Clinical Café Newsletter
By: Ronda Polansky M.S. CCC-SLP
Happy Independence Day! God Bless the USA!
Happy 4th of July to everyone celebrating our country’s independence but don’t forget to honor our veterans and current military who have served to ensure our FREEDOM!
We know that freedom does not come free… there is a cost!
DiagnosTEX will be closed Monday July 4th, but will run vans Tuesday – Friday that week.
New history/consult forms for 2016 – New Medicare Requirements including Meaningful Use (MU), Physician Quality Reporting System (PQRS), and the new MIPS, result in New Paperwork. This has been delayed due to upcoming Medicare changes and new required information for PQRS and MU. These forms will be noticeably different. We are forced to update our forms more regularly as more changes occur in billing. No one likes adjusting to this as we get all the new paperwork out to everyone, but once you get one, please begin using them immediately. We will be handing them out on the van, mailing them in the newsletters, they will be on the website and IF you need one faxed to you please call. If we continue to get old consult forms after July 1, we will not place the patient on the pending list until the new form is completed in its entirety. Please help us with this transition. There are still 2 history/consult forms: 1 for facilities and 1 for home health, please make sure you are utilizing the correct one for your location. Thank you!
Reasonable and Necessary Guidelines – No matter what an LCD may state, the national coverage determination or CMS manual of reasonable and necessary guidelines still apply Section 18629a0 (1) (A) of the Social Security Act ( SSA) directs as follows: “no payment may be made under Part A or Part B for any expense incurred for items or services not reasonable or necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member”. Therefore, to be considered “reasonable and necessary” the patients’ medical record must clearly document medical necessity. For any service reported to Medicare it is expected that the medical record (includes DTEX HX and consult form) clearly demonstrates that the service meets criteria. Pt should not be refusing treatment or recommendations (AMA), evaluation cannot be for the convenience of the family request (do not document “family requests/wants an MBSS”), and diagnosis documented must be appropriate for patient condition (HTN is not a dysphagia diagnosis, document MORE appropriate diagnosis). ALL documentation will be submitted in the event of an Insurance or Medicare audit, which includes the DTEX forms that you fill out. Please make them complete and applicable to the dysphagia.
Upcoming CEU course
- ASHA Connect – July 8-10 in Minneapolis, MN (on.asha.org )
- Deciphering Dysphagia with Ampcare’s ESP Friday July 22, 2016 in Dallas, Texas. For more information and more dates go to www.ampcarellc.com
TSHA Self reporting CEU’s – Please be aware this is now in place with TSHA. Anyone who has taken a TSHA approved course anywhere between 2015 to current, needs to understand the self-reporting instructions.
Texas Speech-Language-Hearing Association
- Go to http://www.txsha.org.
- Click on Continuing Education and then TSHA CE Registry.
- Click on the grey Access the TSHA CE Registry button.
- Enter your Username and Password and click the grey Logon button. Non-members will have to create a guest account on the TSHA website to gain access to the reporting tool.
- Click the blue Add Sponsor Course button.
- Enter the Verification Code of the course and click the blue Search button.
- Click the blue Select button. Note: If the button is grey, you have already added this course to you registry. If your course is not listed, please contact the Sponsor to make sure you have the correct verification code.
- Enter the date you completed the course and reenter the verification code.
- Affirm that you completed the course in its entirety. Note that TSHA will be conducting random audits to verify that your name was on the Sponsor’s roster provided to TSHA.
- Click the orange Next button.
- Fill out the course evaluation and click the orange Submit button.
Now that you have added this course to your registry, you will have a permanent record of your completion of this course. You will also be able to print a course completion certificate by clicking on the PDF icon next to your course. Note: If you are not a TSHA member, you will be able to self-report this course and print a certificate for your files, but the course will not be added to a registry and the certificate will only be available for five days after you complete the steps to report.
Dysphagia Tidbit – How aging effect the swallow – Some changes that effect swallowing in the aging is obvious, for example, missing dentition or poor dentition effects how food is prepared in the mouth. Other changes can be less obvious but nevertheless worthy of our attention as SLP’s:
- Reduced bulk and sensitivity in VC – if the airway is not protected completely or quickly during the swallow, material may penetrate or aspirate. There is less consistency in VC closure in the elderly and this is the first line of defense in the airway, if it is compromised, there is a higher risk for aspiration.
- Reduced bulk and strength in the tongue and pharynx – The pharynx constricts from top to bottom during a swallow to help move and propel food and liquids from the mouth into the esophagus, if this action is incomplete, retention and/or residue may remain in the throat after the swallow and pose an increased risk of penetration and aspiration after the swallow.
- The pharyngeal area is longer and more dilated in the elderly than in younger age groups. A single swallow is approximately 1 sec but can be up to 20% longer in the geriatric population. This means the airway has to be protected longer.
- The PES must relax to allow food and liquids to enter the esophageal phase – as we age the size of the sphincter opening may decrease and as this happens, solid foods, pills or even larger cup sips may have more difficulty passing through and feel like it is “getting stuck”.
These are just a few of the issues associated with aging and swallowing. Other changes occur as brain functions change, increased use of medications, the ability to smell, oral dryness, respiratory function and osteoarthritis effecting the spine. By 2030 individuals over the age of 65 will account for 19% of the population and 20% of them are estimated to experience some degree of dysphagia. These numbers motivate us to understand aging and dysphagia and learn more that will help us treat and possibly prevent dysphagia and ultimately aspiration pneumonia.