December 2010 Newsletter

Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
December 2010
During the holiday season, our thoughts turn gratefully to those who have made our success possible. In this spirit we say simply but sincerely, may the gift of overflowing peace, joy and happiness be yours at Christmas and throughout the New Year! All of us at DiagnosTEX wish everyone a very Merry Christmas!

The 2011 DiagnosTEX Dysphagia Calendar is arriving this month

DiagnosTEX Christmas treats to our SLPs – This is just a token of our appreciation for your support and friendship. We are also celebrating our 7th year in business, and everyone at DiagnosTEX thanks you for the honor of being part of your dysphagia management team and trusting us with your patients!

DiagnosTEX 2010 December Holiday Schedule – DiagnosTEX will operate only ½ day on Christmas Eve. We will be closed the Monday after Christmas. We want to meet all of your MBSS needs as we know PO feeding becomes very important on several levels to many patients around the holidays. We must also be considerate to all of our DiagnosTEX employees, and their families. Please keep these holiday schedules in mind when scheduling your MBSS in December! ******Please take note and keep in mind that during this busy time of year, specific requests for specific times and days become exponentially difficult to accommodate. We may be unable to quickly schedule your patient with specific time and day requests. Please notify your staff, patients, and families of this. ******

********NEW HISTORY INTAKE FORM*********** – Please note the new history form included, please start using this form immediately. New Medicare regulations change every year and we must change with them. They require new and different information to prove medical necessity for evaluating the patient for dysphagia, which requires more documentation! It is frustrating but necessary. We thank you for doing you part to help us meet these requirements,

Live Web/Telephone Seminar – 2011 Coding update for SLP’s
CEU’s – 0.2
December 8, 2010 (3-5pm EST) Live Broadcast. For more information go to www.asha.org
Billing efficiently for reimbursement of speech-language pathology services can be challenging, especially in our ever-changing world of health care procedures and regulations. Maximizing reimbursement requires a current understanding of the diagnostic (ICD-9) and procedural (CPT) coding systems, including how codes are valued and how new codes are added.

A new area association – Tarrant Area Speech Language Association (TASHA)
For more information contact Therapy 2000, Courtney Mullaney at 817-507-1505
Or Courtney.mullaney@T2000.com

Medicare Cuts – The Senate has voted to delay additional cuts until December 31, 2010

Hydration – Its everyone’s responsibility to help (patient, family, healthcare staff)
Many dysphagic patients are known to drink less, so it is important to ensure adequate amounts of fluid to keep your patient well hydrated. This is particularly true of patients on thickened foods and liquids. Fluid requirements are usually calculated as 30ml per kg of body weight, or 6-8 cups of fluid a day.
Hints for keeping patients hydrated
• Remind your elderly patients to drink, they will forget
• Tea and coffee count as fluid
• Fluids are more than just water – milkshakes, soups, sorbet, ice cream, jellies, custard and fizzy drinks all count.
• Offer them fruits and vegetables, esp. those with high water content like watermelon, tomatoes, which are 90% water
• Encourage patient to take a full cup of liquid with all medications
• Adopt “happy hour” during treatment sessions to have a full cup of fluid daily.

Holiday puree or easy to puree suggestions
1. Thickened egg nog
2. Canned pumpkin (topped with whipped cream)
3. Canned pie fillings (topped with whipped cream)
4. Mashed sweet potatoes and melted marshmallows
5. Whipped topping on pudding of any flavor
6. Apple sauce and cinnamon, or baked apples
7. Tamales

Dysphagia Tidbit – Dysphagia and Hospital Stays Researchers from Mount Sinai School of Medicine have found that hospitalized patients with dysphagia, or difficulty swallowing, averaged a 40 percent longer hospital stay than patients without the condition. They also had a generally poorer prognosis. The research is published in the August issue of Archives of Otolaryngology–Head & Neck Surgery. The researchers evaluated more than 77 million hospital admissions during 2005-2006, 271,983 of which were associated with dysphagia, as indicated by the National Hospital Discharge Survey (NHDS). The median number of days in the hospital for patients with dysphagia was 4.04, compared to 2.40 days for patients without dysphagia. Mortality increased significantly in patients with dysphagia and disk disorders or heart disease, and those undergoing rehabilitation had a greater than 13-fold increased risk of mortality. Patients ages 75 and older were twice as likely to have dysphagia. “Our study shows that dysphagia has a significant impact on length of stay and prognostic indicators,” said Kenneth W. Altman, MD, PhD, Associate Professor of Otolaryngology, lead author on the study. “Early identification of dysphagia and therapeutic intervention are critical to preventing further complications in these patients and reducing length of stay. These data indicate the necessity for health care providers to prevent or diagnose this condition early to reduce complications. “The impact of dysphagia on hospital resources was also substantial. Patients with dysphagia are often at risk of aspirating, which often requires antibiotic use and intubation. The increased mortality risk associated with the condition also increases end-of-life costs. Using a measurement tool previously developed for community-acquired pneumonia, the researchers estimated the cost of dysphagia at nearly $550 million over the two year period. “With our country moving into a value-based health care system, we will truly feel the impact of the costs associated with dysphagia,” said Dr. Altman. “As such, it’s important to develop strategies to prevent and treat this debilitating condition to reduce those costs.” Dysphagia is present with a number of serious conditions, which may contribute to mortality risk. The most common conditions associated with dysphagia were stroke, aspiration pneumonia, urinary tract infection, esophageal disease, fluid or electrolyte disorder, and congestive heart failure. Patients with these conditions are especially susceptible to aspiration. The authors emphasize that dysphagia is severely underreported, due to minor cases not being documented, or clinicians seeing it as a side effect of another condition rather than a condition itself. Speech Pathologists should implement assessment tools to identify dysphagia in high risk patients, including the elderly, stroke and rehabilitation patients, and patients with malnutrition, neurodegenerative disease, pneumonia, or heart disease. Dr. Altman. “At Mount Sinai, said we are making every effort to identify these patients early to prevent further complications.”