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Food

Americans Can Kiss Shitty Hospital Food Goodbye

Thanks to the Affordable Care Act, hospitalized Americans can say au revoire to jiggly jello and stinky meatloaf.
Photo via Flickr userLindsey Turner

Those nauseatingly odiferous slabs of gray meatloaf and wiggly Jell-O cups are going to be culinary dinosaurs at hospitals across America in the near future.

Patients can raise trays of thanks to Obamacare.

The Affordable Care Act has changed the game for hospital food service providers, who are dealing with several new, competing pressures on their departments. As both patient satisfaction scores and readmission rates play a newly important role to hospital finances, determining patient and cafeteria menus has become a more delicate operation than ever before.

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Many food service directors are re-calibrating their menu options as a response to the law, searching for a balance of food that will nourish patients, but also leave them with positive feelings about their hospital stay.

In one study by FoodService Director Magazine, out of a sampling of 136 hospitals surveyed across the country, 40 percent said that Obamacare would impact their food service department, and 20 percent said Obamacare would greatly impact their food service (19 percent said it would have a minimal impact, and the rest said it would have no impact or weren't sure).

"On the patient side, you now get penalized for high readmission, and hospitals are looking at food service as a way to bump down the readmission rate," says Becky Schilling, Editor of FoodService Director Magazine.

But here's what's really going on. The ACA reduces Medicare reimbursement payments to hospitals with excess patient readmission rates (as determined by this formula). To help lower readmission rates, many major food service providers have committed to serving lighter food that isn't smothered in cream sauce, slathered in butter, or battered and fried; meals that would make a healthy person feel like complete shit, too.

In the past year, for instance, Morrison Healthcare, a food service company that serves more than 585 hospitals and health care systems across the country, rolled out a new menu for patients that reduces sodium and calories from its standard hospital patient menu—its "stealth health" options include multigrain pancakes, freshly prepared soups, steel-cut oats and whole wheat pasta dishes.

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But like most people who've been stripped naked, placed in a hospital gown, and forced to watch a marathon of soap operas for an extended period of time, most hospital patients often prefer a hamburger to a quinoa salad.

"What people tend to want in the hospital is comfort foods," says Angelo Mojica, director of food and nutrition services at University of North Carolina Hospitals. "That's what's making people happy, in a lot of cases."

From a food service director's perspective, this is a bit of a catch-22. If a hospital's patient satisfaction scores are below a certain threshold (as determined by a survey called HCAHPS) it deals a blow to the hospital's Medicaid reimbursement under Obamacare.

So the dilemma on the hospital's food front is: do you keep patients happy by serving them onion rings, while risking increased readmission rates, or do you stick with a menu full of healthy grilled chicken dishes and risk lowering overall satisfaction scores?

Even though it sounds like a case of the twilight zone, there are ways to compromise. UNCH is one example. In January, UNCH put a new, more liberal system in place, where no food item from the (outrageously exhaustive) menu is entirely off-limits to a patient. This is how it works: suppose you're recovering from a double bypass surgery as a result of a lifetime of bad food choices. A dietician puts you on something called a "heart-healthy flex diet," designed to steer you toward healthier options. But none of UNCH's low-fat, low sodium menu items appeal to you—not the chili lime shrimp burrito, the tilapia en papillotte, the wok-seared tofu or California rolls. You only have eyes for the fried chicken breast. UNCH will serve it to you, with a slap on the wrist.

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"The patient will get yellow-carded—like in soccer," says Mojica.

A yellow card placed on the tray of your artery-clogging meal of choice explains exactly why the hospital recommended a low-fat diet for you in the first place. Then, if you order fried chicken (or a similarly un-heart-healthy choice) for your next meal, you get red-carded, and a dietician drops in to talk you through how diet affects your overall health and well-being. But do patients actually give a shit? UNC has found that in the first few months of the program, red-carded patients have, in fact, begun to stick to their diets in statistically significant numbers.

"What happens when you take something away from someone is they get mad," says Mojica. "We're trying to drive education so that patients can be happy with the decisions they make for themselves."

UNCH says the system is still too new to track whether red-carded patients have changed their food choices outside the hospital. Under Mojica's tenure, with the introduction of the hospital's lengthy and varied à la carte menu, and this new "heart healthy flex" initiative, patient satisfaction scores have jumped about 70 percentage points.

On the other hand, some dieticians scoff at the idea of hospitals serving comfort food, ever.

"As a dietician, I think hospitals should not compromise on health. It seems to me that should go without saying," says Susan Levin, a registered dietician at the Physicians Committee for Responsible Medicine. "Hospitals shouldn't be catering to the standard American dietary preferences, which are typically higher in salt, fat and sugar."

PCRM has published multiple studies shaming "the worst hospital food environments" in the country. Offenders this year include the Greenville Memorial Hospital's Heart and Vascular Institute, which PCRM noted serves hot dogs to patients, and the Virginia Commonwealth University Medical Center, which lists roast beef on the patient menu.

Regardless of new financial pressures under Obamacare, hospitals should take responsibility and base their menus on low-fat, low-sodium and high-fiber options, says Levin. From her point of view, patient satisfaction scores and money aren't as important as serving nutritious food to patients and staff.

"I don't think there's any excuse for catering to bad dietary habits," says Levin. "You have to trust that patients are smart enough to know that they are not being admitted into an Outback Steakhouse. They're being admitted into a healthcare facility whose goal is to heal them." Au revoire, fluorescent orange jello.