ABSTRACT
Specialized nutrition support (SNS), different from the usual diet, is a therapy that requires appropriate clinical decisions to assure efficacy and reduce risk (i. e., complications). SNS, especially total parenteral nutrition (TPN), is expensive (1). The cost of TPN is estimated to be $3 billion annually (2), while that of enteral nutrition is about $370 million (3). In this era of health care reform, the cost-consciousness of health care providers, the public, and government agencies is great. The Agency for Healthcare Policy and Research was created to promote research on medical outcomes and develop guidelines for practice (4). These practice guidelines will inevitably be incorporated into reimbursement policies of federal programs (5). Rationing of health care may be a reality, since demand is potentially unlimited, whereas resources are limited (1). One may consider current government reimbursement policies, i.e., DRGs, as a type of rationing since a payment is provided per diagnosis while it is the hospital's responsibility to control costs of therapy so as not to exceed this payment and lose money. Specific to nutrition support, Twomey and Patching report hospitals with fixed budgets placing a ceiling on the number of patients who are allowed to receive TPN on any given day. If this quota is exceeded, the hospital will run out of money by the end of the year (l).
