August 2012 Newsletter


August 2012

Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

Monthly Motivator
Your work is to discover your skill and then with all your heart to give yourself to it. That’s the mark of a true professional.

Upcoming HolidayDiagnosTEX will be closed on Labor Day, Monday September 3, 2012.  Please keep this in consideration this when scheduling your studies. We will operate Tuesday – Friday that week.


Interesting fact: The first observance of Labor Day is believed to have been a parade of 10,000 workers on Sept. 5, 1882, inNew York City, organized by Peter J. McGuire, a Carpenters and Joiners Union secretary. By 1893, more than half the states were observing “Labor Day” on one day or another, and Congress passed a bill to establish a federal holiday in 1894. President Grover Cleveland signed the bill soon afterward, designating the first Monday in September as Labor Day.  

What are we celebrating? 155.2 million people 16 and older in the nation’s labor force in June 2012.  Source: U.S. Bureau of Labor Statistics


Patient pending to be scheduled for MBSS who is discharged from your facility or has passed-away PLEASECALL US and let us know!  If you have sent paperwork in for us to schedule an MBSS and your patient has pass-away or is discharged from the facility, PLEASE call and let us know as soon as possible.  If your patient has been discharged and we organize the schedule and call you to confirm the time and only then we are informed that the patient is no longer at the facility, this can really cause a collapse in our entire schedule. This would require us to call other scheduled facilities back to reschedule their time to adjust the day to stay efficient on the van.  Please help us and let us know if there is any reason we do not need to schedule your patient and need to remove them from the pending list.  We would very much appreciate your assistance with this and keeping us informed on your patient’s status.


Websites of Health Conditions Impacted by Dysphagia

•Alzheimer’s –

•Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s Disease –

•Cerebral Palsy –

•Huntington’s Disease –

•Muscular Dystrophy (MD) –

•Muscular Sclerosis (MS) –

•Parkinson’s –

•Post-Polio Syndrome –

•Sjögren’s Syndrome –

•Spinal Cord Injury –

•Stroke –

•Traumatic Brain Injury (TBI) –


Texas Summers – HOT! HOT! HOT!  Unfortunately this time of year is one we dread in the mobile business!  Hot temperatures, being parked on hot concrete in the sun, running A/Cs on high, and/or sitting in one location for long periods of time can often cause our generators to overheat.  We take numerous precautions, provide extensive preventative maintenance on our equipment, and strive to ensure this does not happen… but the Texas summer can be unforgiving!  Generators can only get “so hot” in triple digit temperatures before yielding to the heat. Please be aware that IF these generator issues occur, we may have to adjust your scheduled time.  It would be helpful (to us, your patients, and the completion of your studies) if we can park under a portico or in a shaded area.  Please check with your administrators on this; we appreciate your understanding and flexibility during these hot summer months. 


Medicare Manual Medical Review of those effected by therapy cap – Those of you who attended my last CEU know I spoke of many upcoming changes and documentation requirements.  New healthcare regulations going into effect this year affect SLP’s directly. Even though the therapy cap was extended with the exception process through December 2012, much attention was brought to it. The 2012 therapy cap is $1880.00 for combine PT and ST. The new Act tightens the therapy cap by requiring CMS to conduct “manual medical reviews” of all claims exceeding $3700 on or after October, 1, 2012. . Overview of documentation for Medicare OP therapy services visit:


Medicare requires documentation of the patient’s therapy progress on requests for repeat studies. Please document progress on the HX forms you fax to us.

The Centers for Medicare and Medicaid Services (CMS) states that therapy services shall be payable when the medical record and the information on the claim form consistently and accurately report covered therapy services. Documentation should also include objective measures of the patient’s improvement as a means to justify therapy services. It is imperative that SLP’s ensure that documentation is sufficient to justify the services billed. Documentation must comply with all legal/regulatory requirements applicable to Medicare claims. Documentation should justify the necessity of the services provided during the reporting period, and include, for example, objective evidence or a clinically supportable statement of expectation that the patient’s condition has the potential to improve or is improving in response to therapy; maximum improvement is yet to be attained; and there is an expectation that the anticipated improvement is attainable in a reasonable and generally predictable period of time.


Objective evidence consists of standardized patient assessment instruments, outcome measurements tools, or measurable assessments of functional outcome such as NOMS. Use of objective measures at the beginning of treatment, during and/or after treatment is recommended to quantify progress and support justifications for continued treatment. Such tools are not required, but their use will enhance the justification for needed therapy and repeat evaluations including the MBSS.


CMS Example of a SLP Progress Note:

The Plan states diagnosis is 787.2 – Dysphagia secondary to other late effects of CVA. Patient is on a restricted diet and wants to drink thick liquids.

Therapy is planned 3X week, 45 minute sessions for 6 weeks.

Long term goal is to consume a mechanical soft diet with thin liquids without complications such as aspiration pneumonia.

Short Term

Goal 1: Patient will improve rate of laryngeal elevation/timing of closure by using the super-supraglottic swallow on saliva swallows without cues from ___% of trials (baseline) to ____% (goal).

Goal 2: Patient will compensate for reduced laryngeal elevation by controlling bolus size to ½ teaspoon without cues from ___%( baseline) to ___% (goal).


Additional examples of Short Term Goals:

1. Pt will tolerate ____ (15 or 30) minutes of NMES at a level of ______ to suprahyoidal musculature to improve _____ (hyolaryngeal elevation, manage secretions) and decrease the risk of penetration and aspiration.

2. Pt will increase initiation of swallow reflex with presentation of 10cc/tablespoon size bolus ranging from _____a mod-severe delay of  (10-6 seconds) to a mild 2-4 sec delay _____ (5-1 second) to reduce pharyngeal delay, posterior bolus leakage and increased risk of dysphagia. decrease risk of aspiration.

3. Pt will demonstrate the ability to manage oral secretions better by decreasing the amount expelled from the oral cavity from ____ (1) cup(s) to ____ (1/2) cup(s) or initiating cued volitional swallows every 2 minutes during treatment of dysphagia.

Hospice and Hospice diagnosis

Just a reminder that the hospice diagnosis CAN NOT be related to the dysphagia, or it will not be covered.


Requested repeat Studies on patients who have signed an AMA on diet recommendations from previous MBSS – There must be documentation of a change in status or therapy progress for Medicare to cover a repeat study on someone who has signed an AMA as a result of a previous recommendation on an MBSS. Please document a status change and/or what progress you have observed, on the Consult Request form that you fax to us. Please educate your patients and their families on this as well, as they may be required to pay out of pocket if they want a repeat MBSS completed.


Speak Out! Parkinson’s Voice Project

RICHARDSON,TX– Parkinson Voice Project is proud to announce that recording artist Lee Greenwood will be the featured performer at the seventh annual Speak Out! celebration, to be held on Sunday, September 23rd at 4:00pm, at theEisemannCenterfor Performing Arts inRichardson,Texas. Lee Greenwood and 120 people with Parkinson’s (members of Parkinson Voice Project’s The LOUD Crowd®) will perform favorite patriotic songs with audience participation. Tickets will be available through theEisemannCenterfor Performing Arts box office beginning July 23, 2012. A limited number of free tickets will be made available to active duty military, veterans, and their families.

What: Speak OutAmerica!

Where: EisemannCenter for Performing Arts;2351 Performance Drive,Richardson,TX

When: Sunday, September 23, 2012 from 4:00pm to 5:30pm

How: Tickets go on sale on July 13th. Call theEisemannCenter ticket office at (972) 744-4650 or visit Tickets prices range from $21 – $42

Why: To educate the community about Parkinson disease and to raise money for Parkinson Voice Project

For more information, visit or


Samantha Elandary, MA, CCC-SLP

Parkinson Voice Project

500 N. Coit Rd #2085RichardsonTX75080



Dysphagia Tidbit – Dysphagia Journal study reviewed (Bullet Points)

Do Cervical Degenerative Disease Associate with Foreign Body Sensation of the Pharynx?

Takayuki Furuta, Masanori Takemura, Junzo Tsuita, and Yoshitaka Oku

  • 225 patients (150 patients with symptoms of lump in throat)
  • Reports have shown severe cervical osteophytes and Diffuse Idiopathic Skeletal Hyperostosis (DISH or Forestier’s Disease) may cause dysphagia
  • Completed 2009-2010 – ages ranges were 18-80 yo
  • Subjects excluded from study – trauma, surgery, radiotherapy of neck or severe dysphagia, organic disease in aerodigestive tract
  • Study group – reported symptoms of lump in throat
  • Control group – reported no lump in throat symptoms
  • Lateral neck was obtained on all patients at C4-C5 with upper margin of thyroid cartilage
  • 150 patients (82 men, 68 women) in study group
  • 75 patients (47 men and 28 women) in control group
  • More cervical osteophytes could be observed in study group and physical mechanical obstruction
  • There was no noted difference in either age and/or sex of the subjects
  • More osteophytes (more than 2) noted at the levels of C45, C56, C67
  • Inflammation and edema resulted from repetitive pharyngeal or esophageal motion over the osteophytes
  • Study group provided with anti-inflammatory agents, muscle relaxants and changes in diet = 25% experience relief from symptoms after meds, 20% were self limiting, and more than 50% did not experience improvement after trying several types of therapies
  • Lump in throat was significantly demonstrated with those at C45, C56, C67