Wednesday, July 9, 2008

Medicare and Nutrition Update

Thank you, thank you, thank you to all my colleagues and all the cancer patients who have contacted your two US Senators and House congressional representative at my urging over the past several years to voice your support of various bills that have been introduced to update and streamline the process for deciding how additional medical diagnoses (such as cancer) can ultimately achieve payment/reimbursement from Medicare for the professional services and expertise of Registered Dietitians (RD) who provide nutritional assessments, education, and counseling, which is formally called Medical Nutrition Therapy or MNT.

Currently only those people with the diagnosis of either kidney disease receiving dialysis or diabetes have expertise from a Registered Dietitian covered as part of their comprehensive care, and reimbursement for both of these diagnoses literally needed an "act of Congress" to be included as a covered cost of care.

The bill that passed the Senate Wednesday, July 9, and was passed earlier by the House of Representatives contains language that should allow MNT to be expanded to cover therapy considered reasonable and necessary for the prevention of an illness or disability. To be covered in the future, preventive services must be proven to be necessary and reasonable and receive a recommendation from the United States Preventive Services Task Force (USPSTF).

Expanding MNT to conditions such as pre-diabetes should be approved by Medicare relatively quickly since the evidence is so strong that proper nutrition intervention can prevent the progression of this potentially expensive, debilitating, and even fatal disease. Other conditions (such as a cancer diagnosis) as recommended by the USPSTF based on current and emerging research in the future also would be evaluated by the American Dietetic Association and submitted to Medicare for consideration of reimbursement for the professional services of the Registered Dietitian.

I have lost count of the number of letters I have written to my two Senators and House Representative about the importance and potential benefits of this coverage over the past many years (at least the past 5 years, if not more). I have also personally visited each of their offices in Washington, DC and even happened to meet one of my Senators on a airplane where we had an in-depth discussion about the various benefits from Medicare (and ultimately private insurance carriers, too) covering Medical Nutrition Therapy for numerous diagnoses.

My focus has always been on what needs to happen to have Registered Dietitians and MNT included as part of comprehensive cancer care. However, it does not bother me one bit that the first diagnosis to likely benefit from this new bill (which is still to be signed and/or vetoed by President Bush, fortunately with enough votes available to override a veto if needed) may be pre-diabetes as opposed to cancer.

The reality is (1) 57 million Americans having a pre-diabetes diagnosis (many not knowing it), (2) most people with a pre-diabetes diagnosis are overweight or obese, (3) being overweight or obesity is a risk factor for many types of common cancer, and (4) many patients with a new diagnosis of cancer are already receiving benefits from Medicare. Therefore, many new cancer patients will likely already have or will be newly diagnosed with pre-diabetes concurrently with their cancer diagnosis, which will permit them to become eligible for having MNT coverage by Registered Dietitians who can help prioritize and evaluate all of their nutritional concerns to optimize their pre-diabetes care along with both cancer treatment and long-term survival after a cancer diagnosis. At least that is how I see the positive to this new bill and development!

As more and more research is done showing the benefits of MNT (i.e., nutritional evaluation and recommendations by RDs who specialize in nutritional oncology) regarding cancer prevention and also for cancer patients during treatment and recovery, I am confident that that day will come in which individualized and proactive nutritional care will become an automatic component of true comprehensive cancer care, just as one would expect surgery, radiation, or chemotherapy to be individualized to person's a specific situation and needs in order to optimize the odds for full recovery.

The road to inclusion of Medical Nutrition Therapy as a preventive service in a bill about Medicare reimbursement has been long and difficult, and the journey is not yet complete for cancer patients. However, the passage of this bill is more than one more baby step along the way. It is a giant step, and is the result of the vision, passion, and dedication of professional colleagues and patients from all part of our country. Again, I send my heart-felt gratitude to all those who helped make this possible. Your efforts will improve the care for those millions of patients to follow, who will also thank you. :-)

Diana Dyer, MS, RD


Fisher said...

I did see an RD after my Stage III BC diagnosis three years ago, but really learned far more from reading your book. I think your book should be required reading for everyone diagnosed with BC. It empowered me to take charge. The really amazing thing is that my oncologist is starting to agree more and more with what I do to stay healthy.

Anonymous said...

Hi! Ms.Diana Dyer!

How are you!

I'm Carol from China. I happen to see your blog website online which makes me feel very lucky. Since I'm newcomer here, I'm stil reading and learning from your blog. I'm really deeply moved by all your nonstop efforts of so many years given to all needed patients. My English is not good, sorry for my poor expression.

My mother was diagnosed Breast Cancer on May.14th this year, and took an operation of mastectomy and also chemotherapy. She is now at third round of chemotherapy at hospital. I still can remember that strong helpless and fear felt by all my family at my mother's first diagnosis. Then I started to read many health-care books and surfed on internet whenever if possible to learn anything about Breast Cancer. I still have so many future things to share with my mom, i can't lose her in my life...

Not long after this big blow did i decided to learn more knowledge as much as possible about diet nutrition and other tips beneficial to BC. I'll fight BC together with my mom. I really feel very lucky that i can meet you online and I'll come here often to learn from you. Many thanks for your support to patients and all your sharing.

Have a nice day!
Carol from China

Anonymous said...

Hi! Ms.Diana Dyer,

How are you!

I have a question for you, pls. Can my mom drink Soybean Juice? We use juice-extractor to make soybean juice and let mom drink one glass every day since we think it's nutritional. But I hear of some people say that soy food contains phytoestrogens which may encourage some growth of breast cancer cells. If this claim is right, soybean juice may be cause recurrence of BC. What should I do? Do i need to stop my mom to drink soybean juice right now?

Thanks for your help. I'm looking forward to your reply.

Carol from China

Diana Dyer said...

Thanks for your heart-warming comment. I just love hearing success stories! I send my best wishes for decades of health, healing, and hope!

Diana Dyer said...

Thanks for visiting all the way from China and sharing a bit of your own family's cancer story. For questions about the inclusion of soy for breast cancer patients, please visit my web site at, use the search function to find Q&A's about any topic you wish, including the use of soy for breast cancer. I am drinking a soy shake/smoothie right now. :-)
All my best wishes to you mom,

Anonymous said...

Hi! Ms.Diana,

many thanks for your reply which gave me much confidence to fight BC with my mom. thanks for your kind wish.

I'll visit your website and learn, learn, learn.

Have a nice day!