April 2011 Newsletter

April 2011
Happy Spring & Happy Easter
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Monthly Motivator:
Science has never drummed up quite as effective
a tranquilizing agent as a sunny spring day.

DON’T MISS IT!!! Upcoming May Conference – Saturday May 21, 2011 in Arlington, TX
Deciphering Dysphagia with E-Stim – Neuromuscular Re-education of the Submandibular Muscles to Increase Laryngeal Elevation Using Class II NMES Device Limited space, sign up soon. Registration information is included in this newsletter. 8.0 ASHA CEUs. Don’t miss it!

Dysphagia Research Society 2011 Annual Convention – It was a great experience! Lots of great dysphagia research is going on around the world! Christine Carmichael PhD, CCC-SLP from Our Lady of the Lake University in San Antonio presented a research study utilizing the AMPCARE E-stim protocol, with positive results noted under fluoro with the 20 subjects.

May is Better Speech and Hearing Month Get prepared at www.asha.org
The King’s Speech has spotlighted our field, bringing understanding and acceptance. Although this movie was set back many years ago with King George VI, the basic treatment principles are the same…. encouragement and building the sense of self-esteem. This movie inspires; that is its greatest accomplishment. King’s Speech posters can be ordered for $5.00 at www.StutteringHelp.org.
Look for new dysphagia educational sheets in May to promote MBSH Month! Ask for yours next month when we see you! You can find other educational handouts in our Clinical Café at www.dysphagiadiagnostex.com.

“No Fridays” – We have had numerous requests for “no Fridays” recently. Those of you who know me and have heard me speak know that this is a very sensitive matter to me. Please be aware this will likely delay your studies several days until we return to the area again. This “no Friday” information goes into the medical record if the MBSS was declined due to the “day of the week”. Please consider the liability issues if medical records are ever requested from us regarding a LTC or dysphagia legal case. We have been advised this could be considered “insufficient and below current, general and acceptable professional standards” if reviewed by legal council in the event of dysphagia/aspiration case and the delay in a proper diagnostic evaluation. I would like to reiterate that being mobile allows the convenience of “us coming to you” and the patient not having to be transported anywhere… not for the flexibility of specific time and day. We would highly recommend a free standing outpatient facility for these special requests.
Home Health Service Contracts – The consolidated billing legislation states under PPS that a Home Health Agency (HHA) must bill for all Home Health services (which includes nursing and therapy services). DiagnosTEX provides mobile dysphagia consultation including the modified barium swallow study (MBSS) service. Included in this service is the speech therapy code 92611, which is the speech portion of the radiological examination for dysphagia (the MBSS). DiagnosTEX is unable to bill this code to Medicare because it falls under consolidated billing relating to speech therapy services. The HHA is responsible for reimbursing the provider of this service. The HH would then bill its fiscal intermediary and be reimbursed under the Medicare fee schedule. The law requires that all Home Health services paid on a cost basis be included in the PPS rate. Therefore, the PPS rate will include all nursing and therapy services. DiagnosTEX requires a signed service agreement with all entities to which we provide this service. This service agreement states the fee schedule for the 92611. If you have any questions, feel free to call and speak with our billing department. To continue servicing your Home Health residents, DiagnosTEX will require a signed service contract with the HHA and the 92611 will be billed to the HHA for the requested service. If we do not have a contract with the HHA, we will be unable to complete the requested service for the MBSS.

Interesting Alzheimer’s Disease (AD) facts
• Over 5 million people in America and 26 million worldwide have been diagnosed with AD. By the year 2050 the number of Americans diagnosed is estimated to be between 11 to 16 million, 106 worldwide.
• 1 in 8 over the age of 65 and 1 in 2 over the age of 85 carry this diagnosis.
• The more severe the dementia, the more they live in their own reality.
• The average life span of an AD patient after entering LTC is 5 years.
• There is a 2x greater risk of being diagnosed with AD if the patient’s mother was diagnosed with AD.
• 1 out of 4 AD patients take antipsychotic meds.
• 1 out of 10 patients with AD warrant the need for antipsychotic medications.

Dysphagia Tidbit – Dysphagia and Dehydration in the Elderly
Read more in ADVANCE 2/21/11 Vol 21,. No 4
Dehydration is defined as an excessive loss of water from the body through fluid deprivation or an illness. There are 3 different types of dehydration:
1) isotonic – most common form of dehydration, this occurs when an equal amount of water and salt is lost from the body
2) hypotonic – when the loss of salt exceeds the loss of water
3) hypertonic – when the loss of water exceeds the loss of salt
Sometimes dehydration and dysphagia can have the same etiology, but in other cases the cause may be different. A history of dehydration can cause a person not to want to drink or eat which can result in weight loss, another problem we identify with dysphagia. Compromised motility is a risk factor for dehydration, as some individuals cannot get up and get water for themselves. Diabetes is another concern in regards to dehydration. An elevated blood sugar level can cause sugar to spill over into the urine, and adding water can cause dehydration accompanied with frequent urination. Educating others about dehydration and dysphagia is a duty of the SLP and important to successful treatment.