[Congressional Record Volume 145, Number 89 (Tuesday, June 22, 1999)]
[House]
[Page H4711]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page H4711]]
                   TRIBUTE TO NUTRITION PROFESSIONALS

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Florida (Mr. Bilirakis) is recognized for 5 minutes.
  Mr. BILIRAKIS. Mr. Speaker, I rise today to pay tribute to the 
dedicated nutrition professionals who work in hospitals, WIC clinics, 
nursing homes, school lunch and breakfast programs, and many other 
settings where they are striving to improve the nutritional health of 
our Nation's citizens.

                              {time}  1800

  I would like to call special attention to one important segment of 
our population where nutrition services have proven to make a 
significant difference among our senior citizens.
  In many ways, our Nation's health care system is the best in the 
world, partially because our free market system allows innovations to 
occur at a pace that is demanded by the health care consumer.
  Unfortunately, too often the largest health program in the country, 
the Medicare program, is unresponsive and fails to keep pace with the 
advances that medical science demonstrates are effective.
  In recent years, as science and society have uncovered more 
information about the critically important role of nutrition in the 
prevention, treatment and management of disease, more and more 
Americans have demanded that nutrition services be a standard part of 
their health care protection. In fact, by one estimate, 75 percent of 
all managed care health plans in America now offer some degree of 
coverage for nutrition therapy services.
  Therefore, it is disheartening, Mr. Speaker, though perhaps not 
surprising, to realize that nutrition services are inadequately covered 
under the Medicare program. While the science of nutrition has advanced 
at a rapid pace over the last several decades, Medicare's coverage of 
nutrition services has remained largely static.
  Under Medicare's conditions of participation, appropriate nutrition 
care is a standard part of the hospital program. However, the 
outpatient, or Part B, portion of the program fails to provide reliable 
nutrition coverage. It makes little sense to me that Medicare 
beneficiaries can receive comprehensive nutrition care only after they 
have become so sick that they are admitted to the hospital. For many 
years, health care treatment has been shifting away from inpatient 
facilities like hospitals and more toward outpatient settings. And yet, 
still we find Medicare adhering to an outdated system where nutrition 
therapy services are available only in the acute-care setting.
  This clearly is a reflection of a system that is in need of change. 
Our modern health care program ought to ensure the adequacy and 
equitability of nutrition services in both inpatient and outpatient 
settings. A great number of diseases can be prevented and managed 
throughout patient nutrition therapy. Research proves that renal 
disease, diabetes, cancer, heart disease, and other illnesses respond 
well to nutrition interventions.
  Nutrition professionals have documented the ability of well-nourished 
individuals to better resist disease and to tolerate other therapy than 
those who are under-nourished. These individuals are also better 
equipped to recover from acute illness, surgical interventions, and 
trauma. As a result, they experience fewer and shorter hospital stays, 
need less medication, and suffer fewer medical complications. All this 
can save money and lives.
  A constituent of mine recently visited me and explained just how 
effective these services can be and what a difference they can make in 
people's lives. The constituent is a dietician from Florida who told me 
about a case involving her mother-in-law who lives in a different 
State.
  During a routine medical visit, her mother-in-law was found to have a 
high blood sugar level. Her physician gave her medication and a blood 
glucose monitor to check her blood sugar level but gave her no 
directions about using the monitor or changing her diet. Within 2 
weeks, she was hospitalized with severe low blood sugar and heart 
palpitations.
  After working with a dietician, she is now off the medication and 
able to control other blood sugar level. However with nutrition 
counseling from the beginning, that hospitalization could have been 
avoided, saving the cost of the hospitalization as well as saving that 
mother-in-law from a life-threatening situation.
  Now, I do not know if that physician lacked knowledge about the 
importance of nutrition in the treatment of diabetes or, knowing that 
the services were not likely to be reimbursed, did not want to put his 
patient to that expense. But the bottom line is that our health care 
system must provide patients with access to this important service.
  According to my constituent, there are many other diseases that can 
be successfully managed with the medical nutrition therapy.
  Mr. Speaker, I recently spoke with a constituent who is a dietetic 
intern working in the James A. Haley Veterans' Administration Hospital 
in Tampa, Florida. She described the rigorous educational and training 
requirements that she and others preparing for a career in dietetics 
must undergo.
  With 5 years specifically devoted to the study of nutrition, 
registered dieticians learn to apply the principles of nutrition, 
biochemistry, and physiology toward the prevention and treatment of 
diseases. Most physicians understand that registered dieticians are the 
best qualified professionals to furnish nutrition therapy.
  Clearly, registered dieticians are a valuable and indispensable part 
of the health care team, and Medicare beneficiaries ought to have 
reliable outpatient access to the care they deliver.
  This Congress, Mr. Speaker, should carefully examine coverage for 
medical nutrition therapy as one important way to help strengthen 
Medicare for our children and grandchildren.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, will the gentleman yield?
  Mr. BILIRAKIS. I yield to the gentlewoman from Connecticut.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I just wanted to rise in 
support of the comments of the gentleman from Florida (Mr. Bilirakis) 
this evening in support of medical nutrition therapy.
  It is truly a tragedy that we seem unable to reorganize Medicare in 
such a way that preventive health measures like nutrition therapy can 
be adopted. In the first few years, $2.3 billion could be saved, which 
would offset the overall longer cost of $2.7 billion. After the third 
year, the savings outweigh the cost. And savings for patients with 
diabetes alone would total $1.6 billion over the 7 years.
  Since diabetes and cardiovascular disease affect 60 percent of the 
Medicare population, this is just clearly a good way to both save money 
and improve the quality of care.
  The Lewin Group recently completed a study for the Department of 
Defense that estimated that annual net savings could be developed of 
$3.1 million if medical nutrition therapy was included in the Tricare 
benefit program for our military personnel.
  The evidence is just growing out there. I believe it is overwhelming. 
I thank my colleague tonight for taking the floor in support of medical 
nutrition therapy as a covered benefit under Medicare, and I join him 
in supporting that.
  Mr. BILIRAKIS. Mr. Speaker, reclaiming my time, I thank the 
gentlewoman for her comments. There are not many people, if any, in 
this House of Representatives that know more about health care than the 
gentlewoman from Connecticut (Mrs. Johnson) and I appreciate her 
comments.
  It is typical, is it not, when we talk about preventive care that 
today's dollars are not taken into the consideration, the ultimate 
savings over the long haul?

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