Happy Spring & Happy Easter
Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
April hath put a spirit of youth in everything.—William Shakespeare
MAY is Better Speech and Hearing Month – Be prepared! This is next month! This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. ASHA has many resources to help you celebrate BHSM every day. www.asha.org . Some good educational material to share can also be found in the booklet ABOVE and BEYOND.
ABOVE and BEYOND By: Ronda Polansky M.S. CCC-SLP – Patient, Caregiver, and Healthcare Professional Educational Reference Sheets and Handouts for Effective Dysphagia Rehabilitation. Over 30 handouts on specific disorders in dysphagia in ONE location to use in your practice, plus a resource section for SLP’s on cranial nerve testing, pharyngeal exercises, and treatment techniques. A need to have booklet in your therapy bag!! Cost: $40.00. (plus S&H). Call us and we will get one out to you!
DVD – What you Can Not See At Bedside – Copies of MBSS studies for education of staff and families on various disorders and clear episodes of penetrations and aspirations. Cost – $40.00 (plus S & H). Great educational tool for anyone!
March weather – March was little hard on us as a mobile unit. We were shut down several days due to road conditions and had many pending studies to make up and of course you can only do so many studies in a day and be in so many places in one day. We ran several Fridays trying to get to everyone in, I apologize for the delays we have worked very hard and extended hours to meet everyone’s needs, as long as locations were open to flexibility in scheduling on late days or Fridays.
Scheduling pending studies – I would like to ask everyone to PLEASE let us know if you have sent paperwork for a study to be scheduled and the patient leaves the building/ discharged or expires, please notify us immediately. As most of you know, we base our schedules around geographical areas for time efficiency as well as cost. When we schedule a facility, leave a message, and then get a return call later that the patient is no longer at the facility, this requires us to adjust our scheduled times for the entire day. As soon as you are aware the patient has discharged please call or fax us letting us know to take them off the pending list. Thank you so much for your help with this. In addition, if we attempt to schedule your facility and you decline the appt date/time, we document the reason on our paperwork and then the patient will go back on the pending list. This study may be several more days before being rescheduled. Usually at the beginning of each day we have approximately 60+ patients waiting to scheduled.
Recorded MBSS during the exam – As most of you know, we make a copy of the MBSS on a DVD to give to the facility or treating SLP. What the facility or treating SLP does with the DVD is under the liability of those locations/individuals once it is in their possession. The DVD is a part of the medical record. There are no other recordings allowed on the van at any time by any form using a smart phone, IPad or any other device for recording. This is posted in all of our vans. Please let your staff and or family members know that these are DiagnosTEX rules and regulations on our mobile clinics and in accordance with HIPAA regulations. The DVD records both visual and audio. Thank you
Repeat Studies – Medicare is red-flagging multiple studies/repeat studies and denying payment without clear documentation of medical necessity. They will not pay for REPEAT studies for reasons that include such things as the following:
- Family request (please do not write this statement on your documentation anywhere, including hx /consult form. This is in no way a definition of medical necessity in Medicare’s book)
- Pt has already signed a waiver/AMA and is on a diet (Medicare will not cover if the reason, is “just want to see if they are doing better”, because if they are not, they will continue to eat anyway and Medicare will not consider this exam as “medically necessary” if they will not follow the recommendations)
- Recent MBSS with NPO recommendations, but now not a candidate for a PEG (this does not change results)
- More than 3 studies in a 6 month period, with same recommendations and no progress
- Repeat study when patient is receiving no ST therapy, unless patient has had a dramatic decline since discharge from therapy.
There must be clear documented change in therapy goals (improvement), medical status (improvement or decline), and /or a new onset of a dysphagia related diagnosis. If none of these apply the facility or family/pt must sign a form to accept responsibility for payment for MBSS. Medicare will not pay even with a “physician’s order” if medical necessity is not clearly identified and documented.
Dysphagia Tidbit – Swallow Expansion Device – This information below is something I read recently that I thought was interesting, it appears to address cricopharyngeal issues. I have very limited knowledge of this device and there is limited research available at this time, but I wanted to pass this along to share interesting up and coming technology.
What is the Swallow Expansion Device? The swallow expansion device (SED) is a small titanium implant that is planted on the larynx through a small incision in the neck. The procedure to place the implant takes less than 15 minutes and is performed without the need for sedation. The implant has a small post (piercing) that protrudes through the skin. When a person swallows, the patient pulls the device forward and the upper esophageal sphincter opens to super-physiologic (greater than normal) proportions and allows food to pass. The procedure requires the patient to allow 8 weeks for the surgical site to heal and for the SED to integrate before attempting to use the device.
In June of 2014, the FDA approved a clinical trial (ClinicalTrials.gov Identifier: NCT02296528) – Safety and Efficacy of the Swallow Expansion Device (SED). This is a Phase I trial that is open to 5 patients with profound feeding tube dependent oropharyngeal dysphagia. The primary outcome measures are improvement in UES opening and swallowing safety as measured via fluoroscopy. If swallowing is improved and there is no aspiration, the patient will be taught how to coordinate pulling the SED with the correct amount of force at the appropriate time during swallowing. This training will be performed under the guidance of a speech and language pathologist.