katiejmiles.weebly.com  · Web viewRegistered Dietitian Nutritionist (RDN): is a food and nutrition expert who has met the minimum academic and professional requirements to qualify

EMP LO YI NG A RE GI STER ED D IE T IT I AN NUTR IT I ONI ST AT

PH YS IO THE RAP Y ASSO CI ATE S OF G EO RG IA

APRIL 2015

DEPARTMENT OF NUTRITION

COORDINATED PROGRAM, COHORT XV

Allie Moshier

Anna McKenzie

Brooke Dickson

Grace Stuhrman

Katherine Cain

Katie Miles

Kelsey Higgins

Lisa Sakalik

Michelle Giang

Moriah Bellissimo

Steven Pham

Taylor Blake

TABLE OF CONTENTS

Table of Contents........................................................................................................................................2

Definitions...................................................................................................................................................3

Executive Summary.....................................................................................................................................5

Mission Statement......................................................................................................................................9

Goals and Objectives.................................................................................................................................10

Description of Services..............................................................................................................................11

Marketing Analysis....................................................................................................................................15

Marketing Plan..........................................................................................................................................37

Financial Plan.............................................................................................................................................39

Appendix...................................................................................................................................................44

References.............................................................................................................................................44

Job Descirption......................................................................................................................................45

Survey to Registered Dietitian Nutritionists..........................................................................................49

Survey to Physiotherapy Associate Clients............................................................................................51

Sample Materials...................................................................................................................................52

Marketing Materials..............................................................................................................................59

Nutrition Assessment............................................................................................................................61

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DEFINITIONS

1. Registered Dietitian Nutritionist (RDN): is a food and nutrition expert who has met the minimum academic and professional requirements to qualify for the credential "RDN”.

2. Medical Nutrition Therapy (MNT): an individualized dietary instruction that incorporates diet therapy counseling for a nutrition-related problem.

3. Nutrition Care Process (NCP): a systematic problem solving method developed by the Academy of Nutrition and Dietetics that dietetic professionals use to think critically, make decisions addressing nutrition-related problems, and provide safe, effective, high-quality nutrition care. NCP incorporates MNT through performing a comprehensive nutrition assessment determining the nutrition diagnosis; Planning and implementing a nutrition intervention using evidence-based nutrition practice guidelines; and Monitoring and evaluating an individual’s progress over subsequent visits with the RDN.

4. The Academy (Academy of Nutrition and Dietetics): is the world’s largest organization of food and nutrition professionals. The Academy is committed to improving the nation's health and advancing the profession of dietetics through research, education and advocacy.

5. National Provider Identification (NPI) Number: is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).

6. Incident to Physician Billing: are services where the physician uses his or her authority to delegate the performance of certain services to other individuals with the necessary skills, education and training.

7. Bioelectrical Impedance: a commonly used method for estimating body composition and body fat.

8. Tanita: a brand of bioelectrical impedance analysis machines. In this case, used to measure body composition.

9. Skinfold Calipers: a device that measures the thickness of a fold of skin, measured in a standardized way, gives an estimate of the thickness of fat beneath the skin and is used as a measure of body fat

10. Nutrition Care Manual: a publication with nutrition information, resources and references for more than 90 conditions and topics

11. Continuing Education Unit (CEU): a measure used in continuing education programs, particularly those required in a licensed profession, for the professional to maintain the license.

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12. Nutribase: A computer software used to analyze diets and nutrient intakes

13. Indirect Calorimetry: a technique that provides accurate estimates of energy expenditure from measures of carbon dioxide production and oxygen consumption during rest and steady-state exercise.

14. MedGem: brand of indirect calorimetry machine

15. GI: gastrointestinal; of or relating to the stomach and the intestines.

16. Comorbidity: the simultaneous presence of two chronic diseases or conditions in a patient.

17. BMI: Body Mass Index; a ratio of height to weight used for population assessment of overweight and obesity

18. Survey Monkey: an online program that provides free, customizable surveys, as well as tools that include data analysis, sample selection, bias elimination, and data representation tools.

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EXECUTIVE SUMMARY

Recuperation from surgery or injury is accelerated through the collaboration among different

health care professionals. Inadequate nutrient intake can lead to less than optimal results while

completing physical therapy1. Working as a team, skilled clinicians from different health care

fields enhance understanding amongst each discipline and learn to provide quality care2.

Current Physiotherapy Associates clients would benefit from the addition of an RDN providing

medical nutrition therapy (MNT) as a part of their recovery program. MNT can provide both

preventive and rehabilitative advantages to address issues like weight management, chronic

illnesses, and bone health. The inclusion of services by an RDN to clients receiving physical

therapy will provide food and nutrition related guidance through MNT to shorten length of

recovery and improve individual health outcomes.

Goals, Objectives, and Description of Services

The overall goals of the registered dietitian nutritionists (RDNs) of Physiotherapy Associates are

to improve dietary habits and to aid and shorten recovery time of clients (3 goals are listed on

page 8 of this document). The RDNs are devoted to providing guidance and science-based

nutrition advice in order to increase self-efficacy of clients when making food choices. The RDN

will provide numerous services. Individual assessments and follow ups will include

anthropometric screenings, dietary analysis of food intake, calculation of nutrition requirements,

and customized meal plans. Nutrition counseling will be provided to clients as appropriate for

their health concerns. Family nutrition counseling assessments and follow ups will also be

available. Monthly group nutrition seminars will be conducted in two-hour segments and vary in

location. The subjects of the seminars will be based on client interests as determined by

nutrition surveys. Seminars may include grocery store tours, food demonstrations, and nutrition

presentations. Continuing education courses for Physiotherapy employees will be offered to

provide an overview of nutrition concepts and will occur monthly to explain the importance of

nutrition services related to a variety of conditions and disease states.

The Physiotherapy RDN will maintain dietetic registration and continuing education

requirements. All candidates for this position should hold either a bachelors or masters degree

in nutrition or related area granted by a nationally or regionally accredited college or university.

Additionally, a supervised practice program approved by the Accreditation Council for Education

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in Nutrition and Dietetics (ACEND) must have been completed. Candidates must have the

ability to work independently, or as a part of a larger health care team, and provide client-

centered care.

Financial Plan

The recommended RDN’s annual salary is $56,580. Including 18% for benefits, taxes, and 401-

K, the total compensation is $69,000 per year. The total start-up expenses for the RDN are

$11,630 which includes supplies, resources, and technology. Examples include, but are not

limited to, a laptop computer, nutrient analysis software, indirect calorimeter, body composition

scale, membership with the Academy of Nutrition and Dietetics, and subscription service to the

most recent Nutrition Care Manual. The RDN will work eight hours a day and receive four weeks

off for vacation and holidays. The RDN will have seven billable hours each day available for

counseling and charting on clients for initial assessments, follow-up sessions or group sessions

including nutrition education sessions. At a reimbursement rate of $125/hour, the projected

gross revenue over a five year period ranges from $210,000-$231,525. The adjusted net

revenue ranges from $121,480-$154,435 per year. These numbers are subject to change based

on the actual number of billable hours the RDN works per day. Profit generated from nutrition

services can be used to hire additional RDNs and expand services. Part or full-time RDNs will

need to be employed in the following years to meet demands.

Marketing Analysis

Two anonymous, voluntary, one page surveys were created to conduct a market analysis.

Paper surveys were provided to current Physiotherapy Associates clients in order to obtain

statistics regarding interest in nutrition services. Electronic surveys were distributed to 200

RDNs in the southeast United States using Survey Monkey to review workplace setting, amount

of patients seen per day, employment status, income, billing, and reimbursement.

Forty-two responses were received from the RDNs. A majority of the respondents reported

working in a private practice setting. Many also reported working in a setting with other health

professions including physicians, nurses, social workers, and physical therapists. RDNs see a

range of 1 to over 10 clients a day. Most RDNs schedule their own appointments and are

employed full time with hours ranging from 40 to 60 hours per week. The top two income levels

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were $50,000-59,000 and greater than $70,000; half of the RDNs are salaried. Experience in

the field of nutrition ranged from 6 to 25 years. Services were billed in 15 minute increments, 30

minute increments, or hourly. Therefore, we anticipate the RDN working with Physiotherapy

Associates to work alongside other healthcare professionals, see up to seven clients per day,

be responsible for setting up their appointments, work full time, and receive reimbursements

through clients’ insurance policies.

Paper surveys were distributed to 27 different Physiotherapy Associates’ clinics across Georgia.

Of these 502 responses, most clients who completed the survey were women, and most clients

surveyed were aged 46 and older. Older adults often have more nutritional problems and

comorbidities than their younger counterparts; thus, having an RDN on staff will allow this

population direct access to a nutrition expert who can improve their nutrition outcomes while

generating revenue for Physiotherapy Associates. Almost all respondents have health

insurance. Those who are covered for MNT will likely take advantage of nutrition services, and

can be used as a selling point during marketing. Just over half of the clients were not willing to

travel to receive nutrition services. A possible solution is to have the RDN travel to various

clinics every other week or hold monthly classes. Physiotherapy clients who responded to the

survey were most interested in weight loss/management nutrition services followed by general

health and heart health. Most clients were interested in individual counseling as opposed to

group counseling. Another popular topic was food demonstrations in which the RDN ties in

nutrition and how it applies to meal preparation.

Most of the respondents stated that they do not have a nutrition-related problem; this could be

due to a lack of nutrition knowledge. This can also explain the 20% who answered “not sure”

when asked this question. More than 80% of respondents report they have never seen a RDN.

This indicates the need to increase awareness for benefits of preventive care and health

management through nutrition among Physiotherapy Associates’ clients, especially since many

clients expressed interest.

In addition, a survey conducted by Caruso Physical Therapy and Nutrition, LLC and Integrated

Rehabilitation Group Inc. were reviewed. Both of these companies, though not located in

Georgia, offer physical therapy and nutrition services, and weight management and wellness

programs. This further supports the need for interdisciplinary practices that will serve as a one-

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stop opportunity where clients can receive many of their health care needs. This will establish

fluid communication among clinicians, which will optimize health outcomes.

Marketing Plan

The marketing plan is designed to maximize exposure of the newly hired RDN to generate client

acquisition as quickly as possible. Direct marketing by way of telephone calls to previous and

current clients on behalf of their physical therapist will be used in conjunction with the current

marketing team employed by Physiotherapy Associates. The RDN will utilize handouts, and

marketing materials designed specifically for the physician offices that currently refer clients to

the clinics for physical therapy. These methods will create a client database and identify clients

to receive nutrition services provided by the RDN. It is a two-fold marketing plan in that some

clients who come in initially for nutrition services may also require physical therapy treatment as

well, providing an increased client base for both the physical therapists and the RDNs.

Marketing can also be conducted by the RDN at health fairs, corporate events, lunch-and-learn

meetings, and booths at charity race days. These events are becoming popular with the general

public and can generate leads for potential clients.

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MISSION STATEMENT

It is the mission of the registered dietitian nutritionists of Physiotherapy Associates to improve

the dietary habits to aid and shorten recovery time of clients. Our experienced registered

dietitian nutritionists are devoted to providing guidance to clients in setting individual goals and

expert nutrition advice based on the most current scientific research to help clients increase

self-efficacy in making sensible food choices. Programs are created to equip the client

with healthy long-term food choice and eating habits.

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GOALS AND OBJECTIVES

1) The Registered dietitian nutritionist will serve as the nutrition expert at Physiotherapy

Associates of Georgia.

a. To provide evidence-based nutrition education through individual counseling

sessions and group classes

b. To provide employee wellness programs and offer continuing education units to

physical therapists and occupational therapists. 

c. To work alongside other health professionals as an interdisciplinary team to

deliver effective care to clients.

2) The Registered dietitian nutritionist will market their services to increase the scope of

services offered by Physiotherapy Associates of Georgia.

a. To incorporate a nutrition-screening tool at each client’s initial appointment with

the physical therapist.

b. To assess the client population’s interest in nutrition services by administering

surveys.

c. To perform a chart audit to evaluate the nutritional needs based on

anthropometrics, comorbidities, and disease susceptibility of the client

population.

3) The Registered dietitian nutritionist will provide affordable nutrition services in order to

increase revenue for Physiotherapy Associates of Georgia.

a. To create an appointment package consisting of a one-hour initial evaluation and

three 30-minute follow up counseling sessions.

b. To follow the procedures of insurance policies to ensure reimbursement

of nutrition services.

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DESCRIPTION OF SERVICES

The mission of the RDN of Physiotherapy Associates is to improve the dietary habits to

aid and shorten recovery time of clients. The RDNs are devoted to optimizing clients’ health by

setting individual goals and providing research-based nutrition advice to increase clients’

healthy food choices.  The RDN will provide services tailored towards the target audience of

clients who visit Physiotherapy Associates Clinics in the metro Atlanta area and the employees

of those clinics by providing:

Individual nutrition assessments and follow up consultations to clients who have nutrition

related problems or are seeking nutrition guidance

Family nutrition counseling assessments and follow up consultations to clients who have

nutrition related problems or are seeking nutrition guidance as a family

Monthly group nutrition seminars throughout the year that promote interesting topics,

nutritional concerns, food demonstrations, and grocery store tours

Continuing education courses in general nutrition for Physiotherapy employees

The description of these services, sourcing and fulfillment responsibilities, and job

description will be described in detail in the following pages.  

Services

Individual Nutrition Consultations

RDN services will offer clients a primary nutrition assessment and/or follow up consultations.

The initial visit with an RDN will take approximately one hour and the cost to the client will be

$100. Subsequent visits will last approximately 30 minutes, cost $50 and are scheduled on an

individual basis. Packages may be offered to clients that will cost $150 and consist of an initial

assessment and 2 follow up sessions and include services such as anthropometric screening, a

dietary analysis, calculation of nutrition requirements, and customized meal plans.

Anthropometric screenings may include height, weight, waist circumference, body composition,

and blood pressure measurements. Analysis of dietary intake will be conducted through nutrition

software such as NutriBase. Medical nutrition therapy will be available to clients with

comorbidities such as diabetes, obesity, hypertension and hyperlipidemia and includes a review

of dietary and eating habits, analysis of nutritional health, and a personalized nutrition treatment

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plan.  Nutrition education and resources will be provided to clients as needed. The RDN will

work alongside physical therapists in order to provide the best recovery plan for clients.

Family Nutrition Consultations

The family nutrition consultations will be a benefit to those who might require the support of

family members to help achieve their nutrition-related goals. The family counseling sessions will

include a 60-minute initial nutrition session at $150.  Any follow up sessions, lasting

approximately 30 minutes, will cost $75.  Packages of family consultations will cost $240 and

consist of an initial session and 2 subsequent follow up sessions. These sessions will educate

family members on specific nutrition needs or concerns related to various conditions such as GI

distress, Crohn’s, Diabetes (type 1 and 2), obesity, dyslipidemia, etc.  Sessions will take into

account the family dynamic as it influences changing eating habits and eating behaviors. In

these sessions any questions or concerns that family members may have will be addressed as

well as tips on how to operate as a unit for success.

Monthly Group Nutrition Education Sessions

The RDN will be in charge of providing clients and other interested individuals with monthly

nutrition-related educational sessions. These seminars will be based on client interests

determined by the nutrition survey. It is the responsibility of the RDN to host the event or find a

qualified team or personnel to lead these monthly sessions. Examples of these events include

grocery store tours, food demonstrations, nutrition presentations, etc. The duration of these

events will be two hours. Each location will receive the same nutrition seminar for that month.

Food demonstrations and nutrition presentations can be held in conference rooms at

Physiotherapy Associates facilities. Grocery store tours can be held at local grocery stores

near the clients’ main facility. The nutrition education session will include a light lunch that will

reflect the discussion topic for the class. There will be a minimum class size of 5 and a

maximum class size of 30 participants per location. Clients will be able to attend these sessions

for the small fee of $25 to cover the cost of the lunch and billable time spent with the RDN. The

purpose of the nutrition education sessions include letting the clients of Physiotherapy learn

about interesting and current nutrition topics while marketing the nutrition services offered by the

RDN. An additional responsibility of the RDN is to advertise the monthly meetings to clients and

to the general public with the use of flyers, word of mouth, and social media.

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Monthly Continuing Education Courses

Basic nutrition concepts will be taught to the physical therapists involving micronutrients and

macronutrient distribution (i.e., carbohydrate, lipid, protein; recommended daily intakes and

sources) on a monthly basis.  Related dietary information regarding topics such as fiber and

lipoproteins will help expand the physical therapists’ nutrition knowledge and make them aware

of the importance of nutrition for different conditions and various disease states. For example,

clients who are diagnosed with dyslipidemia will receive nutrition education from the RDN

regarding a high fiber diet; the attending physical therapists will then be able to encourage their

clients to make healthy choices and refer them to the RDN if the client needs more counseling

about their diet. CEU’s would include topics such as micronutrients (vitamins and minerals),

their requirements, and functions in the body.  Nutrition information regarding specific disease

states and how it affects patients’ conditions will also be addressed. Including GI distress,

Crohn’s, Diabetes (type 1 and 2), obesity, and dyslipidemia.  Classes regarding proper nutrition

for specific populations would also be taught, for example, nutrition education regarding sports

nutrition and recommendations for athletes.  Nutrition classes will be offered to PTs addressing

the human lifecycle: childhood, adolescence, adult, pregnancy, and elderly.  Each of these life

stages requires different nutrients and in different amounts; the RDN will educate the physical

therapists on each of them. These monthly courses will serve to help the physical therapist

recognize the importance of nutrition during various disease states and provide encouragement

to their clients to seek nutrition counseling from the RDN on staff at Physiotherapy.

Sourcing and Fulfillment

Location

The location of the RDN will vary among the four participating clinics, in Buckhead, Dunwoody,

Peachtree City, and East Cobb, with each day corresponding with a specific clinic.  The RDN

will have a portable laptop computer equipped with all necessary technology needed for

practice. A desk, chair, and access to a printer will be available at each clinic for the RDN to

utilize when they are working at that specific location.  The RDN will also carry a food model set,

sugar and fat test tube set, and MedGem™ analyzer while traveling to each location.  A

Tanita™ scale will be purchased for use in each of the four clinics for body composition

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assessment purposes. Individuals with pacemakers and pregnant women are discouraged from

using the Tanita scale, a non-bioelectrical impedance scale will be used instead.

Tools

There will be a variety of tools created and developed by the RDN at Physiotherapy.  The first

tool that will be created upon hiring is a nutrition survey that will be completed by every existing

client and all new clients in the future.  This survey will be a brief, single-page document that will

include information asking about any chronic illness the client has and their interest in nutrition

services.  The next tool that will be created by the RDN at Physiotherapy will be a nutrition

assessment form for clients seeking nutrition consultation in the individual, family, or group

setting.  This assessment will include information on current dietary patterns, nutrition

supplements, goals they are seeking through the nutrition consultation, and perceived barriers

to those goals. Additional tools will include the creation and adaptation of handouts as needed

with the assistance of the Nutrition Care Manual offered by the Academy of Nutrition and

Dietetics

Technology

The technology needed for the RDN at Physiotherapy will include the most current informatics

such as a laptop computer with NutriBase™ diet analysis software.  Additional technology

needed includes the MedGem™ indirect calorimeter with a supply of mouthpieces and the

Tanita™ body composition scale for determining RMR in clients and getting an accurate

measure of weight, percent muscle, and percent fat.

Resources

The practice-based resource that will be necessary includes a membership with the Academy of

Nutrition and Dietetics and the most updated version of the Nutrition Care Manual. Both of

these resources will help the RDN connect with other members for advice and insight on

counseling clients with particular conditions and provide the most current information regarding

macronutrient and micronutrient recommendations and resources for providing evidence-based

practice to the clients of Physiotherapy

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MARKETING ANALYSIS

Literature Review

Chronic life-style related conditions are among the leading causes of disability and early death.

Health care professionals need to address lifestyle-related risk factors with their patients.

Frerichs et al. (2012) conducted a systematic review to examine whether physical therapists can

counsel and change lifestyle behavior effectively. “Lifestyle conditions” was defined as the non-

communicable conditions contributing to premature morbidity. These included heart disease,

hypertension, cerebrovascular disease, cancer, smoking-related conditions, type 2 diabetes and

obesity. The studies reviewed by Frerichs included health behavior change interventions by

physical therapists alone or with other members of the interprofessional team in which physical

therapists contributed to a component of the intervention. By the end of the selection process,

seven articles remained for review. Three studies evaluated interventions only provided by

physical therapists, and the remaining four studies included a multidisciplinary team. The

interventions with just physical therapists focused solely on physical activity. The intervention

goals with the multidisciplinary team (including a RDN) were more complex and focused on

dietary counseling and physical activity. The study review concluded that long-term lifestyle

behavior change may require more than providing exercise prescription given by the physical

therapists along. Health counseling delivered by physical therapists may be effective in the short

term. In order to see long-term changes, more intervention components may be needed.1

Eriksson et al, (2006) conducted a 3-month randomized controlled trial with a one-year follow up

to evaluate the effects on cardiovascular risk factors, physical activity and quality of life of a

lifestyle intervention program. The 151 subjects had been diagnosed with hypertension,

dyslipidemia, type 2 diabetes, obesity or any combination, and the subjects were divided into an

intervention or control group. The subjects’ BMI, waist circumference, hip circumference, blood

pressure, total cholesterol and triglycerides levels, fasting blood glucose (if not diabetic), and

HbA1c (if diabetic) were recorded. A questionnaire was given to assess physical activity and

smoking habits. A physiotherapist, RDN, and physician conducted the intervention, which

consisted of supervised exercise, diet counseling and follow-up meetings. The control group

received usual primary care treatment and one meeting with the team. After one year follow up,

only the intervention group showed statistically significant improvements.2 This study shows the

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benefits of a multi-professional team, specifically the collaboration between physiotherapists

and RDN.

Morris et al. (2009) discussed the relationship between poor nutrition and obesity and conditions

that are managed by physical therapists. Poor nutrition negatively impacts health outcomes,

including physical therapy goals. It was found that physical therapists believed that providing

advice on nutrition and weight management would improve outcomes, but they were not

confident in addressing these issues. This article discusses strategies for physical therapists to

use to discuss nutrition with their patients, but also emphasizes the importance of a RDN.

Referrals may be necessary for nutritional diagnostic, therapy, and counseling services for

disease prevention and management. This article mentions that medical nutrition therapy and

RDN services improve clinical outcomes for many medical conditions and are cost-effective. 3

Registered dietitian nutritionists play a vital role in health promotion and disease prevention by

delivering nutrition-focused services, which improve health outcomes for patients with a wide

variety of medical conditions.4 They bring value to the multidisciplinary team by providing care

coordination, evidence-based care, and quality-improvement leadership, and their services

would be beneficial in collaboration with services provided by physical therapists.5

Registered Dietitian Nutritionist Survey

An anonymous and voluntary online survey created on surveymonkey.com was sent to

registered dietitian nutritionists in the South East via e-mail. Email addresses were obtained

from the Academy of Nutrition and Dietetics website, www.eatright.org. The eleven-question

survey was sent to 200 registered dietitian nutritionists and 42 completed it. The data was

analyzed using SurveyMonkey and the results are as follows. Based on the survey results, there

is 95% confidence level and a confidence interval of 15.

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Type of Practice

Private

Practi

ce + an

other

setti

ng

Private

Practi

ce

Outpatien

t

Comm

unity

Clinica

l0

20

40

Twelve percent (5) of the respondents reported working in both a private practice and an

additional setting. Some of the additional settings included dialysis centers and wellness

centers. Twenty-nine percent (12) of the respondents reported working in a private practice

setting. Nineteen percent (8) of the respondents reported working in an outpatient setting, who

included diabetes education centers, weight management clinics, bariatric offices, and physician

practice offices. Twenty-one percent (9) of the respondents reported working in a community

setting, primarily wellness centers. Nineteen percent (8) of the respondents reported working in

a clinical setting.

Percentage of RDNs working with other healthcare professionals

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Sixty-two percent (26) of the respondents do work in a setting with other health professions, and

38% (16) do not. A follow-up question would be needed to find out what specific health

professions are working alongside these RDNs.

Number of patients/clients seen each day

Twenty-six percent (11) of the respondents see 1-3 patients/clients per day. Thirty-six percent

(15) of the respondents see 4-6 patients/clients per day. Fourteen percent (6) of the

respondents see 7-9 patients/clients per day. Twenty-four percent (10) of the respondents see

at least 10 patients/clients per day. Those who see more than 10 patients may work in a setting

like a hospital where they are required to follow-up with patients whereas an outpatient RDN

who sees 4-6 patients per day can spend more time with their patient appointments.

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Scheduling appointments

N/A Someone Else Me0

20

40

60

Thirty-one percent (13) of the respondents reported that someone else schedules the

appointments. 57% (24) of the respondents schedule their own appointments. 12% (5) of the

respondents reported that scheduling appointments was not applicable to their setting.

Employment Status: Full time, Part time, or As Needed

Sixty percent (25) of the RDNs were employed full time and their hours ranged from 40-60

hours per week. 7% (3) of the RDNs worked full time at one job and had an additional job where

they worked part time also. Part time hours were from as little as 8 hours per week to as much

as 32 hours per week. 29% (12) of the RDNs work part time. Only 5% (2) of the RDNs worked

as needed, one of which was in private practice and one who worked in community. Full time

employment offers benefits along with either a salary or an hourly wage. Part-time employment

offers part-time wages with limited benefits. As needed RDNs tend to get paid high hourly

wages, but forego benefits.

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Median Yearly Income

The top two income levels were $50,000-59,000 and greater than $70,000. The high response

rate for the first income level was expected because the national median income reported by the

Academy of Nutrition and Dietetics falls within that range; however, the surprising result was

that the income level of greater than $70,000 had the highest response rate. There could be

many factors affecting this including a response bias and practice setting, and years of

experience. Those who work in private practice tend to make a higher yearly income than those

who work in the public realm. The same positive correlation is expected with years of

experience and yearly income.

Contracted vs. Salaried

Fifty percent (21) of the RDNs are salaried, 33% (14) of the RDNs are contracted, and 7% (3) of

the RDNs are both contracted and salaried because of their various work environments. Several

of the RDNs are self-employed and 1 RDN charged fee-for-service.

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Reimbursement by a Third Party

Fifty-two percent (22) of the respondents stated that a third party payer does not reimburse their

services, while 48% (20) stated that their services are reimbursed. This percentage may

change if we adjusted for job settings.

Reimbursement Codes

Many of the RDNs used current procedural terminology (CPT) codes when billing for their

services. The codes used for an initial assessment and a follow up session were as follows,

97802 (8), 97803 (7). For medical nutrition therapy services the codes included 97804(4), and

99401-99404. MNT (medical nutrition therapy) would be those who required nutrition services

who had a linked comorbidity, such as diabetes, obesity, and renal disease. Nutrition counseling

could also be used for an initial and follow up session which can includes weight loss

counseling, healthy diet and lifestyle education and those who would seek nutrition services

without a comorbidity. Other CPT codes mentioned were G0108, G0109, 9214, 99213, and

585.6. Coverage includes three hours in the initial calendar year, and two follow-up hours in

subsequent years with a physician referral. G codes can be used when additional hours of MNT

services are provided beyond the number of hours typically covered, when the treating

physician determines there is a change of diagnosis or medical condition that makes a change

in diet necessary- G0270 (individual) and G0271 (group).

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Billing

Third Party N/A Me0

20

40

60

Several people billed for their services in 15-minute increments (4). Price rates ranged from

$38-$44 for 15-minute increments. One of the RDNs had a package for $189 per month. This

included an initial assessment and two follow up sessions. Hourly rates ranged from $40-$176

with the lower end consisting of community and clinical setting and the higher end being private

practice and outpatient settings. One outpatient setting RDN had group sessions priced at $32

per 30 minutes sessions. Follow-up appointments ranged from $25-$75. From the survey, it can

be seen that the responsibility of billing falls into three different categories. Fifty-five percent (23)

of the services are billed by a third party payer. Thirty-one percent (13) of the RDNs are in

charge of the billing. Fourteen percent of the RDNs said this question was not applicable.

Registered Dietitian Nutritionist Survey Follow-Up

After analyzing the results from the first survey for RDNs from the Southeastern United States, it

seemed necessary to send a follow-up survey using SurveyMonkey to make sense of unclear

results and to acquire more information. This five-question survey was sent to the same RDNs

anticipating to receive a statistically significant response rate. Twenty-nine surveys were filled

out completely and analyzed. The results from the follow-up surveys are as follows:

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Percentage of RDNs working with other healthcare professionals

The first question was a repeat question from the first survey. 59% replied yes when asked if

they worked with other healthcare professionals. The remaining RDNs (41%) replied no.

Other Health Care Professionals

Next, the RDNs were asked to specify which healthcare professionals they worked with. Of the

29 responses, 52% said they worked with physicians and/or nurses. The next biggest

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LegendMD/DO Physicians DMD/DDS Dentists SLP Speech PathologistsRN Registered Nurses SW Social Workers DC Doctor of ChiropractorsPA Physician Assistants OT Occupational Therapists CPT Certified Personal

TrainersPT Physical Therapists PharmD Pharmacists DT Dietetics TechniciansRT Respiratory Therapists Surgeon Surgeons N/A Not Available

percentage, 38%, was responses from RDNs who did not work with any other healthcare

professionals. 28% worked with a social worker and 10% worked with a physical therapist.

Median Annual Income

They were then asked about their median annual income. 29% reported having a median

income between $50,000 - $59,999. The second highest percentage was 21.4% earning

between $70,000 - $99,999. 14% reported earning 30,000 - $39,999. Around 10% reported

earning less than $30,000 and 7% earned greater than $100,000.

Years of Experience

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Additionally, the RDNs were asked how many years of experience they had in the field of

nutrition. The largest percentage of responders was 21% and they have 16-20 years of

experience in the field of nutrition. The categories 6-10 and 12-25 years of experience both had

a 17% response. 14% reported having less than 2 years and another 14% had 11-15 years of

experience. Only 7% had greater than 30 years of experience with nutrition.

The final question asked the RDNs about how they billed for the services that they provide.

Forty-one percent bill in 15-minute increments, whereas 34% bill in 30- minute increments.

Twenty-one percent use hourly billing. Both weekly and monthly billing had a response of 7%.

Twenty-eight percent use pay per visit billing. Fifty-five percent of the RDNs checked the other

box and left a comment describing how they billed their clients. Twenty-eight percent do not bill

for their services (salaried or do not see clients). The CPT billing codes that the RDNs listed

include 97802, 87804, G0108, and G0109. Some rates stated on the survey for different

practices included: $65/hour for a follow up and $100/hour for an initial assessment, $150/hour

for an individual initial assessment and $250 for a corporate setting, $100 for the initial session

and $40 for follow-ups, and another practice stated they charged $120 for the initial session and

$80 for follow-ups.

Physiotherapy Associates’ Client Survey Analysis

An anonymous and voluntary one-page survey was given to clients from 27 different

Physiotherapy Associates’ clinics across Georgia. Basic demographic information was asked,

including gender and age range as well as whether or not they had medical insurance. The

remaining questions pertained to nutrition. Clients were asked about their nutrition interests, if

they were willing to travel to receive nutrition services, if they had a nutrition problem, if they had

ever seen a registered dietitian nutritionist, and the types of services that would appeal to them

the most. The raw data can be found by following this link:

https://docs.google.com/spreadsheets/d/1vdrNs3Kl8cKKKxZ1otNR9s6KkOuXdJx0wAZ6dWem

VFo/edit?usp=sharing.

501 survey responses were analyzed and the results are as follows.

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Gender

Of these 502 clients, 331 (66%) were women, 165 (33%) men, and 6 (6%) elected not to

respond. This result can influence whether or not nutrition services should be marketed more

towards females.

Age

The three largest age groups were 46-55 years old [114 clients (23%)], followed closely by

clients aged 66+ [109 clients (19%)], and clients falling between the ages of 56-65 years [94

clients (22%)]. These three groups combined means approximately (61%) of clients surveyed

were between the ages of 46-66+. Older adults often have more nutritional problems and

comorbidities than teenagers [9 clients (2%)] and young adults [29 clients (6%)]. Having an

RDN on staff will allow this population direct access to a nutrition expert who can not only help

them, but will also bring in more revenue to Physiotherapy Associates.

Insurance

487 (97%) currently have some form of health insurance. This will be extremely helpful when

starting to discuss nutrition services offered with clients and when dealing with medical

reimbursement. Clients will be more likely to participate with an RDN if insurance covers some

or all of the expense.

Willingness to Travel for Nutrition Services

Approximately 260 (52%) clients were not willing to travel to receive nutrition services, while 53

(11%) were willing to travel, and 184 (37%) were unsure if they would be willing to travel or not.

This can be resolved, for example, by having the registered dietitian nutritionist travel to various

clinics every other week, by holding monthly classes at varying clinics on topics of interest, or

similar approaches that will limit the amount the clients have to travel and to maximize the

nutrition services the RDN has to offer. The monthly topics could stimulate client interest and

could result in the clients to be more willing to travel to see the RDN for individual counseling.

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Nutrition Interests

Weight Management

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Decatur has the highest percentage of participants state they had interest in weight

management/weight loss. The next two highest were Kennesaw and Conyers.

Heart Health

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For heart healthy diets, bone health, blood pressure, gastrointestinal, and diabetes, there were

no cost centers that had a higher percentage of participants respond yes than no. Kennesaw

had the highest percentage interested in heart health. Norcross had the highest percentage

interested in bone health. Decatur and Conyers had the highest percentage interested in blood

pressure. White circle had the highest percentage interested in gastrointestinal health and

diabetes.

Bone Health

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High Blood Pressure

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Gastrointestinal Health

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Diabetes/Pre-diabetes

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General Health

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General Health was also a high topic of interest for the various cost centers. An anonymous

“survey 1” center had the highest percentage of interest, followed by Kennestone. McDonough

and Smyrna were close behind.

Cancer

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Pregnancy

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Other Category

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Cancer, pregnancy, and other were not of high interest to the Physiotherapy and associates

clients. For Cancer, the highest percentage of interest was in Norcross and Kennesaw. For

pregnancy, the highest percentage of interest was in White Circle. For the other category, the

highest percentage of interest was in “Survey 2” location and Lenox.

Nutrition Services

When evaluating the surveys, the type of nutrition service that most of the clients were

interested in was individual counseling, totaling 226 clients (45%). This would entail a one-on-

one session between the registered dietitian nutritionist and the client. Typically, individual

counseling begins with an initial session and then follow-up sessions. The initial session is

generally used to determine the needs of the client, assess current behaviors, and analyze

anthropometrics.

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0

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Type of Nutrition Counseling

Family CounselingGroup sessionsIndividual sessionsGrocery Store ToursFood Demos

The next type of nutrition service that clients are interested in is food demonstrations, which

totals to 124 clients (25%). A food demonstration is typically conducted in a group setting and

will teach clients how to cook healthy meals. These demonstrations can be catered to the

group’s needs, such as heart healthy meals or can be based on a theme, such as healthy meals

for the holidays. For the remaining services, there were 80 clients interested in grocery store

tours (16%), 75 clients interested in group sessions (15%), and 69 clients interested in family

counseling (14%). The number of clients interested in these services was minimal, but they may

still be beneficial to those who are interested and are another way of bringing in revenue.

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Individual Counseling Desire by City

Yes

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Yes

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Family Counseling Desire by City

Yes

Acknowledgement of a Nutrition Problem

Three hundred twenty out of 501 (64%) responders stated that they do not have a nutrition-

related problem. This number may be inflated due to a lack of nutrition knowledge.  It can also

explain the 99 people (20%) who answered “not sure” when asked the same In contrast, 73

people (15%) admitted to having a nutrition problem while the rest chose not to answer. These

results may be affected by personal and knowledge bias. Some people may have answered

“no” because they genuinely think that they do not have a nutrition problem but in fact they do;

they may have been reluctant to answer yes because of the negative associations with having a

“problem.” About 20% of all survey responders were not sure if they had a nutrition-related

problem, which indicates a need for nutrition education in this sample.

Have you previously seen a Registered Dietitian Nutritionist?

Only 78 out of 501 (16%) responders have previously seen a registered dietitian nutritionist.

This percentage is in agreement with the percentage of people who replied “yes” to having a

nutrition problem (15%). More than 4 out of 5 survey responders (83%) have never seen a RDN

before. This proves that there needs to be an increased awareness for nutrition services among

Physiotherapy Associates’ clients, especially since there is so much nutrition interest as shown

above.

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Competitive Analysis

Caruso Physical Therapy and Nutrition, LLC is a private practice physical therapy and nutrition

office operating in Allentown, New Jersey. It is owned and run by a husband (physical therapist)

and wife (registered dietitian nutritionist) by the names of Joseph and Olivia Caruso. Their

mission is to provide exceptional, high quality, comprehensive, individualized, ethical, outpatient

hands-on physical therapy, nutrition, and wellness through the expertise of licensed

professionals focusing on patient education, injury prevention, and skilled treatment. They offer

physical therapy, nutrition counseling, medical weight management, a wellness program, and a

Pilate’s reformer program. Nutrition services that are offered include:

Educating and advising a wide range of patients with dietary-related disorders on the

practical ways in which they can improve their health by adopting healthier eating habits.

Translating the science of nutrition into everyday information about food

Analyzing the nutritional content of food and make recommendations

Calculating patient's nutritional requirements using equations based on assessments of

blood chemistry, temperature, stress, mobility and other relevant factors

Instructing bariatric patients pre-op and post-op on gastric bypass nutrition education

Educating other health professionals (doctors, nurses) about food and nutrition issues

Educating parents, informing and introducing them to nutritional conscious diets for their

children

Providing education materials that we have created for all patients

Counseling can be in the form of: individual, group, internet, or telephone

The payment option for physical therapy services include out of pocket costs for hour-long

sessions. They advertise patient centered treatment by removing the restrictions that insurance

companies place on physical therapy (15 minute session limits). For nutrition services, they

remain in-network with insurance companies because there are no time restrictions on how long

the RDN can spend with a patient. More information can be found at: www.carusoptRDN.com

Integrated Rehabilitation Group Inc. is a physical and hand therapy group based in the

Northwest United States that also offers nutrition services at three of their twenty-nine clinics.

Their mission is to provide superior physical and hand therapy with exceptional results. Our goal

Page | 36

is complete customer satisfaction in a friendly and positive environment for our employees and

patients. Additionally, IRG Inc. is contracted with most major insurance companies.

IRG Inc. has one registered dietitian nutritionist listed on their website by the name Julie Mahler

who provides services at three locations in Washington. She has a master’s degree in Nutrition

and has a certification in Adult Weight Management. Her nutrition services include:

Developing health and wellness programs for corporations and other organizations

Teaching health education workshops for sports teams, corporations, schools, and other

organizations

Individualized nutrition counseling

Analyzing recipes for sports teams

More information can be found at: http://www.irgpt.com/clinic/physical-hand-therapy-mill-

creek/

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MARKETING PLAN

The marketing plan will consist of both internal and external marketing strategies. Utilizing

Physiotherapy Associates’ outside marketing team will help to expand exposure, allowing for the

RDN to focus on internal strategies and counseling clients. A combination of internal and

external marketing will bring in clients to both the RDN and the Physical Therapists within the

clinics serviced.

Internal Marketing

Using the existing client database for those who have visited the serviced clinics, as well as

those Physiotherapy Clinics within a 20-mile radius, the RDN will be able to contact those

clients to inform them that the new services offered by a RDN are available and may be covered

by their insurance. This phone time should be performed on a daily basis to ensure the

maximum amount of people can be reached and informed. A phone script should be used in

order to create enough interest to grab the potential client’s attention and set up an appointment

or invitation to a monthly nutrition education session for more details. If necessary, the RDN can

advise an interested client to contact the billing the department of Physiotherapy to determine if

a physician referral is necessary to receive medical nutrition therapy benefits. In addition, fliers

and literature should be made available to the waiting rooms of these clinics.

Another aspect that will be crucial is to reach out to the current physical therapists in the clinics

where literature and marketing will be implemented to provide education on how RDN services

will work in tandem with their current therapies to create optimum health results. This can be

achieved with monthly nutrition education sessions or seminars that could potentially provide

continuing education credits for the therapists in attendance.

External Marketing

External marketing is mutually beneficial for both the RDN and new clients for Physiotherapy

Associates. Utilizing social media sites can help spread the word that this new service is

available. The marketing team for Physiotherapy Associates will be provided with flyers to

present to health care professionals that they visit with the applicable information where a RDN

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can be beneficial to their clients’ health. These flyers will be disease-specific and include the

applicable insurance reimbursement codes.

Community outreach can also prove beneficial in marketing as it is often free to provide simple

screenings at health fair booths, healthcare open enrollment fairs at local companies, 5K runs,

speaking engagements, and other health-focused events. A portable Tanita scale can provide

basic information as well as create interest in a potential client.

Provided are materials from the Academy of Nutrition and Dietetics that can be used either in

the physical therapy office or to be given to potential referring physicians.

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FINANCIAL PLAN

Salary

In order to calculate the RD’s salary, we applied results from a survey of 42 RDNs in the greater

Atlanta area. Based on these surveys, the top two income brackets were greater than

$70,000/annual income and $50,000-$59,000/annual income. We calculated that the RD’s

salary would be $56,580 annually based on feedback from the surveys and research of annual

income of RDs in the Atlanta area (Bureau of Statistics). After adding 18% for benefits, taxes

and 401K the total salary comes to $69,000 per year. We also took into account that the RD

coming in would have a master’s degree, a full-time position in an outpatient setting, and less

than 2 years of experience as an RD. Is there an opportunity for the RDN to receive bonuses,

such as some of the PTs receive yearly?

Start-Up Expenses

In Table 1, fixed asset expenses include items that require a one-time purchase. Operating

expenses include items that require continuous investment or renewal. The equipment and

resources outlined are tools for nutrition assessments and education. These tools include items

such as an indirect calorimetry machine (Med Gem), a body mass/fat mass analyzing scale

(Tanita Scale), pamphlets and handouts, and nutrient analysis software (Nutribase). In addition,

food models and fat, sugar, and salt test tubes provide visual teaching tools for clients.

Based on the research, the software program chosen for the RDN was Nutribase Professional.

This system, compared to other nutrient analysis software, has a greater nutrient database, free

annual support and updates after the first year of purchase, and could export analysis reports

into excel, CSV, and word processor formats. It also has interesting features that make

interacting and collecting data from clients easy, clients can download a burnable CD onto their

computer to record food intake for example. The CD can also be customized to include the

RDN’s return email address, and business logo/image. Also in regards to client management,

this system allows the RDN to track and graph body fat percentages, body chemistry values,

and other anthropometrics. It is a robust system that will serve as a beneficial tool for the RDN

at Physiotherapy Associates.

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Operating expenses are also listed in Table 1. They include materials that are required for the

first year of hire. Supplies include a utility cart to transport equipment from clinics, storage

containers for food models and test tube sets, office supplies, nutrition pamphlets, the Nutrition

Care Manual, and disposable gloves and wipes for cleaning the Tanita scale. Some of these

items will be reoccurring in the following years. Advertising and promotion expenses include

initial material costs for promoting the RD and services offered.

Table 1: Start-Up and First Year Expenses

Start-Up Expenses AmountFixed Assets ExpensesComputer $1,600Phone $150Color Printer/Scanner $400Tanita Scale $2,100MedGem (with software) $4,300Nutribase Professional $800Food Model Set $400Sugar, Fat, and Salt Test Tube Set $100Office Supplies $500Total $10,350Operating ExpensesSupplies* $800Advertising and Promotion** $250Academy of Nutrition and Dietetics Membership

$230

Total $1,280Grand Total $11,630

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Yearly Reoccurring Expenses

Table 2 lists reoccurring expenses. The total marketing cost for the year is calculated based on

an estimated $200 monthly expense. The RD’s role will involve traveling to various

Physiotherapy Associates clinic sites for client appointments and group nutrition education

sessions. The mileage is based on the 2015 IRS Standard Mileage Rate and weekly travel to

each clinic site. Reoccurring supply costs include items such as Med Gem mouthpieces,

pamphlets, the annual Nutrition Care Manual, office supplies, and disposable gloves and wipes

to clean the Tanita scale after client use. We also included a $20 monthly expense for any

additional miscellaneous costs that may arise.

Membership to the Academy of Nutrition and Dietetics was also factored into reoccurring costs.

AND is a valuable resource tool for evidence-based practice that is up-to-date in regards to

medical nutrition therapy. In addition, members are able to access educational materials for

clients on various topics and conditions. The cost for membership is $230.00 annually with a

$25.00 one-time processing fee. Continuing education costs for maintaining the RD’s

credentials were estimated to cost $200. The Food and Nutrition Conference and Expo (FNCE)

is a three day national nutrition conference held annually that exposes RDs to valuable

information on nutrition recommendations, trends, and emerging research in our field.

Furthermore, FNCE provides a chance for physiotherapists to collaborate with the RD on

discovering the most relevant emerging research that may benefit clients. The total cost for

FNCE includes registration, lodging, travel, driving/parking and food and were determined

based on 80% finance from Physiotherapy Associates.

Table 2: Reoccurring Expenses Following First Year

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Yearly Reoccurring Expenses AmountMarketing $2,400Mileage ($0.575/mile) $3,500Supplies $1000Academy of Nutrition and Dietetics Registration and Continuing Education

$450

Food and Nutrition Conference and Expo $500Miscellaneous $240Total: $7,890

Projections

Through research and interviews with local RDNs, we calculated the revenue and profit one

RDN could earn for Physiotherapy Associates, including paid time off (PTO) (Table 3). These

calculations are based off an eight-hour work day (9:00 AM - 5:30 PM including a thirty minute

lunch break) and four-weeks off for vacation and holidays. The RD has seven billable hours

each day available for meeting and charting-on clients for initial assessments, follow-up

sessions or group sessions including nutrition education sessions. One hour is allotted for

completing various tasks such as meetings, training, lunch with potential physicians and

referring organizations, and presentations.

The total cost to hire a RDN for the first year, including startup expenses, reoccurring expenses,

and salary is estimated to be $88,520. Initial staffing of a RD would cost Physiotherapy

Associates $1,844 per five day work week and $369 per day. Therefore, the RDN would need to

have a minimum of 3.69 reimbursable hours per day to break even. In the following years,

reoccurring expenses and salary for continued employment totals to $77,090. This costs

Physiotherapy Associates $1,606 per week and $321 per day. Therefore, the RDN would have

a minimum of 3.20 reimbursable hours per day to break even.

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Based on a maximum of seven billable hours, we were able to calculate the gross revenue for

Physiotherapy Associates. A total of seven billable hours was multiplied by five to account for

the workdays per week and then again by 48 for the number of weeks worked in a year. This

value was multiplied by two reimbursement rates of $100 and $125 per hour to determine gross

revenue. We estimated these rates based on interviews with local RDNs and average

reimbursement rates. We included a range to account for clients paying for services through

private health insurance, out-of-pocket, and discounted packages. To calculate adjusted net

revenue, we subtracted projected gross revenue from the total expenses and salary. We

projected revenue over a five year period and accounted for a yearly 3% increase and 5%

increase. The values are shown in Table 3 and categorized by year.

These projections estimate that a profit of $79,480 - $121,480 for Physiotherapy Associates can

be met by the end of the first year if the RD meets a total of seven productive hours per day.

This number is subject to change based on the actual number of billable hours the RD works

per day. Profit generated from RD services can be used to hire additional RDs and expand

services. Part- or full-time RDs will ultimately need to be employed in the following years to

meet demands.

Table 3: Estimated 5-Year Projection

Year 1 Years to Follow

Expenses Total(Salary + Expenses)

$88,520 $77,090

RD Cost per Week $1844 $1606

RD Cost per Day $369 $321

$125/hourProjected Gross

Year 1 Adjusted Net

Year 1

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Revenue Revenue

$210,000 Year 3 $121,480 Year 3

3% $216,300 $139,210

5% $220,500 Year 5 $143,410 Year 5

3% $222,480$145,390

5% $231,525$154,435

$100/hourProjected Gross Revenue

Year 1Adjusted Net Revenue

Year 1

$168,000 Year 3 $79,480 Year 3

3% $173,040 $95,950

5% $176,400 Year 5 $99,310 Year 5

3% $178,231$101,141

5% $185,220$108,130

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APPENDIX

REFERENCES

1) Frerichs W, Kaltenbacher E, Leur J, Dean E. Can physical therapists counsel patients with

lifestyle-related health conditions effectively? A systemic review and implications. Physiother

Theory Pract. 2012;28(8):571-587. doi:10.3109/09593985.2011.654179.

2) Eriksson KM, Westborg C-J, Eliasson M. A randomized trial of lifestyle intervention in

primary healthcare for the modification of cardiovascular risk factors. The Bjorknas study.

Scand J Public Health. 2006;34:453-461.

3) Morris D, Kitchin E, Clark D. Strategies for optimizing nutrition and weight reduction in

physical therapy practice: The evidence. Physiother Theory Pract. 2009;25(5-6):408-423.

doi:10.1080/09593980902835369.

4) Position of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion

and Chronic Disease Prevention. J Acad Nutr Diet. 2013;113:972-979.

5) Jortberg B, Fleming M. Registered Dietitian Nutritionists Bring Value to Emerging Health

Care Delivery Models. J Acad Nutr Diet. 2014;114(12):2017-2022.

6) National Center for Health Statistics. Health, United States, 2013: With Special Feature on

Prescription Drugs. Hyattsville MD. 2014. Available at:

http:/www.cdc.gov/nchs/data/hus/hus13.pdf#064.

7) Peery AF, Dellon ES, Lund J, et al. Burden of Gastrointestinal Disease in the United States:

2012 Update. Gastroenterology. 2012;143(5):1179-1187.e3.

doi:10.1053/j.gastro.2012.08.002.

8) Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates

of Diabetes and Its Burden in the United States, 2014. Atlanta GA US Dep Health Hum

Serv. 2014.

9) Anemia. 2013. Available at: http://emedicine.medscape.com/article/198475-overview.

Accessed May 23, 2014.

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JOB DESCIRPTION

Job Title/Position:

Registered Dietitian Nutritionist (RDN) - Full time; approximately 40 hours per week

Primary Duties and Responsibilities:

Individual Nutrition Consultation

RDN will offer clients a primary nutrition assessment and/or follow up consultations

Sessions will include services such as an anthropometric screening, a dietary analysis of

food intake, calculation of nutrition requirements, and customized meal plan.

Anthropometric screenings may include the following: height, weight, waist

circumference, body composition, and blood pressure measurements

Analysis of dietary intake may be conducted through nutrition software such as

NutriBase™

Medical nutrition therapy will be administered to clients and includes a review of dietary

and eating habits, analysis of nutritional health, and a personalized nutrition treatment

plan

Nutrition education and resources should be provided to clients as needed

RDN will work in collaboration with physical therapists in order to provide the best

recovery plan for clients

Family Nutrition Consultation

RDN will conduct family nutrition consultations involving the client and their family or

other important support personnel

RDN will educate family members on specific nutrition needs or concerns related to

various conditions such as GI distress, Crohn’s, Diabetes (type 1 and 2), obesity, and

dyslipidemia

RDN will address family dynamic in eating behavior change

RDN will address questions or concerns that family members may have as well as tips

on how to operate as a unit for success

Monthly Nutrition Education Sessions

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The RDN will be in charge of providing clients and other interested individuals with

monthly nutrition-related seminars based on client interests that last approximately one

to two hours and is completed at each specific location where nutrition services are

offered

The RDN will host the event or find a qualified team or personnel to lead these monthly

meetings

The RDN will advertise the monthly meetings to clients and to the general public with the

use of flyers, word of mouth, and social media

Continuing Education Units for Employees of Physiotherapy

The RDN will serve as a nutrition educator and nutrition resource at the physical therapy

clinics for the physical therapists

The RDN will teach basic nutrition concepts and in-depth topics

Classes will be held during staff lunch times at 2 scheduled times once a month, giving

the PTs options of which class time will fit better into their schedule

The RDN will help the physical therapists recognize clients who need nutrition

counseling based on their condition or disease state at the physical therapy clinics

Description of topics covered in CEU sessions:

o Basic nutrition concepts involving macronutrients and macronutrient distribution

(i.e., carbohydrate, lipid, protein; recommended daily intakes and sources)

o Related dietary information regarding fiber, lipoproteins

o Micronutrients (vitamins and minerals), their requirements, and functions in the

body

o Nutrition information regarding specific disease states and how it affects patients’

conditions: GI distress, Crohn’s, Diabetes (type 1 and 2), obesity

o Nutrition education regarding sports nutrition and recommendations for athletes

o Nutrition classes to PTs addressing the human lifecycle: childhood, adolescence,

adult, pregnancy and elderly

Professional Development:

Participate in nutrition research studies and communicate findings through reports,

abstracts, presentations, and publication

Maintain dietetic registration and continuing education requirements

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Develops and implements an individualized portfolio plan for professional growth and

development

Participates in interdisciplinary meetings in the Physiotherapy Associates offices with

other health professionals to discuss projects, initiatives, and task forces

Knowledge and Skills Requirements:

Education/Experience:

Bachelors and/or masters degree in nutrition, foods and nutrition, or related area,

granted by a U.S regionally accredited college or university

Completion of a supervised practice program approved by the Accreditation Council for

Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics

Minimum one-year of experience of dietetics practice and/or 1,200 hours of supervised

dietetics practice

Certification/License:

RDN or eligible for registration by the Commission on Dietetic Registration of the

Academy of Nutrition and Dietetics

Certification/Licensure as required by the State of Georgia

Malpractice Insurance:

Protection against claims arising from actual or alleged errors or omissions throughout

the course of professional duties is available through insurance providers such as

Mercer Consumer, a service of Mercer Health and Benefits Administration LLC.

Skills and Abilities:

Knowledge of the Nutrition Care Process and ability to apply all steps of the process

Comprehensive knowledge and application of medical nutrition therapy for a variety of

conditions such as obesity, type 2 diabetes mellitus, hypertension, congestive heart

failure, chronic kidney disease, and food allergies.

Knowledge of human behavior and methods for implementing effective behavior change

Effective communication, presentation, and counseling skills

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Ability to accurately measure height and body weight

Ability to accurately assess body composition

General knowledge of nutrient analysis, word processing, and spreadsheet software

Ability to organize tasks and work independently

Ability to communicate effectively in written and verbal formats to patients, public,

medical staff, and physical therapists

Ability to manage time, to be organized, and keep records effectively

Some marketing to referring organizations and potential clients

Some knowledge of billing as it relates to the dietetics profession

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SURVEY TO REGISTERED DIETITIAN NUTRITIONISTS

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SURVEY TO PHYSIOTHERAPY ASSOCIATE CLIENTS

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SAMPLE MATERIALS

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MARKETING MATERIALS

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NUTRITION ASSESSMENT

Name: ______________________________________________ Date: ______________

Age: _____ Gender: _____ DOB: _______ Height: ______ Weight: ________

Goal Weight: _____ Goal BMI:________

Phone: ( ) _______- _______ Email: _________________________

Have you ever worked with a dietitian? [] Yes Where? __________ [] No

Have you worked with a personal trainer? [] Yes, when ____________ [] No

Describe any current medical condition(s) you may have:

_______________________________________________________________________

_______________________________________________________________________

How long have you had this condition? ________________________________________

Describe any significant past medical history or surgeries:

_______________________________________________________________________

________________________________________________________________________

When was your last cholesterol test and what was the result?

_______________________________________________________________________

When was your last blood pressure check and what was your reading?

______________________________________________________________________

Do you have a family history of any of the following: high blood pressure, diabetes, heart

disease, or high cholesterol (or any other comorbidities)? If yes please describe.

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_______________________________________________________________________

List current treatment and/or medications (name/dose):___________________________

_______________________________________________________________________

List current supplements (vitamins, minerals, herbals, as well as any protein drinks or bars):

________________________________________________________________________

______________________________________________________________________

Have you changed your diet to lose weight? If so, describe how and when:

_______________________________________________________________________

Have you experienced any recent weight change? If yes, how much have you gained/lost

and how quickly?

______________________________________________________________________

Have you been prescribed a specific diet by a physician or other health professional?

If so, please describe (approximate date and length of time):

_______________________________________________________________________

_______________________________________________________________________

Please respond to the following questions or statements:

It’s hard for me to stop eating when full.

_____ Often _____ Sometimes _____ Rarely _____ Never

I go through long periods of time (>4 hours) without eating.

_____ often _____ Sometimes _____Rarely _____ Never

I eat to avoid dealing with problems.

_____ Often _____ Sometimes _____ Rarely _____ Never

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I have determined that there are “safe” foods that are okay for me to eat and “bad”

foods that I refuse to eat (“safe” and “bad” foods referring to calories and impact on overall

medical condition). [] Yes [] No

Do you follow a restrictive diet such as refusing to eat carbohydrates, fat, gluten, and/or sodium?

[] Yes [] No

If so, please list them here: _______________________________________________________

Have you ever had or been diagnosed with an eating disorder? [] Yes [] No

If yes, what eating disorder was it and when were you diagnosed? __________________

_______________________________________________________________________

Do you any food allergies/intolerances? [] Yes [] No

If yes, please describe:

_______________________________________________________________________

Physical Activity Profile: Do you currently exercise? [] Yes [] No

Type of exercise? ________________________________________________________

How often?_______________________________ How long? ______________(Min/hr.)

Barriers to exercise:

[] Lack of time [] Cost Lack of energy

[] Illness/Injury Lack of motivation [] Do not feel comfortable

List 3 goals you now anticipate achieving while working with the dietitian.

1.______________________________________________________________________

2.______________________________________________________________________

3.______________________________________________________________________

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Eating Pattern History:

Who shops/prepares food at your home?_______________________________________

I cook: [] Always [] Most of the time [] Sometimes

I prepare my food: [] Mixed [] Broiled/baked [] Fried

I eat out: [] < 1x/ week [] 1x/week [] 2 – 3x per week [] >3x/week

Where? __________________________________________________

I eat: [] Every 3 – 4 hours during the day[] 3x/day [] 2x/day [] varies

I skip meals: [] Always [] Often [] Sometimes [] Never

I skip this meal most often: [] None [] Breakfast [] Lunch [] Dinner

I have an alcoholic beverage: [] never [] 1 – 3x/week [] 4 – 5x/week [] daily

How many per week: _____liquor _____beer _____wine

How many cups of water do you drink in a day? __________

List foods you enjoy and eat regularly in the spaces provided below:

A. Dairy (Includes milk (skim, 1%, 2%), yogurt, puddings made with milk):

B. Fruit:

C. Non-Starchy Vegetables (everything but corn, potatoes, beans, and peas):

D. Grains (bread, cereal, rice, pasta, crackers, granola, corn, potatoes, beans, peas):

E. Protein (Eggs, cheese, fish, chicken, beef, pork, tofu, meat analogues):

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F. Fat (Oils, nuts, peanut butter, avocado, salad dressings, sour cream, margarine):

List any foods you dislike or will not eat/cannot eat (i.e. food allergies):

______________________________________________________________________

1-Day Food Record (Weekday)

Please fill out the table below to the best of your ability. Aim at beingaccurate and descriptive with types and amounts of food eaten. List allbeverages, including water and alcoholic beverages drunk throughout

the day. An example is provided for you. Please do this for one week day and one weekend day.

Time Food Item Amount

Eaten

Brand/Type How

Prepared

Location

Example:

8:00 AM

Egg whitesCheeseToastMargarineOJ

31 slice2 slices1 tsp1 cup

Kroger 2% reduced fatWhole WheatI Can’t Believe It’s Not ButterTropicana OJ

Pan-fried

Toasted

Home

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