DiagnosTEX June 2016 Newsletter

Clinical Café Newsletter

By: Ronda Polansky M.S. CCC-SLP

Happy Father’s Day to all the DADs!

and

Do not forget to fly your American flag on the 14^th in honor of our country, our troops and our freedom!

Flag Day falls within National Flag Week, a time when Americans reflect on the foundations of the nation’s freedom. The flag of the United States represents freedom and has been an enduring symbol of the country’s ideals since its early days. During both events, Americans also remember their loyalty to the nation, reaffirm their belief in liberty and justice, and observe the nation’s unity. Although Flag Day is a nationwide observance, it is not a public holiday in many parts of the United States. It is a legal holiday in a few areas in the USA, such as Montour County in Pennsylvania.

New DiagnosTEX Staff – We have hired 2 new SLP’s. We are excited about this as we know they will be an asset to the team and DTEX family! Most of you who have used us over the past 12 years have seen and understand the extensive training program we put our employees through, so we again ask for your patience and understanding during our training process on the vans to continue to provide you with the same quality studies across the staff.

Changes in Health Care Reporting, Documentation, and Reimbursement

Medicare has now transitioned to pay-for-performance. In 2015, Congress repealed the SGR formula for calculating Medicare payment rates, replacing it by a new system called MIPS – Merit-Based Incentive Payment System. Physicians, PA, NP, clinical nurse specialists, and nurse anesthetists are required to report in MIPS in 2017, the data will affect payments in 2019. .MIPS is designed to be program to provide financial winners and losers based on performance against one’s peers. Under the new system, separate payments adjustments under the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VM), and the Medicare EHR Incentive Program will end on December 31, 2018. However, changes are already taking place and providers need to know what to expect from Medicare in 2016, with regards to penalties and incentives. Providers and physicians need to be aware of changes to Medicare PQRS, Value-Based Modifier and Meaningful Use programs for the 2016 reporting year, as well as key deadlines for the 2016 reporting year. MIPS consolidates MU and PQRS and newly developed measure based on National Quality Strategy which include domains such as: patient safety, patient/family engagement, care coordination, clinical process/effectiveness, population and public health and efficient use of healthcare resources.

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!

Required paperwork for scheduling:

DiagnosTEX history/consult form – Please use new 2016 form

DiagnosTEX Authorization form for billing purposes

Copy of the patient’s face sheet from the medical chart

Copy of History and Physical (H & P) from the medical chart – required to help with ICD 10 billing

Additional forms:
HH patients will require an additional form acknowledging all billing, travel fee and evaluation procedure
Observation Consent form – if applicable, can be provided on site but must be signed by any non-healthcare professional observing the MBSS

What to Do When Patients Complain of Globus Sensation “Food Sticking in the Throat” When diagnosing and treating oral-pharyngeal swallowing disorders, we must be mindful of the relationship between events occurring in the lower esophagus – particularly at the lower esophageal sphincter (LES) – and the status and function of the upper esophageal sphincter (UES). Although the physiological mechanisms at work have yet to be fully determined, it is understood that many patients with gastroesophageal reflux disease (GERD) complain of symptoms well above the LES, often in the neck. A 2004 study by Brent Roeder et al found that 31 of 46 patients with LES disturbance and GERD referred their symptoms proximally.¹ Patients quite commonly complain of “food sticking in the throat” when visiting a speech-language pathology clinic. These same patients may have a normal videofluorographic swallow study. In these cases, clinicians are advised to do the following:

Take a thorough history asking questions that relate to GERD
Screen the esophagus with the patient standing and swallowing a solid food bolus (i.e. a piece of bagel or a marshmallow)Dysphagia Tidbit
June is Myasthenia Gravis Awareness Month – Swallowing difficulty (dysphagia) is common in individuals with MG. The impact of MG on swallowing may occur gradually or suddenly. Swallowing muscles may become fatigued, particularly toward the end of a meal or when foods require a lot of chewing. Persons with thymomas are more likely to have difficulty with muscles of the face and neck at the time of MG diagnosis, which can cause dysphagia. Treatment for dysphagia is individualized and based on the underlying cause and severity of the swallowing problem. In addition to pharmacological therapy for MG, smaller, more frequent meals can help with reducing fatigue, particularly when solids are soft and do not require a lot of chewing. Resting prior to eating and avoiding talking while eating may also help reduce fatigue. Other strategies that have been reported to help when eating and drinking is to consume cold foods and liquids, as well as to alternate a small bite of solid food with a small sip of a liquid. Additionally, drinking thicker liquids, may be safer. Another strategy is to time meals around the peak of your medication (eating about an hour after taking Mestinon/pyridostigmine, for instance, intended to improve muscle function). For individuals who have difficulty with swallowing pills, crushing a medication or placing them in pudding/applesauce can help. Some medications may also come in liquid form or dissolvable gel caps. Seek advice from a pharmacist regarding options for taking medications. An active swallowing strengthening program is not indicated during a myasthenic crisis or exacerbation, but may be implemented during stability or when in remission. If swallowing exercises are recommended, the exercises should be performed during peak drug therapy and should not be performed immediately prior to eating In persons with MG, dysphagia may persist when other clinical symptoms have improved. In individuals with swallowing problems during the pharyngeal phase, prognosis tends to be poorer. Any concerns related to swallowing should be discussed with your medical doctor. Research will continue to play an important in role in answering questions and developing new treatments for dysphagia in individuals with MG. More this and more information go to www.mysathenia.org