity. The calculations are beyond the scope of this maintenance costs, and other similar equipment
article, thus a “no show” factor is not included in
needs. Historical data can be used to determine
the examples provided.
monthly averages for these supplies, but projections should also be made for supply costs when
Charting / Documentation Time
new services are planned. If RDs are required to
RDs can bill for time spent face-to-face with clicarry pagers or cell phones on which clients and
other healthcare providers can reach them, this
ents, but not for time spent documenting in the
expense should be considered a supply cost.
4

Future Dimensions in Clinical Nutrition Practice

Example Cost Calculation
The ABC method is used at a nutrition counseling
center operated by Morrison Healthcare. An access specialist / office manager provides ancillary
support for registration, scheduling, and billing
for the RD visits. Since the CPT codes for initial
and follow up MNT visits are in 15 minute increments, the costs for services provided are calculated per 15 minute increments. There are 260
working days each year (52 weeks x 5 days/
week), and subtracting 30 days for PTO and professional leave results in 230 days per year, or
approximately 19 working days per month. Assuming 7 hours of patient care time per day
(accounting for breaks and miscellaneous tasks),
there are 532 15 minute increments of patient
care time per month (19 days x 7 hrs/d x 4 units/
hr).
Estimating the total number of potential 15 minute increments of patient care time per month is
Source of Cost
RD Salary, Benefits &
G&A
Food & Nutrition
Products & Supplies
Office Supplies

Per 15
minute
$11.91
$0.16
$0.06

Education Materials
Equipment

$1.00
$0.12

Ancillary Support

$2.93

Documentation & Care
Coordination Time
Professional Dues &
Certification Renewals

$3.97

Total cost

$20.32

$0.17

Fall 2014

important, as most costs are estimated or
tracked monthly. For example, the average
monthly office supply cost is about $30, or $0.06
per 15 minute increment, and is included in the
cost of providing MNT services for those 15 minutes. Table 2 is an example of how these costs
are calculated for 1 unit (15 minute increment)
of CPT code 97802. In this example, the cost for
providing MNT for 15 minutes for an initial visit is
$20.32, including cost categories discussed in the
previous section. Table 3 is an example of how
these costs are calculated for 1 unit (30 minute
increment) of CPT code 97804 for group classes,
with the assumption that an average of three
participants will attend each class. In this example, the cost for providing MNT for 30 minutes
via group classes is $14.49 per participant per
class. It is important to note that costs for group
classes are calculated per client, as that is how
insurance is billed.

Factors influencing cost
Salary $52,000 + benefits (41.2%) + G&A (5%)
[($52,000 x 1.412) + ($52,000 x 0.05)] ÷ 532 ÷ 12 mo
Printing $600/year, food models & displays $400/year
$1000 ÷ 532 ÷ 12 mo
Average monthly cost $30
$30 ÷ 532
Handouts, booklets provided to patient
Phone, copier/fax/printer $65/month
$65 ÷ 532
Scheduler salary + benefits (41.2%), .75 hour time spent
by scheduler per 60 min MNT visit
[($23,000 x 1.412) ÷ 2080 working hours/yr] x .75 =
$11.71 per 60 min session ÷ 4 units per session
5 minutes per 15 min increment
5 ÷ 15 = 33%; $11.91 x 0.33
Continuing education $500/year; certification renewals
$75/year ($300 every 5 years); malpractice insurance
$168/year; Academy and CDR dues $316/year
$1059 ÷ 532 ÷ 12 mo

Table 2: Costs to provide MNT for CPT code 97802, initial assessment and intervention, per 15
minute unit
5

Future Dimensions in Clinical Nutrition Practice

Source of cost
RD Salary, Benefits &
G&A

Per 30
minute
$7.94

Food & Nutrition
Products & Supplies
Office Supplies

$0.10

Education Materials
Equipment

$1.50
$0.08

Ancillary Support

$2.34

Documentation & Care
Coordination time
Professional Dues &
Certification Renewals

$2.38

Total cost

$14.49

$0.04

$0.11

Fall 2014

Factors influencing cost
Salary $52,000 + benefits (41.2%) + G&A (5%)
[($52,000 x 1.412) + ($52,000 x 0.05)] ÷ 266 ÷ 12 mo ÷
3 clients per class
Printing $600/year, food models & displays $400/year
$1000 ÷ 266 ÷ 12 mo ÷ 3 clients
Average monthly cost $30
$30 ÷ 266 ÷ 3 clients
Handouts, booklets provided to patient
Phone, copier/fax/printer $65/month
$65 ÷ 266 ÷ 3 clients
Scheduler salary + benefits (41.2%), .6 hour time spent
by scheduler per client per class
[($23,000 x 1.412) ÷ 2080 working hours/year] x (.6
hour) = $9.36 per 2-hour class ÷ 4 units per class
3 minutes per client per 30 min class
3 min x 3 clients = 9 min ÷ 30 = 30%; $7.94 x 0.3
Continuing education $500/year; certification renewals
$75/year ($300 every 5 years); malpractice insurance
$168/year; AND and CDR dues $316/year
$1059 ÷ 266 ÷ 12 mo ÷ 3 clients

Table 3: Costs to provide MNT for CPT code 97804, group MNT, per 30 minute unit. Assumption
made for an average of 3 participants per class, thus costs are divided by 3 in relevant categories.
Determining Expected Reimbursement
Reimbursement for MNT is dependent on the
insurance policy, and may vary based on the accompanying ICD-9 code. For example, Medicare
reimburses MNT visits for clients with diabetes
and end stage kidney disease, but not for other
diagnoses. The dollar amount reimbursed varies
depending on the insurance provider, and usually
also on geographical location. Many hospitals
and health systems have negotiated a reduced
rate with some insurance providers in order to
become the hospital of choice for that insurance
company’s patients. This type of information is
important to know when determining expected
reimbursement. The CNM can work with the
hospital’s billing department to determine expected reimbursement rates for MNT procedure
codes depending on the payment source. The
Centers for Medicare and Medicaid Services web6

site, www.cms.gov, provides the Physician Fee
Schedule5 search function that can help determine expected reimbursement rates for MNT in
the specific geographic location for Medicare patients.
Tracking Revenue
Revenue tracking should be completed monthly
and reported per CPT code. See Table 4 for a basic example of a revenue tracker that can be
used. This helps the RDs to understand whether
the business is profitable and sustainable, and
helps the medical center assess the financial viability of the program, besides the clinical benefits of the nutrition care provided to clients.
ABC accounting is not only applicable to the CPT
codes for MNT, but also for additional services
delivered by outpatient nutrition centers on fee-

Future Dimensions in Clinical Nutrition Practice

Month
CPT Code
# Units Billed
# Clients

Fall 2014

References
1. Activity Based Costing (ABC) For Hospitals.
Yardley Management Solutions, Inc Website.
http://www.ymsolutions.com/hospital-costaccounting/45-activity-based-costing-abc-forCost / Unit
hospitals-and-health-systems. Accessed June
Expected Revenue
30, 2014.
Total Revenue
2. Franz MJ, Monk A, Bergenstal R, Mazze R.
Outcomes and Cost-Effectiveness of Medical
Table 4. Sample revenue tracker for MNT services
Nutrition Therapy for Non-Insulin-Dependent
Diabetes Mellitus. Diabetes Spectrum. 1996;
for-service or fee-for-product basis. Group pro9:122-127.
grams for health conditions such as weight man3. MNT CPT and G Codes and Definitions. Acadagement, pulmonary or cardiac disease may be
emy of Nutrition and Dietetics website.
billed in part through these codes but may also
http://www.eatright.org/Members/
include product sales such as nutrition workcontent.aspx?id=7495. Accessed June 22,
books. The time and resources to deliver services
2014.
can be systematically calculated to arrive at an
4. Shadix K, Bell-Wilson JA. Finding Your Niche
appropriate cost-based accounting fee for all ser— Certification Options for the RD Today’s
vices.
Dietitian. 2007;9:40.
5. Physician Fee Schedule Search. Centers for
Periodic Evaluation
Medicare and Medicaid Services website.
The costs of providing care should be rehttp://www.cms.gov/apps/physician-feeevaluated on an annual basis. Supply costs
schedule/search/search-criteria.aspx. Upshould be tracked, and a new monthly average
dated April 17, 2014. Accessed June 22,
calculated at the end of the year. Dietitians usu2014.
ally earn raises each year, which changes costs.
Additionally, the benefit cost ratio may change in Wendy Phillips is the Director of Nutrition SysJanuary of each year depending on tax rates and
tems at the University of Virginia Health System,
insurance rate adjustments, so the salary plus
and a Regional Clinical Nutrition Manager with
benefit cost needs to be updated yearly.
Morrison Management Specialists. She can be
reached at wp4b@virginia.edu.
One of the advantages of ABC accounting is that
it allows the hospital or healthcare system to neCynthia Moore is the Assistant Clinical Nutrition
gotiate an employee rate for nutrition services
that is just at or below the cost to deliver the ser- Manager for Ambulatory Care Services at the University of Virginia Health System. She can be
vice. This provides the health system with spereached at clp6g@virginia.edu.
cific knowledge of the cost of service and allows
them flexibility to negotiate discounts both for
Keith Batt is a Business Consultant in the Environthemselves (if self-insured) and other insurance
ment of Care Division for the University of Vircarriers.
ginia Health System. He can be reached at
The authors would like to acknowledge Robert
kb4u@virginia.edu.
Nunley, Manager of Cost Accounting, Medical
Center Finance, University of Virginia Health System, for his assistance.
7

97802

97803

97804

Future Dimensions in Clinical Nutrition Practice

Fall 2014

2015 CNM Symposium Preview
By Caroline Steele, MS, RD, CSP, IBCLC
It was wonderful seeing many of you at FNCE®!
Networking and catching up with all of you talented CNMs made me that much more excited
about the 2015 CNM Symposium in Seattle,
Washington.
With the healthcare environment
rapidly changing,
those in clinical nutrition management are seeking to
increase clinical
quality and patient satisfaction within the confines of limited resources--making the contribution of each team member even more crucial.
Using transformational leadership techniques,
today's clinical nutrition leaders can learn to enhance the motivation, morale, and performance
of the team by connecting them to organizational goals and leveraging the varied strengths
of each member.
The Clinical Nutrition Management DPG Symposium will be an exceptional educational and networking experience. The symposium focus,
Transforming Leaders, will include expert presentations to help attendees:
• Gain the tools needed to communicate
the right message at the right time
• Demonstrate the value of nutrition intervention through meaningful metrics
• Stay abreast of current trends and skills
needed for advanced practice, from novice through expert
Having grown up and lived the majority of my
adult life in Washington State (including time in
Seattle), I am so happy to be going “home” and
sharing the experience with all of you! For those
of you unfamiliar with the area, Seattle is the
gateway to the Pacific Northwest, surrounded by
expansive water, two mountain ranges and three
national parks. Often recognized as one of the
8

best walking cities in the U.S., Seattle’s compact
downtown allows visitors to easily explore some
of the city’s well-known attractions, including
Pike Place Market, the oldest continuouslyoperated farmers’ market in the U.S. A stroll
through the market reveals Seattle’s culinary
bounty: wild salmon, Dungeness crab, fresh produce, strong coffee, craft beers and ales and a
wide selection of internationally acclaimed
Washington wines. Add to that an array of sophisticated restaurants run by creative chefs.
The optional program
this year will be the
Seattle Revealed and
Underground Tour.
This introduction to
Seattle features the
city’s most famous locations including Pike Place Market, The Arboretum, Pioneer Square, Fisherman’s Terminal and
the Waterfront. A stop at Kerry Park will provide
an amazing view of the Seattle Skyline, Elliott
Bay, and Mount Rainier (a sunny day will show
you why locals use the expression “the mountain
is out”). You will also visit the spooky city beneath Seattle’s present street level, where you’ll
learn how the Underground was created. The
subterranean walkways are dry, but the history
certainly isn’t! Learn about Seattle’s colorful
past; how the Founding Fathers’ squabbling led
to Seattle’s complicated street system and how
the solutions to the unique plumbing problems
affected the town’s elevation.
So it is with great pleasure that I welcome you to
join me in my former home of Seattle for an exceptional educational experience. In addition to
lecture presentations, there will be opportunities
to network with other healthcare leaders, visit
vendor displays, and explore the amazing city of
Seattle, Washington. I sincerely hope to see you
there!

Future Dimensions in Clinical Nutrition Practice

Fall 2014

GENIE: Your Nutrition Education
Wishes Have Been Granted!
Jenica K. Abram, MPH, RDN, LDN
You’re asked to give a 30 minute talk on fruits and
vegetables at your child’s school,…the same
week your quarterly board report is due.
Your department’s request to start a diabetes
prevention program was approved,…for thousands less than expected.
You love helping families choose inexpensive,
healthy foods,…but barely have time for your
own lunch break.
Do any of these situations sound familiar? Nutrition education has a positive impact on the health
of clients and communities.1,2 However, external
priorities such as time and money can stand in
the way of great programming. Research has
identified qualities that lead to successful outcomes3–6, but nutrition education programmers
and practitioners can face many barriers to implementing these strategies. The Guide for Effective
Nutrition Interventions and Education (GENIE) is a
free, easy-to-use tool that can help educators apply the latest research to create effective nutrition education programs, advance the literature
on the science of nutrition education, and help
identify and describe best-practices in nutrition
education interventions.
The GENIE checklist can help users design, modify, or compare effective nutrition education programs and is available online at sm.eatright.org/
GENIE. GENIE is divided into 9 categories: Program Description and Importance, Program Goal,
Program Framework, Program Setting Recruitment and Retention Plan, Instructional Methods,
Program Content, Program Materials, Evaluation,
and Sustainability. Each category contains specific, evidence-based quality criteria. These are
elements of nutrition education programs that
research and experts have identified as important
contributors to a program’s success.
9

GENIE has several uses:
1. GENIE can be used to help you develop a new
nutrition education program or modify an
existing program.
2. The GENIE checklist can be used as a selfassessment quality assurance tool for a current nutrition education program.
3. Funders can use the GENIE checklist as a way
to compare and score nutrition education
proposals and guide funding decisions.
The GENIE checklist is available to the public and
requires no log-in or account set-up. To use the
checklist, one clicks ‘yes’ or ‘no’ to indicate the
presence or absence of each criteria. Many criteria are paired with definitions to help users understand terms used in the criteria descriptions.
GENIE automatically totals the criteria marked as
present to provide a total score with a maximum
possible score of thirty-five. Feedback is provided for each category and is designed to help
nutrition educators strengthen their program
plan or proposal. GENIE makes it easy to
download and email your checklist results or
start over with a blank checklist.
GENIE’s evidence-based criteria were rigorously
validated in a three step process. Step one established GENIE’s validity using the expertise of a
panel of thought leaders in nutrition education.
Step two established the tool’s reliability using
trained volunteer reviewers from the Academy's
Dietetics Practice Based Research Network
(DPBRN) to score nutrition education proposals
using GENIE. Step three was a systematic review
of published nutrition education programs. A
complete report on this validation process is under review at the Journal of Nutrition Education
and Behavior.

Fall 2014

Future Dimensions in Clinical Nutrition Practice

There are many resources that have been built
into the website, to help users learn more about
GENIE and design effective nutrition education
interventions.
A glossary terms organized by the GENIE category including definitions and program
examples.
A list of web-based resources that can help
users determine how to include criteria
within a certain category.
A searchable spreadsheet of program data
from over 100 published nutrition education interventions and a listing of evaluation tools.
A chart of GENIE category examples illustrating how criteria was fulfilled in published
manuscripts.
A set of training sample proposals and scoring
benchmarks to help users learn how to
use GENIE effectively.
In addition to these print resources, short video
overviews and narrated PowerPoint tutorials offer further guidance. To learn more about GENIE,
you can access a 60 minute recorded webinar
here: http://www.eatright.org/Foundation/
content.aspx?id=6442480481
GENIE can help you develop strong programming
whether you are putting together a quick presentation for your child’s school, modifying your intervention plans to reduce costs, or creating an
evaluation strategy to measure the impact of
your work. The GENIE checklist and resources can
help support your efforts to create effective nutrition education programs that benefit the communities you serve. GENIE may set the standard for
quality nutrition education. Visit GENIE at
sm.eatright.org/GENIE to learn more about how
this valuable tool can become an important part
of your professional practice.
Footnote: Funding was provided by the ConAgra
Foods Foundation through an educational grant
to the Academy of Nutrition and Dietetics Foundation. The ConAgra Foods Foundation was not
10

involved in the collection, analysis or interpretation of data.
GENIE project team members:
1
• Rosa K Hand, MS, RDN, LD
Senior Manager, DPBRN
1
• Jenica K Abram, MPH, RDN, LDN
ConAgra Foods Foundation Nutrition
Education Research Fellow
2
• Katie Brown EdD, RDN
National Education Director
1
• Paula J Ziegler, PhD, RDN, CFCS
Senior Director, Research & Evidence Analysis
3
• J. Scott Parrott, PhD
Associate Professor
1
• Alison L Steiber, PhD, RDN
Chief Science Officer
1

Academy of Nutrition and Dietetics, 2 Academy
of Nutrition and Dietetics Foundation, 3 Rutgers
University

References
1. Brun J. Nutrition education: A model for effectiveness a synthesis of research. J Nutr Educ.
1985;17(2):ii–S44.
2. Ho M, Garnett SP, Baur L, et al. Effectiveness
of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics.
2012;130(6):e1647–71.
3. Contento I. Review of nutrition education research in the Journal of Nutrition Education
and Behavior, 1998 to 2007. J Nutr Educ Behav. 2008;40(6):331–40.
4. Gillespie AH, Brun JK. Trends and challenges
for nutrition education research. J Nutr Educ.
1992;24(5):222–226.
5. Spahn JM, Reeves RS, Keim KS, et al. State of
the evidence regarding behavior change theories and strategies in nutrition counseling to
facilitate health and food behavior change. J
Am Diet Assoc. 2010;110(6):879–91.
6. Nation M, Crusto C, Wandersman A, et al.
What works in prevention: Principles of effective prevention programs. Am Psychol.
2003;58(6-7):449–456.

Future Dimensions in Clinical Nutrition Practice

Fall 2014

House of Delegates (HOD) Report
Submitted by: Mary Jane Rogalski, MBA, RD, LDN – CNM Delegate
Updates on Previous HOD meetings
The HOD conducted a dialogue on Nutrition Services Delivery and Payment on October 18-19,
2013. As a result of this dialogue session, the
HOD requested the Coding and Coverage Committee (CCC) and the Legislative and Public Policy
Committee (LPPC) collaborated to create a Nutrition Services Delivery and Payment Plan. The
Board of Directors (BOD) approved the submitted
plan which is available to members at
www.eatright.org/hod > Updates to Mega Issues.
The document contains an extensive list of resources for members.
On May 3-4, 2014 the HOD conducted a dialogue
session on the Mega Issue: Engaging Members in
Research. In addition, the HOD discussed proposed Academy BOD by-law changes and the
proposed position concept, “The Role of the RDN
and Nutrition Therapy in the Prevention and
Treatment of Pre-Diabetes and Diabetes”. The
following motions were developed and approved
by the HOD following the dialogue session.
The HOD requested:
• The Council on Research develop a concrete plan to engage members in research,
which includes an outcome measures
component. The plan will empower members at all practice levels and all practice
areas to: successfully use, participate in
and/or conduct research; effectively connect members to existing research resources; recognize members’ contributions to research; and create a strong culture of research for the profession.
• The Academy Bylaws be amended to include the past treasurer on the Board of
Directors and the term of office for a public member to change to three (3) years to
ensure consistency in the terms of office
11

for Board of Directors members
• The Academy develop the proposed position concept, “The Role of the RDN and
Nutrition Therapy in the Prevention and
Treatment of Pre-Diabetes and Diabetes”,
into an Academy position paper by the
Academy Positions Committee.
Fall 2014 HOD Meeting – October 17-18, 2014
The House of Delegates met on October 17 to
discuss the Mega Issue Question: How can all
Academy members utilize, expand and sustain
business and management skills to take advantage of current and emerging professional opportunities? The meeting objectives were to:
1. Identify benefits and successful outcomes
of utilizing business and management
skills.
2. Expand members’ awareness, utilization
and development of business and management resources.
3. Develop strategies to utilize, expand and
sustain business and management skills.
4. Apply business and management skills in
all areas of practice.
5. Recognize, seize and create business and
management opportunities.
On October 18 the Practice Issue Question: What
solutions can the House of Delegates offer to the
Academy, ACEND and NDEP to help increase the
number of supervised practice experience positions and the number of preceptors? Meeting
objectives were to:
1. Brainstorm solutions to increase supervised practice experience positions, especially in non-hospital settings.
2. Brainstorm solutions to increase the number of preceptors.

Future Dimensions in Clinical Nutrition Practice

In September a request was sent via e-blast to
CNM members to complete a survey regarding
these issues. Thank you to those who completed the survey. Responses were shared with
the HOD and represented during the HOD meeting. Additional information and resources about
the Fall 2014 HOD meeting can be found at
www.eatright.org/HOD > Fall 2014 Meeting Materials.

Fall 2014

The HOD Leadership will draft motions for review
and voting by the delegates over the next few
weeks. Members will be notified of the results
via eblast.
Academy updates and reports were provided
prior to the Fall Meeting and can be found at
www.eatright.org > governance > reports.

One free CPEU available to CNM DPG members!
1. Read the article titled “Providing Outpatient Nutrition Services Using an Activity Based Costing
Method” by Wendy Phillips, Cynthia Moore, and Keith Batt.
2. Log on to the CNM DPG website at cnmdpg.org
3. Go to the member’s only section and click on the link for the CPE Exam
4. Take the exam; your CPE certificate will be emailed to you within one week
This article has been approved for 1 CPE, Level 2; Learning Needs Codes 7070, 7080, 7170 .
The test will remain available for three years after the publication date of this edition of Future Dimensions in Clinical Nutrition Practice (November 3rd, 2014).
Visit us at the CNM DPG website—cnmdpg.org. Available resources include:










Searchable member directory
Resource library
The DPG’s guiding principles and strategic plan
The Standards of Professional Performance for Dietitians in Clinical Nutrition Management
Newsletter archives
CNM annual report to members
Eblast archives
Information on the Informatics and Quality and Process Improvement (QPI) subunits
Sign up for the CNM electronic mailing list (EML)
Sign up for the QPI EML—in the members only section, click on the Subunits tab, then QPI
Update your CNM profile—click on Edit Your Profile in the Member Info section

For additional information, contact us at: ClinicalNutritionMgtDPG@gmail.com
Managing Editor:
Jennifer Doley, MBA, RD,
CNSC, FAND
520-872-6109
jdoley@carondelet.org
Lead Features Editor:
Lisa Trombley, MA, RD, CNSC
310-903-2900
ltrombley@dhs.lacounty.gov

12

Features Editors:
Interested in contributing an article to
Leigh-Anne Wooten, MS, RD, LDN the newsletter? Topics of interest in704-355-6660
clude leadership, management, innoleighannewooten@yahoo.com
Amanda Nederostek, MS, RD, CD
(801) 662-5303
amanda.nederostek@imail.org

vations in clinical practice, research
and outcomes, nutrition legislation
and public policy, reimbursement and
coding, informatics, healthcare reform, and many others. If interested,
please contact an editor.

Future Dimensions in Clinical Nutrition Practice

Fall 2014

CNM DPG Announcements
Quality and Process Improvement
Sub-Unit Update
By Sherri Jones, MS, MBA, RDN, LDN, FAND
Plan to Participate in our New QPI Project Contest:
Do you have a quality / process improvement initiative you’d like to share? We are asking interested
CNM members and their teams to submit your successful projects. The contest is a way to share best
practices with others and also recognize our CNM members for the quality work they do. The contest
guidelines and directions are posted on the CNM website. All submissions will be judged by a 5 member panel from the CNM Executive Committee. The 1st place winner will receive free registration to
the 2015 CNM Symposium (a $360 value). In addition, the top 10 projects will be showcased at the
symposium as posters for additional CEUs. As a reminder, an announcement for QI project submissions will be sent as an eBlast to all members. Look for the announcement soon to come, or visit the
CNM website QPI Sub-Unit section for more details. Best of luck to all who submit their great improvement projects!
QPI Sub-Unit Session @ Annual CNM Symposium – April 2015:
The QPI Sub-Unit presents a session each year at the CNM educational symposium. Next year at the
spring symposium in Seattle, WA, we are excited to have Sharon McCauley, Director Quality Management for the Academy of Nutrition and Dietetics as a guest speaker for our QPI Sub-Unit session.
Many exciting things have been happening in Food and Nutrition Quality Management, including the
CMS rule on therapeutic diet orders. Sharon will review updates and share the various tools and resources available to dietetics professionals. If you plan to attend the symposium make sure you do
not miss this opportunity to hear from Sharon McCauley. You will walk away better informed and inspired!
Special QPI Sub-Unit Electronic Mailing List (EML):
We now have close to 100 subscribers to this special EML. For those of you already subscribed, please
feel free to post questions or resources related to quality and process improvement. There is so much
we have to learn from one another…If you are not currently subscribed to the special QPI EML and
wish to do so, you can subscribe to the EML through the QPI Sub-Unit webpage or enter the following
URL directly: http://www.cnmdpg.org/members/page/qpi-sub-unit-member-info.
And as always, if you have any questions or suggestions for the new Quality and Process Improvement Sub-Unit feel free to contact the sub-unit Chair and / or Vice-Chair. The sub-unit is a member
benefit, and thus, we want to be sure to meet your needs and expectations. Continue to visit the QPI
Sub-Unit section of the website for updates.
QPI Sub-Unit Chair:
Sherri Jones, MS, MBA, RDN, LDN, FAND jonessl@upmc.edu
QPI Sub-Unit Vice-Chair: Cindy Hamilton, MS, RD, LD hamiltoc@ccf.org
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Future Dimensions in Clinical Nutrition Practice

Fall 2014

Research Committee Report
By Susan DeHoog, RD
The results of the staffing study were presented at FNCE® on October 19th. Some of the highlights:
Participants: Data were collected from 353 RDNs representing 78 facilities, 4931 patient days, and
46,542 patient encounters. No Veteran Affairs facilities participated; otherwise, facility characteristics appear to be well distributed among types and sizes.
Results: Time required for a patient encounter increased as complexity increased. Time was also associated with the number of activities included in the encounter. We also captured information
about other activities during the day; screening, communications and rounds were the most frequent
and time consuming non-patient activities. Participants were asked to document patient encounters
they did not have time to complete; very few visits were missed. There was some relationship between missed activities and whether the RDs were salaried or hourly, but we could not look on an
individual level to assess whether RDNs were working extra hours than paid to prevent missed activities.
We created a model to estimate time required for patient encounters. The model is different for
adult and pediatric patients, but both are based on the complexity of the patient, whether they are in
the ICU and the type of assessment needed. The model is not a gold standard, however it can be
used to compare a facility’s RD staffing to other like facilities.
Participating facilities received a report of their data and will have an opportunity to attend a webinar
explaining the results. A session was submitted to the 2015 CNM Symposium, and an abstract to the
2015 Clinical Nutrition Week. A manuscript is under development for publication in the Journal of
the Academy of Nutrition and Dietetics (JAND). Further publications may be forthcoming, however
these will need to wait until after the JAND article is published.
Next steps: Further studies are needed to assess the correlation, if any, between RDN time and patient outcomes in order to develop and validate a gold standard model. The CNM Research Committee and the Academy’s Dietetics Practice Based Research Network (DPBRN) are in the early stages of
determining the resources that will be required for such studies.

Advertisements in Future Dimensions
CNM accepts advertising for publication in Future Dimensions in Clinical Nutrition Management. All ads are
subject to approval by the Review Committee and must meet established guidelines. All ads must be camera
ready and received by the Editor by copy deadlines. Fees must accompany the ad at the time of submission.
CNM members receive a 20% discount. Send all inquiries to the Managing Editor, Future Dimensions in Clinical
Nutrition Management. Publication of an advertisement in Future Dimensions in Clinical Nutrition Management should not be construed as endorsement of the advertiser or the product by the CNM DPG or the Academy of Nutrition and Dietetics.
Future Dimensions In Clinical Nutrition Management
Viewpoints and statements in these materials do not necessarily reflect policies and/or official positions of the
Clinical Nutrition Management Dietetic Practice Group or the Academy of Nutrition and Dietetics. © 2014
Clinical Nutrition Management Dietetic Practice Group of the Academy of Nutrition and Dietetics. All rights reserved.

14

Future Dimensions in Clinical Nutrition Practice

Fall 2014

Member Services Report—FNCE® Recap
By Kerry Scott, RDN, CD
Atlanta Georgia was host city to another fabulous FNCE® meeting for 2014. The weather could not
have been more cooperative with sunshine and mid-70’s temperatures. As usual, there was more
offered to see, do and sample than one person can possibly experience.
In the opening session on Saturday October 18th, keynote speaker Peter Diamandis, MD, encouraged
attendees to “think exponentially” with thought-provoking innovations on how human needs for
food, energy, healthcare, education, and communication are being affected by technology. That set
the tone for the next several days in which sessions introduced new opportunities, processes and
products for RDNs and DTRs. On Saturday, the CNM Executive Committee also held its meeting to
review the Plan of Work and budget for the upcoming year.
Our practice group was proud to honor CNM member / former chair and former Academy president
Jessi Pavlinac, MS, RD, CSR, LD as she received a Medallion Award. Jessi’s commitment to volunteer
service, visionary leadership, exceptional professional expertise and collaboration, and inspirational
mentoring and coaching were recognized. Jessi’s contributions to the profession are extensive!!
On Sunday October 19th,
in the session titled
Building and Utilizing a
Clinical Staffing Model:
Benchmarks for Success,
CNM members Susan
DeHoog and Barbara Jordan presented research
results from the study
developed and executed
collaboratively
by the
Barbara Isaacs Jordan, Susan DeHoog, Jessi Pavlinac
CNM DPG and the Dietetics Practice Based Research Network. While this information is preliminary, the published article
will provide a benchmark for clinical nutrition inpatient staffing models and time frames for assessment and reassessment.
Sunday evening CNM members had the opportunity to network and welcome new members at the
Member Reception held at the Marriott. Nancy Lewis, PhD, RDN, FADA , FAND from the Academy
Board of Directors thanked the membership for the work they do to make the Academy the successful organization that it is today with a membership of 99,000 and growing.
On Monday October 20th, the CNM DPG hosted a booth at the DPG/MIG showcase to promote our
upcoming Annual CNM Symposium in Seattle April 11-14th, 2015, in addition to making sure current
members are taking full advantage of the resources available to them through membership, and to
encourage new members to join. If a current CNM member induces a new member to join by January 31st, 2015, complete and submit the new member raffle form to be entered in a drawing for free
registration to the 2015 CNM Symposium. The form can be found on the CNM DPG website under
the CNM Symposium area of the Member Benefits section.
15

Future Dimensions in Clinical Nutrition Practice

Fall 2014

Action Alerts: Why Should I Care?
By Julie Haase, MS, RDN, CD, Public Policy Chair
Take this quick quiz to determine if you should care about public policy:
I bill Medicare or Medicaid
Yes
I work with child or older adult nutrition programs
Yes
I am concerned about agriculture and food access
Yes
Licensure and/or managed care mandates impact my work
Yes

No
No
No
No

If you answered “Yes” to any of the questions, public policy impacts the way you work. So how do
you make a difference in policy?
The Academy actually takes care of a lot of the leg work for us. The Policy Initiatives and Advocacy
(PIA) Team in Washington, D.C. identifies opportunities and challenges in legislative and regulatory
activity. That team then provides guidance to grassroots advocates, like myself, on how to help our
members take action. Our efforts are bi-partisan, so you can get involved in the political process
without getting caught up in the politics.
To take action, you can simply complete an Action Alert when you see it in your in-box. It literally
takes two minutes (I timed myself). Did you know that only 3.3% of Academy members sent letters
to congress to support the National Diabetes Clinical Care Commission Act? We can do better than
that!
Please click on the next Action Alert you see. If you have any questions or suggestions on information
you would like me to present to our DPG, you can reach me at Julie.haase@wfhc.org or at
414.213.6875.

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Future Dimensions in Clinical Nutrition Practice

Fall 2014

Featured Member: Renee Winter-Bertsch,
MS, RD, LDN, CDE
What do you love most about your job?
For as many years as I have been a dietitian I still
get excited about the profession. As Sr. Director I
really enjoy the challenge and the thought of all
the possibilities that we can bring to the health
system and the patients we serve.

How long have you been a CNM?
I have been a dietitian for 29 years. The last 18
years I have practiced in management roles as
CNM and presently as Sr. Director of Clinical Nutrition. I have been a CDE for the last 23 years
and have been active with some aspect of diabetes patient care for the majority of those years.
Briefly describe your current job
My current position as Senior Director is responsible to oversee the Clinical Nutrition Department
for the Geisinger Health System. Geisinger
Health System is an integrated health organization in Central PA which serves 2.6 million residents in 44 counties. There are 55 dietitians in
the health system under Clinical Nutrition. The
areas of practice spread to seven hospitals, two
rehab centers, and over 23 outreach clinic sites.
I also continue to do part time outpatient services in the areas of general MNT and Diabetes
Self-Management Training / Education.
Our department reports to the Chief of System
Services. We do work closely with the Food Service departments in any initiatives that directly
involve patient care. The department collaborates with the health systems Food Service Department, Employee Wellness and Sustainability
to promote our Healthy Selections program, and
Get Fresh Market Programs in addition to patient
care.
17

What is the most challenging part of your job?
The health system in the last three years has purchased four hospitals, and two nursing homes.
My challenge is juggling the travel with the daily
work.
What advice do you have for new CNMs?
Reach out to other managers, seek out a mentor,
always be willing to learn and think outside the
box. Self-reflect on your management skills, work
to improve your skills always. Work to advance
your team, as the future of health care I believe
will require this.
Describe what you think the ideal role of the RD
should be 30 years from now. What do you
think we need to do as a profession to get to
that point?
I think we first need to make sure RDs are here
30 years from now, so it means we need to be
vital to health care. I believe our roles in hospitals will be highly specialized. I think the possibilities with Population Health is wide open - with
outpatient services, public health jobs, wellness
etc. I think we need to be flexible, think outside
the box of what we have done in the past and
train to practice at the highest level our SOP will
allow.
If you couldn’t be a dietitian anymore, what
profession would you choose?
This is tough. I love being a dietitian. If I couldn’t
then I believe I would like to do something to
create - I love to garden, so perhaps landscape
design; or another thing I love is old homes so
perhaps interior design / restoration of old
homes.

Future Dimensions in Clinical Nutrition Practice

Fall 2014

Clinical Nutrition Management Dietetic Practice Group
2014—2015 Executive Committee
Chair
Kathryn Allen, MA, RD, CSO
Kathryn.allen@coramhc.com
Chair-Elect
Caroline Steele, MS, RD, CSP, IBCLC
csteele@choc.org
Immediate Past Chair
Young Hee Kim, MS, RD, LDN, CNSC
YoungHee.Kim@baystatehealth.org

Nutrition Informatics Chair
Janel Welch, MS, RD, LD
jwelch02@unityhealth.org
Nutrition Informatics Vice-Chair
Ann Childers, MS, RDN, MHA, LD
ann.childers@palmettohealth.org
Committee Members
Krista Clark, MBA, RD, LD
kristaclark72@gmail.com

Secretary
Jennifer Wilson, MS, RD, LDN
wilsonjs@ph.upmc.edu

CNM EML Administrator
Deb Hutsler, MS, RD, LD
dhutsler@chmca.org
Assistant Administrator
Laurie Szekely
lszekely@chmca.org

Treasurer
Janet Barcroft, RD, LDN
Janet.Barcroft@H2U.com
Newsletter Managing Editor
Jennifer Doley, MBA, RD, CNSC, FAND
jdoley@carondelet.org
Features Editors
Lisa E. Trombley, MA, RD, CNSC
ltrombley@dhs.lacounty.gov
Leigh-Anne Wooten, MS, RD, LDN
leighannewooten@yahoo.com
Amanda Nederostek, MS, RD, CD
Amanda.nederostek@imail.org
Nominating Committee Chair
Lisa Cherry, MS, RD, CNSC
lisacherry@gmail.com
Kelly Danis, RD, LDN
daniska@upmc.edu
Chair Elect
Wendy Phillips, MS, RD, CNSC, CLE
Wp4b@virginia.edu
Committee Members
Tamara Smith, RD, LD
tsmith@kmc.org
CNM DPG Delegate to the HOD
Mary Jane Rogalski, MBA, RD, LDN
mrogard@charter.net

18

Public Policy Chair
Julie Haase, MS, RD, CD
Julie.Haase@wfhc.org
Member Services Chair
Kerry Scott, RDN, CD
Kerry.scott@providence.org
Committee Members
Alexandra Lautenschlaeger,
RD, LD, LDN
Alexandra.Lautenschlaeger@
rutherfordregional.com
Renee S. Winter-Bertsch,
rsbertsch@geisinger.edu
Marsha Kenner, MS, RD, LDN
mmkrd@aol.com
Lynn Becker, RD, LD
becker@slhs.org
Professional Development Chair
Kelly Danis, RD, LDN
daniska@upmc.edu
Committee Members
Beverly J.D. Hernandez,
PhD, RD, LDN
BeverlyHernandez@TGH.org

Cathy Montgomery, RD, LD
cathymontgomery@me.com
Melissa Payne, MS, RD, LDN
melissa.payne@orlandohealth.com

Research Co-Chairs
Susan DeHoog, RD
sdehoog@u.washington.edu
Barbara Isaacs Jordan, MS, RD,
CDN
jordanb@mskcc.org
Research DPBRN Liaison
Jessie Pavlinac, MS, RD, CSR, LD
pavlinac@ohsu.edu
Committee Members
Debby Kasper, RD, LDN, SNS
debby_kasper@premierinc.com
Barbara Lusk, RD, LDN
blusk@stanfordchildrens.org
Quality and Process
Improvement Chair
Sherri L. Jones,
MS, MBA, RD, LDN, FAND
jonessl@upmc.edu
Quality and Process
Improvement Vice-Chair
Cynthia Hamilton, MS, RD, LD
hamiltoc@ccf.org
Fundraising Chair
Sharron Lent, RD, LD
Lent-sharron@aramark.com
Immediate Past Chair
Monica Milonovich, MS, RD, LD
mmilonov@yahoo.com
Academy of Nutrition and
Dietetics Manager, DPG / MIG
Relations
Mya Wilson, MPH, MBA
mwilson@eatright.org